title: Standardized assessment of breast cancer surgical scars integrating the Vancouver Scar Scale, Short-Form McGill Pain Questionnaire, and patients' perspectives.
abstract: BACKGROUND
  Currently, there is no standardized, comprehensive method to assess surgical scars after breast cancer surgery. This article evaluates the application of the Vancouver Scar Scale, in conjunction with patients' scar self-rating and scar-related pain, in a cohort of breast cancer patients.
  
  
  METHODS
  Data were prospectively collected in 59 women with breast cancer. Scar assessment comprised: 1. objective rating by pairs of independent observers using the Vancouver Scar Scale; 2. patient's ratings of the scar's physical parameters and overall satisfaction; and 3. pain assessment using the Short-Form McGill Pain Questionnaire. A total of 212 scar scores (59 pairs of breast/chest wall and 47 pairs of axillary scar scores) were generated by 13 observers: three physicians, five radiation therapists, and five nurses. Internal consistency was tested using Cronbach's alpha statistics. Interobserver reliability was evaluated with Spearman's rho and intraclass correlation coefficient computations. Convergent validity of the observer and patient ratings was examined with Spearman's correlation statistics. Linear regression analysis was performed to identify significant factors associated with Vancouver Scar Scale scores and patient satisfaction.
  
  
  RESULTS
  The Vancouver Scar Scale, patient self-rating scale, and Short-Form McGill Pain Questionnaire had acceptable internal consistency (Cronbach's alpha 0.79, 0.64, and 0.72 respectively). Interobserver reliability using the Vancouver Scar Scale was significant with Spearman's correlation coefficients of 0.53 for pliability, 0.47 for scar height, 0.49 for vascularity, 0.54 for pigmentation, and 0.66 for overall score (all p values < 0.001). Significant agreement between observer and patient ratings of scar pliability (p = 0.01) and color (p = 0.001) was demonstrated. Mild to moderate pain was reported by more than 40 percent of patients. Patient satisfaction was significantly associated with self-rating of scar pliability and pain, but not Vancouver Scar Scale scores.
  
  
  CONCLUSIONS
  The Vancouver Scar Scale is a reliable and valid tool to objectively evaluate scars after breast cancer surgery. Evaluation of scar-related pain and patients' scar rating and satisfaction provide additional information relevant to scar assessment. This integrated approach is feasible in a busy clinical setting to advance care and research in scar management for breast cancer patients.
authors.affiliation: British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, Canada. ptruong@bccancer.bc.ca
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
authors.forename: Freddy
authors.initials: F
authors.lastname: Abnousi
authors.forename: Celina M
authors.initials: CM
authors.lastname: Yong
authors.forename: Allen
authors.initials: A
authors.lastname: Hayashi
authors.forename: James A
authors.initials: JA
authors.lastname: Runkel
authors.forename: Theressa
authors.initials: T
authors.lastname: Phillips
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D002921:Cicatrix; D004548:Elasticity; D005260:Female; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D015588:Observer Variation; D010147:Pain Measurement; D017060:Patient Satisfaction; D010865:Pilot Projects; D015203:Reproducibility of Results; D012880:Skin Pigmentation; D011795:Surveys and Questionnaires