Quality of Life Research

, Volume 22, Issue 9, pp 2279–2292

Deriving clinically meaningful cut-scores for fatigue in a cohort of breast cancer survivors: a Health, Eating, Activity, and Lifestyle (HEAL) Study

  • Angela M. Stover
  • Bryce B. Reeve
  • Barbara F. Piper
  • Catherine M. Alfano
  • Ashley Wilder Smith
  • Sandra A. Mitchell
  • Leslie Bernstein
  • Kathy B. Baumgartner
  • Anne McTiernan
  • Rachel Ballard-Barbash

DOI: 10.1007/s11136-013-0360-6

Cite this article as:
Stover, A.M., Reeve, B.B., Piper, B.F. et al. Qual Life Res (2013) 22: 2279. doi:10.1007/s11136-013-0360-6



To empirically determine clinically meaningful cut-scores on the 0–10 response scale of the revised Piper Fatigue Scale (PFS-R) and its shorter version (PFS-12). Breast cancer survivors were classified (i.e., none, mild, moderate, or severe fatigue) based on the cut-scores, and relationships between these cut-scores and decrements in health-related quality of life (HRQOL) were examined.


A total of 857 breast cancer survivors, stages in situ-IIIa, from the Health, Eating, Activity, and Lifestyle (HEAL) Study were eligible. Survivors completed the PFS-R, SF-36, and a sexual health scale approximately 3 years after diagnosis. Multivariate analysis of covariance was used to examine five fatigue severity cut-score models, controlling for demographics, clinical characteristics, comorbidity, and antidepressant use. Multivariate regression was used to examine HRQOL decrements by cut-score category.


Analyses supported two similar fatigue severity cut-score models for the PFS-R and PFS-12: ModelA.) none (0), mild (1–3), moderate (4–6), and severe (7–10); and ModelD.) none (0), mild (1–2), moderate (3–5), and severe (6–10). For every threshold increase in fatigue severity, clinically meaningful decrements in physical, mental, and sexual health scores were observed, supporting construct validity of the fatigue cut-scores.


Standardized fatigue cut-scores may enhance interpretability and comparability across studies and populations and guide treating planning.


Cancer-related fatigueBreast cancer survivorsMeasurementPiper Fatigue ScaleHealth-related quality of life



Body mass index


Cancer inventory for problem situations


Cancer-related fatigue


Health, Eating, Activity, and Lifestyle Study


Health-related quality of life


Multivariate analysis of covariance


Mental Component Score for the SF-36


Physical Component Score for the SF-36


Piper Fatigue Scale-Revised


Piper Fatigue Scale-12


Surveillance, epidemiology, and end results (cancer registries)


Medical Outcomes Study Short Form-36

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Angela M. Stover
    • 1
  • Bryce B. Reeve
    • 2
  • Barbara F. Piper
    • 3
  • Catherine M. Alfano
    • 4
  • Ashley Wilder Smith
    • 4
  • Sandra A. Mitchell
    • 4
  • Leslie Bernstein
    • 5
  • Kathy B. Baumgartner
    • 6
  • Anne McTiernan
    • 7
  • Rachel Ballard-Barbash
    • 4
  1. 1.Department of Health BehaviorUniversity of North Carolina - Chapel HillChapel HillUSA
  2. 2.Health Policy & ManagementUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.National UniversitySan DiegoUSA
  4. 4.National Cancer InstituteFrederickUSA
  5. 5.City of Hope National Medical CenterDuarteUSA
  6. 6.University of LouisvilleLouisvilleUSA
  7. 7.Fred Hutchinson Cancer Research CenterSeattleUSA