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Determining the psychometric properties of the Greene Climacteric Scale (GCS) in women previously treated for breast cancer: A pooled analysis of data from the Women's Wellness after Cancer Programs

      Highlights

      • The treatment for breast cancer can lead to treatment-induced menopausal symptoms which are often sudden and severe.
      • The Greene Climacteric Scale is a well-validated climacteric symptom measure for midlife women from the general population but its applicability in the breast cancer population is difficult to determine.
      • Multitrait analysis showed acceptable convergent validity but weak discriminant validity for anxiety, depression, and somatic symptoms.
      • The original Greene Climacteric Scale factor structure undertaken in women not diagnosed with breast cancer was not replicated in this sample.
      • Among women treated for breast cancer, the presence of multiple concurrent and severe menopausal symptoms with possible treatment-related causes underpins the need for a breast cancer-specific measure to enhance their identification and management.

      Abstract

      Objectives

      This paper examines the utility of a common climacteric symptoms scale, the Greene Climacteric Scale (GCS), in two groups of women with a history of breast cancer, those who were at menopause before commencing breast cancer treatment, and those who were not.

      Study design

      This pooled analysis of 297 women previously diagnosed with breast cancer, aged 28–74 years, was undertaken on baseline data from two structured lifestyle interventions: the Women's Wellness After Cancer Program (WWACP) and the Younger Women's Wellness After Cancer Program (YWWACP). Data were split into two data subsets (women who were post-menopausal on commencement of breast cancer treatment and those who were either pre- or peri‑menopausal). Multitrait/multi-item analysis was conducted to test scaling assumptions for each group separately.

      Results

      GCS domain scores were positively skewed, with significant floor effects for vasomotor symptoms and ceiling effects for sexual dysfunction. Multitrait analysis showed acceptable convergent validity (77% of items correlated ≥ 0.40 with their hypothesized domains) but weak discriminant validity for anxiety, depression, and somatic symptoms in both groups. The exploratory factor analysis in women who were menopausal at the commencement of breast cancer treatment and those who were not revealed distinct factor structures that accounted for 60.2% and 62.7% of the total variance, respectively.

      Conclusions

      The original GCS factor structure was not replicated in this sample. Among women previously treated for breast cancer, the presence of multiple concurrent and severe menopausal symptoms with possible treatment-related causes underpins the need for a breast cancer-specific measure to enhance their identification and management.

      Trial IDs, Australian and New Zealand Clinical Trials Registry

      WWACP, ACTRN12614000800628; YWWACP, ACTRN12614001087640

      Keywords

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