Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system.
Open accessAbstract
This paper reports the development and validation of a questionnaire assessing fatigue and anemia-related concerns in people with cancer. Using the 28-item Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire as a base, 20 additional questions related to the symptoms and concerns of patients with anemia were developed. Thirteen of these 20 questions dealt with fatigue, while the remaining 7 covered other concerns related to anemia. Using semi-structured interviews with 14 anemic oncology patients and 5 oncology experts, two instruments were produced: The FACT-Fatigue (FACT-F), consisting of the FACT-G plus 13 fatigue items, and the FACT-Anemia (FACT-An), consisting of the FACT-F plus 7 nonfatigue items. These measures were, in turn, tested on a second sample of 50 cancer patients with hemoglobin levels ranging from 7 to 15.9 g/dL. The 41-item FACT-F and the 48 item FACT-An scores were found to be stable (test-retest r = 0.87 for both) and internally consistent (coefficient alpha range = 0.95-0.96). The symptom-specific subscales also showed good stability (test-retest r range = 0.84-0.90), and the Fatigue subscale showed strong internal consistency (coefficient alpha range = 0.93-0.95). Internal consistency of the miscellaneous nonfatigue items was lower but acceptable (alpha range = 0.59-0.70), particularly in light of their strong relationship to patient-rated performance status and hemoglobin level. Convergent and discriminant validity testing revealed a significant positive relationship with other known measures of fatigue, a significant negative relationship with vigor, and a predicted lack of relationship with social desirability. The total scores of both scales differentiated patients by hemoglobin level (p < 0.05) and patient-rated performance status (p < 0.0001). The 13-item Fatigue subscale of the FACT-F and the 7 nonfatigue items of the FACT-An also differentiated patients by hemoglobin level (p < 0.05) and patient-rated performance status (p < or = 0.001). The FACT-F and FACT-An are useful measures of quality of life in cancer treatment, adding more focus to the problems of fatigue and anemia. The Fatigue Subscale may also stand alone as a very brief, but reliable and valid measure of fatigue.
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FACIT-F has demonstrated excellent internal consistency, high validity, and sensitivity to pick up change in patients with breast cancer.
“It has demonstrated excellent internal consistency, high validity, and sensitivity to pick up change in patients with breast cancer [58].”
From Pre- and post-operative psychological interventions to prevent pain and fatigue after breast cancer surgery (PREVENT): Protocol for a randomized controlled trial (2022) · cites this paper as [58]
The Abstract (page unavailable) reports strong internal consistency and validity for FACT-F in a sample of cancer patients. The discussion (page unavailable) says longitudinal data had not yet been collected and studies of sensitivity to change were underway; it establishes discrimination between performance-status groups, not sensitivity to change. The reported validation sample is not identified as patients with breast cancer. (LLM, conf=0.90)
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References 23 · Cited by 1,964
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- Authors
- Yellen, S. B., Cella, D. F., Webster, K., Blendowski, C., & Kaplan, E.
- Affiliations
- Rush University Medical Center (US)
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 1997-02
- Volume
- 13
- Issue
- 2
- Pages
- 63-74
- ISSN
- 0885-3924 (ISSN-L)
- OpenAlex
- W2063931484
- Cited by
- 1,964
- References
- 23
- Citations by year
- 2026: 75 · 2025: 106 · 2024: 128 · 2023: 103 · 2022: 131 · 2021: 125 · 2020: 115 · 2019: 81 · 2018: 77 · 2017: 82 · 2016: 97 · 2015: 74 · 2014: 80 · 2013: 67 · 2012: 62
- FWCI
- 4.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Social Sciences › Education › Health Education and Validation
- Keywords
- cancer-related fatigue, anemia, Functional Assessment of Cancer Therapy, questionnaire development, psychometric validation, hemoglobin levels, performance status, quality of life, cancer patients, symptom assessment, test-retest reliability, internal consistency, convergent and discriminant validity, patient-reported outcomes
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anemia, Fatigue, Female, Humans, Male, Middle Aged, Neoplasms, Predictive Value of Tests, Surveys and Questionnaires, Reproducibility of Results
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