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We herein describe the development and validation of the Cancer Fatigue Scale (CFS) for assessment of fatigue in cancer patients. We designed this scale specifically to reflect the nature of fatigue experienced by cancer patients, by using factor analysis; the CFS is a 15-item scale composed of 3 subscales (physical, affective, and cognitive subscales). Three hundred seven cancer patients participated in the validation phase. Construct validity, confirmed by repeating factor analysis, was good. Convergent validity, confirmed by a correlation between CFS and a visual analogue scale for fatigue, was also shown to be good (r = 0.67, P < 0.001). The CFS had good stability (average test-retest reliability r = 0.69, P < 0.001) and good internal consistency (Cronbach's alpha coefficient for all 15 items = 0.88). The present study indicates that the CFS is a brief, valid, and feasible measure of fatigue for use with cancer patients.
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PMID:Development and validation of the cancer fatigue scale: a brief, three-dimensional, self-rating scale for assessment of fatigue in cancer patients. 1068 21

Fatigue is one of the most frequent symptoms in cancer patients. However, the precise causes of this fatigue are still unknown, and this situation makes it difficult to combat the problem. The present study was conducted to investigate factors correlated with fatigue in disease-free breast cancer patients. A group of 134 randomly selected ambulatory breast cancer patients who had undergone successful surgical treatment participated. They completed the Cancer Fatigue Scale, the Hospital Anxiety and Depression Scale, the Mental Adjustment to Cancer Scale, and an ad hoc questionnaire detailing physical symptoms, social support, and demographic variables at home and returned them by mail the following day. Multiple regression analysis revealed that fatigue was significantly correlated with dyspnea, insufficient sleep, and depression, and that these three variables accounted for a total of 46% of variance in fatigue. Factors concerned with the cancer and treatment, such as disease stage, lymph node metastasis, number of days since operation, past intravenous chemotherapy, radiotherapy, current use of fluoropyrimidine compounds, and current use of tamoxifen citrate were not correlated with fatigue. The results suggest that fatigue in this population is determined by current physical and psychological distress rather than by the cancer itself and prior cancer treatments, and that the management of dyspnea, insomnia, and depression might be important in reducing fatigue in this population.
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PMID:Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale. 1078 63

Although it has been indicated that patients with lung cancer experience higher level of fatigue than patients with other cancers, few published studies have focused on the characteristics of this fatigue and how it interferes with daily activities. The purpose of this study was to clarify fatigue prevalence and the factors correlated with fatigue, and to develop a screening method for fatigue in patients with advanced lung cancer. One hundred fifty-seven patients completed two fatigue scales (Cancer Fatigue Scale [CFS], and Fatigue Numerical Scale [FNS]) plus other measures, along with a self-administered questionnaire asking whether fatigue had interfered with any of 7 areas of daily activities. Fifty-nine percent of patients had experienced clinical fatigue, which was defined as fatigue that interfered with any daily activities. Logistic regression analysis demonstrated that symptoms of dyspnea on walking, appetite loss, and depression were significant correlated factors. Both CFS and FNS were found to have sufficient sensitivity and specificity for use as a screening tool. The results indicated that fatigue is a frequent and important symptom, which is associated with both physical and psychological distress in this population. The CFS and FNS were confirmed to have sufficient screening ability.
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PMID:Fatigue in ambulatory patients with advanced lung cancer: prevalence, correlated factors, and screening. 1151 97

The purpose was to determine the minimally important clinical difference (MICD) in fatigue as measured by the Profile of Mood States, Schwartz Cancer Fatigue Scale (SCFS), General Fatigue Scale, and a 10-point single-item fatigue measure. The MICD is the smallest amount of change in a symptom (e.g., fatigue) measure that signifies an important change in that symptom. Subjects rated the degree of change in their fatigue over 2 days on a Global Rating Scale. 103 patients were enrolled on this multisite prospective repeated measures design. MICD was determined following established procedures at two time points. Statistically significant changes were observed for moderate and large changes in fatigue, but not for small changes. The scales were sensitive to increases in fatigue over time. The MICD, presented as mean change, for each scale and per item on each scale is: POMS = 5.6, per item = 1.1, SCFS = 5.0, per item = 0.8, GFS = 9.7, per item = 1.0, and the single item measure of fatigue was 2.4 points. This information may be useful in interpreting scale scores and planning studies using these measures.
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PMID:Measurement of fatigue. determining minimally important clinical differences. 1186 94

Fatigue has been recognized as one of the most distressing symptoms in cancer patients. Concise assessment is essential to managing this symptom. To that end, the Brief Fatigue Inventory (BFI), a 9-item questionnaire, was designed to assess fatigue in cancer patients. The purpose of this study was to examine the validity and reliability of the Japanese version of this scale (BFI-J), when compared with previously validated fatigue instruments. We randomly selected 252 cancer patients and presented them with the BFI-J, along with the Cancer Fatigue Scale; Profile of Mood States fatigue, vigor, and depression subscales; and European Organization for Research and Treatment of Cancer QLQ-C30. Specifically, the reliability and construct, criterion, convergent, and discriminant validity of each instrument were evaluated. Additionally, fatigue severity classification was explored using the BFI-J. The results indicated that the BFI-J is a brief, valid, and feasible measure of fatigue for use with Japanese cancer patients.
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PMID:Validation study of the Japanese version of the brief fatigue inventory. 1259 26

A prospective study was designed to investigate the factors predicting fatigue in breast cancer patients using the Cancer Fatigue Scale (CFS) in addition to the Hospital Anxiety and Depression Scale (HADS) and a questionnaire containing items on demographic and clinical data, and measures of patients' physical symptoms. The CFS measures total fatigue score ranging from 0 (lowest level) to 60 (highest level) and contains three subscales namely: physical, affective and cognitive fatigue. The questionnaires were administered to a consecutive sample of breast cancer patients attending the Iranian Center for Breast Cancer either for their treatment or follow-up examination. In all, 112 patients were studied. The mean age of the respondents was 45.7 years (SD11.0). Most had stage II breast cancer (67%) and had completed their initial treatment (45%). The mean total fatigue score of the patients was 18.7 (SD 13.5) and overall 49% reported experiencing fatigue to some degree (from quite a bit to very much). Severe anxiety and depression was reported by 16% and 32%, respectively. The regression analysis revealed that fatigue was predicted by depression ( P=0.003), pain ( P=0.005), current tamoxifen use ( P=0.001), undergoing mastectomy ( P=0.03) and anxiety ( P=0.04). The other variables studied did not emerge as significant predictors of fatigue in the regression analysis. The study findings suggest that in comparison to treatment factors, physical and psychological symptoms have a more important role in cancer-related fatigue and that fatigue should be recognized and managed even before commencing breast cancer treatment.
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PMID:Factors predicting fatigue in breast cancer patients. 1273 Jul 28

This report summarizes findings related to the psychometric properties (internal consistency and construct validity) of the Pittsburgh Sleep Quality Index (PSQI) and discusses issues related to its use based on data from two clinical studies with diverse samples of cancer patients. Subjects completed a questionnaire that included the PSQI, the Schwartz Cancer Fatigue Scale, and specific demographic, disease, and treatment variables. There were complete data on 170 (of 214) cases in Study 1 and 249 (of 259) cases in Study 2. The Cronbach's alpha for the Global Sleep Quality scale was 0.81 in Study 1 and 0.77 in Study 2 A comparison of Global Sleep Quality in two contrasting groups with low and high fatigue yielded statistically significant differences in both samples. Psychometric evaluation supports its internal consistency reliability and construct validity. However, the scoring is rather cumbersome and raises questions regarding level of measurement and appropriate analysis techniques.
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PMID:Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. 1515 38

The purpose of this study was to evaluate the psychometric properties (reliabilities and validities) and ease of use of three translated fatigue instruments: Chinese versions of the Cancer Fatigue Scale, the Fatigue Symptom Inventory (FSI), and the Schwartz Cancer Fatigue Scale-revised. Convenience sampling was used to recruit 243 cancer outpatients at a chemotherapy treatment center in Taiwan. The results indicated that the three scales had good internal consistency (Cronbach's alphas for three total scales > 0.80) and were brief (less than 6 minutes to complete), valid (confirmed by convergent, divergent, and discriminant validity), and feasible measures (completion rates > 97%) of fatigue for use with Taiwanese cancer patients. However, 27% of cancer patients reported that the FSI was difficult for them to complete. Differences in factorial validity between each original scale and its Chinese version indicate a need for further testing in Taiwan.
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PMID:Psychometric testing of three Chinese fatigue instruments in Taiwan. 1687 83

Cancer-related fatigue (CRF) is a significant clinical symptom. Effective assessment of CRF attributes from the patients' perspective is essential. This study tested the psychometric properties of the Wu Cancer Fatigue Scale (WCFS). A total of 172 outpatients with breast cancer, who were at various stages and on various chemotherapy regimens, and were undergoing treatment at one of three cancer clinics in a Midwest metropolitan area, participated in this study. The participants were instructed to complete four instruments in the following order: the 16-item WCFS, Schwartz Cancer Fatigue Scale (SCFS), Geriatric Depression Scale (GDS), and Cancer-Related Fatigue Distress Scale (CRFDS). Structural equation modeling (LISREL 8.54) supported the one-factor measurement model with nine items remaining. Nonsignificant Satorra-Bentler Scaled Chi-square (27)=32.52, P=0.21, standardized root mean square residual=0.032, nonnormal fit index=0.97, comparative fit index=0.98, and incremental fit index=0.98 indicated a good model fit. Convergent validity with the SCFS was 0.78, concurrent validity with the GDS was 0.60, and predictive validity with the CRFDS was 0.73. Internal consistency reliability was alpha=0.91 for the nine-item scale. The revised WCFS is a reliable and valid instrument that aims to measure the subjective characteristics of CRF from the patients' perspective. It may prove useful in both clinical and research settings.
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PMID:Assessing fatigue in persons with cancer: further validation of the Wu Cancer Fatigue Scale. 1693 50

The purpose of this study was to evaluate the cultural appropriateness (ie, semantic equivalence, content equivalence, and conceptual equivalence) of 3 translated fatigue instruments (the Cancer Fatigue Scale, the Fatigue Symptom Inventory, and the Schwartz Cancer Fatigue Scale-revised) by using 2 phases: (a) establishment of semantic and content equivalencies by the rigorous process of translation and back-translation, and (b) evaluation of content equivalence and conceptual equivalence by testing on monolingual subjects with the translated fatigue scales and a questionnaire with fatigue terms list and open-ended questions. Convenience sampling was used to recruit subjects at a chemotherapy treatment center for outpatients in Taiwan. The results indicated that the content in the 3 scales were relevant to the experience of fatigue among Taiwanese from the view of patients, but only the fatigue domains in the Cancer Fatigue Scale-Chinese version was similar to the original construct based on the exploratory factor analysis. However, the results for examining the content equivalencies by the fatigue terms list showed that only 4 items in the list were used to describe fatigue by more than 50% of the patients. Therefore, the contents of the chosen scales might not represent the whole concept of fatigue in Taiwan. Exploration of the content and construct of fatigue in Taiwan and further testing of the translated scales are recommended. In addition, the result in this study is helpful for clinical nurses to understand expressions of fatigue in cancer patients within the Chinese culture but the meaning of fatigue still needs to be further explored.
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PMID:Assessing cultural appropriateness of three translated cancer-related fatigue instruments. 1751 May 76


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