Psychometric properties of the fatigue questionnaire EORTC QLQ-FA12 and proposal of a cut-off value for young adults with cancer

Multidisciplinary analysis of cancer-related fatigue at the time of diagnosis: preliminary results of the BIOCARE FActory cohort

PURPOSE

Cancer-related fatigue (CRF) is a common side effect of cancer and cancer treatment that significantly impairs the quality of life and can persist for years after treatment completion. Although fatigue is often associated with cancer treatment, it is also a result of the disease itself, even before intervention. CRF at the time of diagnosis may affect treatment timing or completion and is a consistent predictor of post-treatment fatigue at any time. The mechanisms underlying CRF are multidimensional and not well understood, particularly at the time of diagnosis.

METHODS

Sixty-five breast cancer patients at the time of diagnosis were included. The participants completed self-assessment questionnaires about CRF, sleep disturbances, and emotional symptoms and wore an accelerometer to assess levels of spontaneous physical activity and sleep quality. During the experimental session, the participants underwent cognitive, neuromuscular, and exercise metabolism evaluations.

RESULTS

Using augmented backward elimination regression, this study found that emotional symptoms and perceived sleep disturbances were the strongest predictors of CRF (adjusted r2 = 0.51). Neuromuscular fatigability and sleep disturbance were also associated with physical dimensions, whereas cognitive performance was associated with cognitive dimensions.

CONCLUSION

At the time of diagnosis, emotional and cognitive dimensions are over-represented compared to the general population, and specific subdimensions have specific predictors that support the idea of distinct mechanisms. Evaluating CRF subdimensions and their potential mechanisms at the time of diagnosis would be particularly relevant for identifying high-risk patients and offering them appropriate interventions.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov (NCT04391543) in May, 2020.

Web-based cognitive rehabilitation intervention for cancer-related cognitive impairment following chemotherapy for aggressive lymphoma: protocol for a randomised pilot trial

INTRODUCTION

Cancer-related cognitive impairment is common among people diagnosed with and treated for cancer. This can be a distressing and disabling side effect for impacted individuals. Interventions to mitigate cognitive dysfunction are available, but, to date, most have been trialled in samples that are largely or exclusively composed of people with solid tumours. Intervention strategies to support cognitive functioning are needed, but there is a paucity of research in this area. The main aim of this study is to test the feasibility and acceptability of methods and procedures intended for use in a definitive trial of a web-based cognitive rehabilitation programme, Responding to Cognitive Concerns (eReCog), in people who have received chemotherapy for aggressive lymphoma.

METHODS AND ANALYSIS

The proposed study is a single-site, parallel-group, pilot randomised controlled trial, with one baseline and one follow-up (or postintervention) assessment. 38 people from the target population with low perceived cognitive function based on the Cognitive Change Screen will be recruited from a specialist cancer centre between July 2023 and June 2024. After baseline assessment, participants will be randomised one-to-one to receive usual care only (a factsheet about changes in memory and thinking for people with cancer) or eReCog plus usual care. The 4-week eReCog intervention consists of four online modules offering psychoeducation on cognitive impairment associated with cancer and its treatment, skills training for improving memory, and attention and relaxation training. Study outcomes will include the feasibility of recruitment and retention at follow-up assessment (primary outcomes), as well as adherence to, usability of and intrinsic motivation to engage with eReCog, and compliance with study measures. The potential efficacy of eReCog will also be evaluated.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Peter MacCallum Cancer Centre Human Research Ethics Committee in Victoria, Australia (HREC/97384/PMCC). Study findings will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry, ACTRN12623000705684.

From a Clustering of Adverse Symptoms after Colorectal Cancer Therapy to Chronic Fatigue and Low Ability to Work: A Cohort Study Analysis with 3 Months of Follow-Up

In colorectal cancer (CRC) patients, apart from fatigue, psychological and physical symptoms often converge, affecting their quality of life and ability to work. Our objective was to ascertain symptom clusters within a year following CRC treatment and their longitudinal association with persistent fatigue and reduced work ability at the 3-month follow-up. We used data from MIRANDA, a multicenter cohort study enrolling adult CRC patients who are starting a 3-week in-patient rehabilitation within a year post-curative CRC treatment. Participants completed questionnaires evaluating symptoms at the start of rehabilitation (baseline) and after three months. We performed an exploratory factor analysis to analyze the clustering of symptoms at baseline. Longitudinal analysis was performed using a multivariable linear regression model with dichotomized symptoms at baseline as independent variables, and the change in fatigue and ability to work from baseline to 3-month-follow-up as separate outcomes, adjusted for covariates. We identified six symptom clusters: fatigue, gastrointestinal symptoms, pain, psychosocial symptoms, urinary symptoms, and chemotherapy side effects. At least one symptom from each factor was associated with higher fatigue or reduced ability to work at the 3-month follow-up. This study highlights the interplay of multiple symptoms in influencing fatigue and work ability among CRC patients post-rehabilitation.

Psychosocial distress in young adults surviving hematological malignancies: a pilot study

PURPOSE

Survivors of cancer during young adulthood face multiple psychosocial challenges following treatment. This study explores psychosocial distress and unmet needs among young adult survivors treated of hematological malignancies.

METHODS

A total of 85 young adults aged between 18 and 39 years at time of diagnosis, were invited to join the survey after the completion of treatment with curative intent. Sociodemographic data and the need for advice were gathered with a self-report questionnaire. A set of standardized questionnaires for quality of life (EORTC QLQ-C30), psychosocial stressors (PHQ-S), fear of progression (PA-F-KF), cancer-related fatigue (EORTC QLQ-FA12), and symptoms of anxiety (GAD-7) or depression (PHQ-9) was employed. Descriptive statistics and multivariate analysis were conducted.

RESULTS

Forty-seven young adult cancer survivors responded. A quarter of patients (26%) reported depressive symptoms, 15% suffered from anxiety, 36% from fear of progression, and 21% reported increased psychosocial stressors. They had a lower QoL than the general population and reported poorer outcomes on all single-item and multi-symptom scales. Employment was significantly associated with lower levels of psychosocial distress, anxiety, fatigue, and better QoL.

CONCLUSION

Young adult cancer survivors exhibited a high disposition for psychosocial distress. They reported excessive demands in everyday life and resumption of work. However, a longitudinal study of young adult cancer survivors is needed to confirm the results of this pilot study. In future, psycho-oncological and social support need to become an inherent part of the aftercare of survivors of young adult cancer survivors.

Predictors for False-Negative Interferon-Gamma Release Assay Results in Hemodialysis Patients with Latent Tuberculosis Infection

The present study aimed to clinically evaluate the effect of T-cell dysfunction in hemodialysis (HD) patients with latent tuberculosis (TB) infection (LTBI) who were false-negatives in the QuantiFERON-TB Gold In-Tube (QFT-GIT) test. Whole blood samples from a total of 20 active TB patients, 83 HD patients, and 52 healthy individuals were collected, and the QFT-GIT test was used for measuring Mycobacterium tuberculosis (MTB)-specific interferon gamma (IFN-γ) level. The positive rate of the IFN-γ release assays (IGRAs) in HD patients was lower than the negative rate. The mean value of MTB-specific IFN-γ level, which determines the positive rate of the IGRA test, was highest in active TB, followed by HD patients and healthy individuals. Among HD patients, phytohemagglutinin A (PHA)-stimulated IFN-γ levels of approximately 40% were 10.00 IU/mL or less. However, there was no low level of PHA-stimulated IFN-γ in the healthy individuals. This reveals that T-cell function in HD patients was reduced compared to healthy individuals, which leads to the possibility that QFT-GIT results in HD patients are false-negative. The clinical manifestations of TB in patients on HD are quite non-specific, making timely diagnosis difficult and delaying the initiation of curative treatment, delay being a major determinant of outcome.

Screening and Assessment of Cancer-Related Fatigue: A Clinical Practice Guideline for Health Care Providers

Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. Regular surveillance is recommended, but few clinical practice guidelines transparently assess study bias, quality, and clinical utility in deriving recommendations of screening and assessment methods. The purpose of this clinical practice guideline (CPG) is to provide recommendations for the screening and assessment of CRF for health care professions treating individuals with cancer. Following best practices for development of a CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) Statement and Emergency Care Research Institute (ECRI) Guidelines Trust Scorecard, this CPG included a systematic search of the literature, quality assessment of included evidence, and stakeholder input from diverse health care fields to derive the final CPG. Ten screening and 15 assessment tools supported by 114 articles were reviewed. One screen (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-30 Core Questionnaire) and 3 assessments (Piper Fatigue Scale-Revised, Functional Assessment of Chronic Illness Therapy-Fatigue, and Patient Reported Outcome Measurement Information System [PROMIS] Fatigue-SF) received an A recommendation ("should be used in clinical practice"), and 1 screen and 5 assessments received a B recommendation ("may be used in clinical practice"). Health care providers have choice in determining appropriate screening and assessment tools to be used across the survivorship care continuum. The large number of tools available to screen for or assess CRF may result in a lack of comprehensive research evidence, leaving gaps in the body of evidence for measurement tools. More research into the responsiveness of these tools is needed in order to adopt their use as outcome measures.

IMPACT

Health care providers should screen for and assess CRF using one of the tools recommended by this CPG.

Mental Load and Fatigue Assessment Instruments: A Systematic Review

Mental load and fatigue are important causes of performance decreases and accidents in different activities. However, a robust systematic review, detailing the instruments used to quantify them, is currently lacking. The purpose of this study was to summarize and classify by derivations the validated instruments used to quantify mental load and fatigue. The most representative electronic databases in the scope of this review, PubMed, WOS, Scopus, SPORTDiscus, and PsycINFO (until September 2020) were searched for studies that included instruments to analyze mental load and fatigue. The quality of the selected studies was scored using a quality assessment checklist. A total of 40 papers were included. Most of the papers used subjective scales (75%) to quantify mental load and fatigue, with a small presence of behavioral (n = 5) and objective techniques (n = 5). Less is known about the analysis of mental load and fatigue using a combination of derivations. Despite the high cost and complexity of objective techniques, research that applies these measures is important for further analysis of brain processes in mental load and fatigue. The design of a battery of tests that include the three types of derivations also seems necessary.

A questionable factor structure of the multidimensional fatigue inventory in the general Dutch population

OBJECTIVE

One of the most commonly used tools to measure fatigue is the Multidimensional Fatigue Inventory (MFI). Studies into the scale structure of the MFI show discrepant findings. The objective of this study was to investigate the scale structure of the MFI in the general Dutch population.

STUDY DESIGN AND SETTING

Using data from a Dutch probability-based internet panel (n = 2512), the original 5-factor model, a 4-factor, and a 5- and 4-bifactor model of the MFI were tested with confirmatory factor analyses. Additional models were investigated using exploratory factor analysis.

RESULTS

Results neither confirmed a 5-factor (RMSEA = 0.120, CFI = 0.933, TLI = 0.920) nor a 4-factor model (RMSEA = 0.122, CFI = 0.928, TLI = 0.917). The two bi-factor models also showed a poor fit (bi-4-factor: RMSEA = 0.151, CFI = 0.895, TLI = 0.873; bi-5-factor: RMSEA = 0.153, CFI = 0.894, TLI = 0.871). Exploratory factor analysis did not support an alternative model, but seemed to show robustness in the loading of the original general fatigue items.

CONCLUSION

Our results did not provide empirical support for a four or five (bi-)factor structure of the MFI, nor for an alternative model. The most reliable scale of the MFI seems to be the general fatigue scale that could be used as a general indicator of fatigue.

Fatigue and resting-state functional brain networks in breast cancer patients treated with chemotherapy

PURPOSE

This longitudinal study aimed to disentangle the impact of chemotherapy on fatigue and hypothetically associated functional brain network alterations.

METHODS

In total, 34 breast cancer patients treated with chemotherapy (BCC +), 32 patients not treated with chemotherapy (BCC -), and 35 non-cancer controls (NC) were included. Fatigue was assessed using the EORTC QLQ-C30 fatigue subscale at two time points: baseline (T1) and six months after completion of chemotherapy or matched intervals (T2). Participants also underwent resting-state functional magnetic resonance imaging (rsfMRI). An atlas spanning 90 cortical and subcortical brain regions was used to extract time series, after which Pearson correlation coefficients were calculated to construct a brain network per participant per timepoint. Network measures of local segregation and global integration were compared between groups and timepoints and correlated with fatigue.

RESULTS

As expected, fatigue increased over time in the BCC + group (p = 0.025) leading to higher fatigue compared to NC at T2 (p = 0.023). Meanwhile, fatigue decreased from T1 to T2 in the BCC - group (p = 0.013). The BCC + group had significantly lower local efficiency than NC at T2 (p = 0.033), while a negative correlation was seen between fatigue and local efficiency across timepoints and all participants (T1 rho = - 0.274, p = 0.006; T2 rho = - 0.207, p = 0.039).

CONCLUSION

Although greater fatigue and lower local functional network segregation co-occur in breast cancer patients after chemotherapy, the relationship between the two generalized across participant subgroups, suggesting that local efficiency is a general neural correlate of fatigue.

Cumulative financial stress as a potential risk factor for cancer-related fatigue among prostate cancer survivors

Introduction

Cancer-related fatigue (CRF) is the most commonly reported treatment-related side effect of prostate cancer (PCa). Recognition of financial hardship among cancer survivors is growing. We investigated, for the first time, associations between levels of financial stress and CRF among PCa survivors.

Methods

We used data from PCa survivors who had been identified through two population-based cancer registries covering the Republic of Ireland and Northern Ireland and had completed a postal questionnaire. CRF was measured by the fatigue subscale of the EORTC QLQ-C30. Financial stress was assessed as household ability to make ends meet (i) pre-diagnosis and (ii) at questionnaire completion (post-diagnosis). Multivariable logistic regression was used to relate financial stress to clinically important CRF (fatigue subscale score ≥ 39 of a possible 100).

Results

Two thousand four hundred fifty-eight PCa survivors were included. Of these, 268 (10.9%) reported pre-diagnosis financial stress only, 317 (12.9%) post-diagnosis stress only and 270 (11.0%) both pre- and post-diagnosis stress (cumulative stress); 470 (19.1%) reported clinically important CRF. After controlling for confounders, survivors with cumulative financial stress exposure were significantly more likely to have CRF (OR = 4.58, 95% CI 3.30–6.35, p < 0.001), compared with those without financial stress. There was a suggestion of a dose-response relationship (OR = 1.83, 95% CI 1.27–2.65, p = 0.001 for pre-diagnosis financial stress only; and OR = 4.11, 95% CI 3.01–5.61, p < 0.001 for post-diagnosis financial stress only).

Conclusions

Financial stress may be an independent risk factor for CRF.

Implications for Cancer Survivors

There may be benefits in targeting interventions for reducing CRF towards survivors with financial stress, or developing strategies to reduce financial stress.

Electronic supplementary material

The online version of this article (10.1007/s11764-020-00906-7) contains supplementary material, which is available to authorized users.

Measuring fatigue in cancer patients: a common metric for six fatigue instruments

PURPOSE

Fatigue is one of the most disabling symptoms in cancer patients. Many instruments exist to measure fatigue. This variety impedes the comparison of data across studies or to the general population. We aimed to estimate a common metric based on six different fatigue instruments (EORTC QLQ-C30 subscale fatigue, EORTC QLQ-FA12, MFI subscale General Fatigue, BFI, Fatigue Scale, and Fatigue Diagnostic Interview Guide) to convert the patients' scores from one of the instruments to another. Additionally, we linked the common metric to the general population.

METHODS

For n = 1225 cancer patients, the common metric was estimated using the Item Response Theory framework. The linking between the common metric of the patients and the general population was estimated using linear regression.

RESULTS

The common metric was based on a model with acceptable fit (CFI = 0.94, SRMR = 0.06). Based on the standard error of measurement the reliability coefficients of the questionnaires ranged from 0.80 to 0.95. The common metric of the six questionnaires, also linked to the general population, is reported graphically and in supplementary crosswalk tables.

CONCLUSIONS

Our study enables researchers and clinicians to directly compare results across studies using different fatigue questionnaires and to assess the degree of fatigue with respect to the general population.

Cancer-Related Fatigue and Associated Factors in Young Adult Cancer Patients

Purpose: Cancer-related fatigue (CRF) is a highly burdensome and long-lasting symptom of cancer and its therapy. This study aims to examine the severity of CRF in its different dimensions and to assess medical and sociodemographic factors associated with CRF in young adults with cancer (adolescents and young adults [AYAs]). Methods: Patients with malignant cancer (diagnosed within the last 4 years) aged 18-39 years at diagnosis were assessed. CRF was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Fatigue Module (EORTC QLQ-FA12) Questionnaire. Sociodemographic and medical data were collected with self-report questionnaires. Descriptive analyses, cluster analysis, and multiple regression analysis were used to examine CRF in AYAs. Results: In total, n = 577 patients were included. Respondents' fatigue scores were highest for the physical subscale (mean = 45.6; standard deviation [SD] = 28.2), followed by the emotional (mean = 26.7; SD = 28.8) and cognitive dimensions (mean = 19.7; SD = 22.7). Female participants, patients with an additional disease, and patients with financial problems resulting from having cancer reported significantly higher fatigue scores for all three of the subscales (R² range: 0.10-0.22). Testicular cancer patients had the lowest CRF scores for every dimension. Breast and gynecological cancer patients had the highest emotional and cognitive fatigue scores. Conclusion: Medical variables such as cancer site and therapy scheme seem to have little influence. Caregivers should assess CRF in AYAs independent of their medical characteristics. Reducing additional burdens may represent a way of reducing CRF in AYA cancer patients.