Document Type : Original Article(s)


1 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Medical Oncology-Hematology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

5 Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

6 Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

7 Department of Internal Medicine, School of Medicine, Cancer Prevention Research Center, Seyyed AlShohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

8 Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

9 Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

10 Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: Understanding the close interaction between the specialties of cardiology and oncology is necessary for early detection of cardiovascular disease (CVD) events in cancer patients. For the risk assessment of CVD in Breast and Colorectal Cancers (CIBC) study, in the current study we aimed to validate a questionnaire for the assessment of clinical history in patients with breast cancer and colorectal cancer (CRC).METHODS: We determined the content validity of the questionnaire using the 2 indexes of content validity ratio (CVR) and content validity index (CVI) to examine the specificity, simplicity, clarity, and transparency of the items. Content validity assessment was performed through a panel of experts including 2 oncologists, 5 cardiologists, 2 general practitioners, and 1 epidemiologist. The reliability of the questionnaire was estimated using Cronbach's alpha coefficient in 50 patients. Intraclass correlation coefficient (ICC) was used to examine the reproducibility of the questionnaire during 1 week.RESULTS: The CRC and breast cancer questionnaire were designed with 16 and 32 questions, respectively. To obtain acceptable CVR, 5 and 11 questions were removed from the CRC and breast cancer questionnaires, respectively. Cronbach's alpha was 0.70 in the breast cancer questionnaire and 0.94 in the CRC questionnaire. All questions had a CVI of higher than 80%. The ICC in the breast cancer questionnaire ranged between 0.71 and 0.96 and in CRC questionnaire ranged between 0.78 and 0.98.CONCLUSION: The validity and reliability of our newly developed questionnaire was desirable. The reliability of the breast cancer questions was acceptable and that of the CRC questions was excellent. Thus, thus questionnaire can be used in this group of patients regardless of whether the goal is cardiac care or not.


  1. Torabi Parizi M, Kalantari M, Ghavidel F. Evaluation of head and neck cancer patients’ knowledge regarding complications of chemotherapy and radiotherapy in patients referring to Kerman University of Medical Sciences treatment centers. J Dent Med Tehran Univ Med Sci 2018; 31(2): 83-90. [In Persian].
  2. Sasser AC, Rousculp MD, Birnbaum HG, Oster EF, Lufkin E, Mallet D. Economic burden of osteoporosis, breast cancer, and cardiovascular disease among postmenopausal women in an employed population. Womens Health Issues 2005; 15(3): 97-108.
  3. Malekzade M, Peykani S, Amani O. Comparative study of quality of life in women survived with those suffered from breast cancer while under chemotherapy. J Health Promot Manag 2017; 6(4): 8-14. [In Persian].
  4. Hosseinzadeh A, Daraei A. Environmental factors associated with sporadic colorectal cancer. J Health Syst Res 2012; 8(2): 229-36. [In Persian].
  5. Moamer S, Baghestani A, Pourhoseingholi MA, Maboudi A, Shahsavari S, Zali M, et al. Application of the parametric regression model with the four-parameter log-logistic distribution for determining of the effecting factors on the survival rate of colorectal cancer patients in the presence of competing risks. Iran Red Crescent Med J 2017; 19(6): e55609.
  6. Kirkham AA, Davis MK. Exercise Prevention of cardiovascular disease in breast cancer survivors. J Oncol 2015; 2015: 917606.
  7. Esplugas R, Arenas M, Serra N, Belles M, Bonet M, Gascon M, et al. Effect of radiotherapy on the expression of cardiovascular disease-related miRNA-146a, -155, -221 and -222 in blood of women with breast cancer. PLoS One 2019; 14(5): e0217443.
  8. Nhola LF, Abdelmoneim SS, Villarraga HR, Kohli M, Grothey A, Bordun KA, et al. Echocardiographic assessment for the detection of cardiotoxicity due to vascular endothelial growth factor inhibitor therapy in metastatic renal cell and colorectal cancers. J Am Soc Echocardiogr 2019; 32(2): 267-76.
  9. Tang XM, Chen H, Liu Y, Huang BL, Zhang XQ, Yuan JM, et al. The cardiotoxicity of cetuximab as single therapy in Chinese chemotherapy-refractory metastatic colorectal cancer patients. Medicine (Baltimore) 2017; 96(3): e5946.
  10. Hong RA, Iimura T, Sumida KN, Eager RM. Cardio-oncology/onco-cardiology. Clin Cardiol 2010; 33(12): 733-7.
  11. Lawshe CH. A quantitative approach to content validity. Pers Psychol 1975; 28(4): 563-75.
  12. Danesh A, Amiri M, Zamani A, Tazhibi M, Ganji F. Knowledge, attitude and practice (KAP) rate of women employees of education organization about breast self-examination, Shahrekord, 1998. J Shahrekord Univ Med Sci 2002; 4(2): 47-52. [In Persian].
  13. Naghibi A, Jamshidi P, Yazdani J, Rostami F. Identification of factors associated with breast cancer screening based on the PEN-3 Model among female school teachers in Kermanshah. Iran J Health Educ Health Promot 2016; 4(1): 58-64. [In Persian].
  14. Khodayarian M, Peyghambari F, Mazloomy Mahmoodabad S, Morowatisharifabad MA, Lamyian M. Development and psychometric evaluation of a protection motivation theorybased scale assessing the adherence of Iranian women breast cancer prevention behaviors. Iran J Breast Dis 2019; 12(1): 8-18. [In Persian].
  15. Shouri Bidgoli AR, Taheri Kharame Z, Asayesh H, Sharififard F, Sheydaiyan Arani M, Hajaligol A, et al. A study of knowledge, attitude, and practice on colorectal cancer screening among individuals older than 50 years based on Health Belief Model. Qom Univ Med Sci J 2015; 9(1): 59-65. [In Persian].
  16. Mahmoodi Rad G, Fotoorchi F, Mogharab M, Karbasi SH, Tavakoli MR. Physical activity in patients with colorectal cancer. J Birjand Univ Med Sci 2005; 12(1): 9-15. [In Persian].
  17. Kawthaisong C, Promthet S, Kamsa-Ard S, Duangsong R. questionnaire validation of colorectal cancer literacy scale among Thai people in northeastern Thailand. Asian Pac J Cancer Prev 2019; 20(2): 645-51.
  18. Heidari Z, Feizi A. Transcultural adaptation and validation of the Persian version of the breast cancer awareness measure (BCAM) questionnaire. Cancer Med 2018; 7(10): 5237-51.
  19. Norsa'adah B, Aminu AR, Zaidi Z. Validity and reliability of questionnaire on knowledge, attitude and dietary practices related to colorectal cancer. Malays J Med Sci 2020; 27(1): 115-23.
  20. Kwok C, Ogunsiji O, Lee CF. Validation of the breast cancer screening beliefs questionnaire among African Australian women. BMC Public Health 2016; 16: 117.
  21. Ashton-Prolla P, Giacomazzi J, Schmidt AV, Roth FL, Palmero EI, Kalakun L, et al. Development and validation of a simple questionnaire for the identification of hereditary breast cancer in primary care. BMC Cancer 2009; 9: 283.
  22. Grarup KR, Devoogdt N, Strand LI. The Danish version of Lymphoedema Functioning, Disability and Health Questionnaire (Lymph-ICF) for breast cancer survivors: Translation and cultural adaptation followed by validity and reliability testing. Physiother Theory Pract 2019; 35(4): 327-40.
  23. Momayyezi M, Fallahzadeh H. Construction and validation of Breast Cancer Awareness Scale in Iranian women. J Caring Sci 2020; 9(3): 140-7.