O4-4 Linguistic validation of a Japanese version of the Chemotherapy-induced Alopecia Distress Scale

Chemotherapy-induced alopecia (CIA) is one of the most distressing adverse events caused by chemotherapy. The Chemotherapy-induced Alopecia Distress Scale (CADS) is a psychometrically validated, condition-specific, patient-reported outcome measure for assessing CIA-related distress. It consists of 17 items in four domains (physical, emotional, activity, and relationship). We translated the CADS into Japanese and validated it linguistically. After forward and backward translation, an interim Japanese version of the CADS was completed. Cognitive interviews with 10 breast cancer patients were conducted at Toranomon Hospital, Tokyo, Japan in September 2020. Participants were asked to complete the interim CADS and were interviewed to evaluate conceptual equivalence between our translation and the original English version. Participants were also asked to answer whether any items were “difficult to answer”, “confusing”, “difficult to understand”, or “upsetting”, and requested to propose any other possible phrases to express their feelings better. Median age of the participants was 57 years. All had a certain level of CIA: two participants were in Stage III, and eight were in de novo Stage IV or metastatic disease. Eight of the 17 items were identified as difficult to answer by two or more participants. Phrases frequently identified as difficult to answer were “burning or prickling resulting pain”, “feeling different from others”, “feeling lonely”, and “sexual relationship”. Furthermore, seven items were identified as difficult to understand by two or more participants. The phrase most frequently identified as difficult to understand was “burning or prickling resulting pain”. The most frequent revision proposal was a change of “scarf” for “hat” according to Japanese customs. We modified six items and finalized the Japanese CADS. The Japanese CADS has been linguistically validated. Psychometric validation of the scale is ongoing.