Body Image Scale for Cancer Patients (BIS): A Full Guide for Researchers and Clinicians
Published
The Body Image Scale (BIS) is a 10-item measure of body image changes in cancer patients, scored 0 to 30. Learn its items, scoring and evidence.
Introduction
The Body Image Scale (BIS) is a brief 10-item patient self-report questionnaire that assesses changes in body image in people with cancer, such as changes in appearance after surgery, radiotherapy or systemic treatment. P. Hopwood, I. Fletcher, A. Lee and S. Al Ghazal published it in 2001.
The BIS appeared in the European Journal of Cancer and has received more than 1,400 citations. It is intended for any cancer site and any type of cancer treatment. This guide explains its items, scoring, versions and evidence.
Key Features of the Body Image Scale (BIS)
Purpose and Use
The BIS was designed for use in clinical trials alongside broader quality-of-life measures such as the EORTC QLQ-C30, and as a specific scale in psychosocial research.
Target Population
The BIS is intended for adults with cancer.
Structure
The BIS has 10 items covering emotional, behavioral and cognitive aspects of body image since diagnosis or treatment:
Feeling self-conscious about appearanceFeeling less physically attractiveDissatisfaction with appearance when dressedFeeling less feminine or masculineDifficulty looking at oneself nakedFeeling less sexually attractiveAvoiding people because of appearanceFeeling the body is less whole after treatmentDissatisfaction with the bodyDissatisfaction with the scarScoring Method
Items are rated for the past week on a 4-point scale: not at all (0), a little (1), quite a bit (2) and very much (3).
Total score: sum the 10 items, for a range of 0 to 30.Direction: in Version 2, all items are negatively phrased and scored in the same direction, so no reverse scoring is needed.Missing items: if one or two items are missing, impute them from the mean of the answered items. Item 10 can be marked "not applicable".Transformation: raw scores can be converted to a 0–100 range if a study needs it.A score of 0 means no symptoms or distress, and higher scores mean more distress. The BIS is a single scale with no subscales, and no clinical cut-off is available.
Administration Format
The BIS is a brief patient self-report questionnaire.
Applications of the Body Image Scale (BIS)
The BIS supports several uses:
Clinical trials: measuring body image alongside other quality-of-life outcomes.Psycho-oncology research: studying body image after cancer treatment.Treatment comparison: the original study showed sensitivity to change.Languages and availability
The development article states that the BIS has been translated into several European languages, but no specific versions are listed. A systematic review of its measurement properties summarizes later studies.
Reliability and Validity
In the original development study, the BIS showed high internal consistency (Cronbach's alpha = 0.93), good discriminant validity and sensitivity to change.
Validation studies:
A body image scale for use with cancer patients (2001): study linkA systematic review of the measurement properties of the Body Image Scale in cancer patients (2018): study linkLimitations and Considerations
Keep these points in mind:
Breast cancer samples: psychometric testing of the final version was limited to breast cancer patients.No cut-off: no clinical cut-off score is available.Other groups: interpret results cautiously in other cancer groups and cultures until more validation is available.Other Versions And Related Questionnaires
Version 1 had five positively and five negatively phrased items and was tested in 276 cancer patients. Version 2, the published scale, phrases all items negatively and was tested in 682 breast cancer patients.
These questionnaires are related:
EORTC QLQ-C30; see the ResRef QLQ-C30 guideEORTC Breast Cancer Module (QLQ-BR23), which includes four BIS itemsFunctional Assessment of Cancer Therapy (FACT) scalesA body image measure for survivors of childhood cancer, which uses one BIS itemBody Self-Relations QuestionnaireAdditional Resources
The original article: linkThe original article lists Dr P. Hopwood, CRC Psychological Medicine Group, Christie Hospital NHS Trust, Manchester, UK, at penelope.hopwood@man.ac.uk.Browse more oncology questionnaires in the ResRef database.Frequently Asked Questions (FAQ)
What does the Body Image Scale measure?The BIS measures changes in body image in people with cancer, such as feeling less attractive, self-conscious, less whole or dissatisfied with a scar after surgery, radiotherapy or other treatment.
How is the BIS scored?Each of the 10 items is rated from 0 (not at all) to 3 (very much) for the past week, and the items are summed for a total of 0 to 30. Higher scores mean more body image distress.
Does the BIS have a cut-off score?No. No clinical cut-off score is available. The BIS is used as a single continuous scale, and raw scores can be converted to 0–100 if needed.
Can the BIS be used for any cancer?It was designed for any cancer site and treatment, but testing of the final version was limited to breast cancer, so use in other groups should be interpreted cautiously.
A Word from ResRef About the Body Image Scale (BIS)
The BIS is a brief patient-reported tool for assessing body image changes in cancer patients, particularly in clinical trials and psychosocial research. In the original development study it showed high internal consistency (Cronbach's alpha 0.93) and good discriminant validity and sensitivity to change. Psychometric testing of the final version was limited to breast cancer samples, and no clinical cut-off score is available. Use in other cancer groups and cross-cultural settings should be interpreted cautiously until further validation is available.
References
Hopwood, P., Fletcher, I., Lee, A., & Al Ghazal, S. (2001). A body image scale for use with cancer patients. European Journal of Cancer, 37(2), 189–197. https://doi.org/10.1016/s0959-8049(00)00353-1Melissant, H. C., Neijenhuijs, K. I., Jansen, F., Aaronson, N. K., Groenvold, M., Holzner, B., Terwee, C. B., van Uden-Kraan, C. F., Cuijpers, P., & Verdonck-de Leeuw, I. M. (2018). A systematic review of the measurement properties of the Body Image Scale (BIS) in cancer patients. Supportive Care in Cancer, 26(6), 1715–1726. https://doi.org/10.1007/s00520-018-4145-x