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

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Abstract

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.

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Abbreviations

BFI9:

Sum of the nine items of the BFI (item range = 0–10, scale range = 0–10)

CFI:

Comparative fit index

Chi²:

Chi-squared statistic

CI:

Confidence interval

df:

Degrees of freedom

DIG11:

Sum of the eleven binary symptom items of the DIG for Fatigue (item range: 0/1, scale range = 0–11) FA12: Sum of the twelve items of the EORTC QLQ-FA12 (item range = 1–4, scale range = 0-100)

FA3:

Sum of the three-item fatigue scale of the EORTC QLQ-C30 (item range = 1–4, scale range = 0-100) FS11: Sum of the eleven items of the FS (item range = 0–3, scale range = 0–33)

GP:

General population

M:

Mean

MFI4:

Sum of the four-item General Fatigue scale of the MFI-20 (item range = 1–5, scale range = 4–20); RMSEA: Root mean square error of approximation

SD:

Standard deviation

SRMR:

Standardized root mean square residual

TLI:

Tucker–Lewis Index

T-scores(GP):

Estimation of T-scores for the German general population (mean = 50, standard deviation = 10)

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Acknowledgements

We thank all patients who participated in this study, and the German Cancer Aid for funding the study.

Funding

This study was supported by the German Cancer Aid (Grant Number: 7011 2267).

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Authors and Affiliations

  1. Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany

    Michael Friedrich, Andreas Hinz & Susanne Kuhnt

  2. Rehabilitation Clinic Bad Oexen, Bad Oeynhausen, Germany

    Thomas Schulte

  3. Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

    Matthias Rose & Felix Fischer

  4. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    Matthias Rose

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  1. Michael Friedrich
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Correspondence to Michael Friedrich.

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Friedrich, M., Hinz, A., Kuhnt, S. et al. Measuring fatigue in cancer patients: a common metric for six fatigue instruments. Qual Life Res 28, 1615–1626 (2019). https://doi.org/10.1007/s11136-019-02147-3

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