Supportive Care in Cancer

, Volume 13, Issue 4, pp 246–254 | Cite as

Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool

  • Simon Van BelleEmail author
  • Robert Paridaens
  • Georges Evers
  • Joseph Kerger
  • Dominique Bron
  • Jan Foubert
  • Gerrit Ponnet
  • Didier Vander Steichel
  • Christine Heremans
  • Dominique Rosillon
Original Article


The objective was to validate the use of the proposed International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) criteria for fatigue (P-ICD10) through comparison with the Functional Assessment of Cancer Therapy Fatigue (FACT-F) subscale and three visual analogue scale (VAS) qualities in cancer patients thought to be fatigued. Fatigue was assessed in 834 cancer patients at three clinical centres in Belgium, using P-ICD10, FACT-F, and VAS to assess: level of energy (VAS1), quality of life (VAS2), and ability to perform daily activities (VAS3). Of the 834 interviewed cancer patients, 54% were classified as fatigued by the P-ICD10 criteria. Internal consistency of P-ICD10 was very good (alpha coefficient 0.82). The principal component analysis corroborated good internal consistency with all variables included in the first component; a second component was used to identify psychological fatigue (concentration and short-term memory disabilities). An abridged set of screening tools based on the first three general symptoms of the P-ICD10 is proposed with 100% specificity and 86% specificity, respectively. There was a marked decrease in FACT-F and VAS1 scores in patients diagnosed as fatigued by the P-ICD10 (mean±SD, FACT-F 20±9 vs 39±8, VAS1 34±21 vs 61±21). A logistic regression model between P-ICD10 criteria diagnosis and FACT-F (VAS1) identified a score of 34 (61) on the FACT-F scale as a proposed cut-off point for the diagnosis of fatigue. The ICD-10 criteria can be recommended as a diagnostic tool, whereas the FACT-F scale and the level of energy 100-mm VAS assess the intensity of fatigue, and are more suitable for follow-up of cancer-related fatigue.


Fatigue Assessment Diagnosis Cancer 



The authors want to thank the nursing staff for their assistance in screening the patients.


  1. 1.
    Miaskowski C, Portenoy RK (1998) Update on the assessment and management of cancer related fatigue. In: Berger AM, Portenoy RK, Weissman DE (eds) Principles and practice of supportive oncology updates. Lippincott Williams & Wilkins, Philadelphia, pp 1–10Google Scholar
  2. 2.
    Irvine DM, Vincent L, Bubela N, Thompson L, Graydon J (1991) A critical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nurs 14:188–199PubMedGoogle Scholar
  3. 3.
    Vogelzang NJ, Breitbart W, Cella D, et al (1997) Patient, caregiver and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 34 [Suppl 2]:4–12Google Scholar
  4. 4.
    Detmar SB, Aaronson NK, Wever LD, Muller M, Schornagel JH (2000) How are you feeling? Who wants to know? Patients’ and oncologists’ preferences for discussing health-related quality-of-life issues. J Clin Oncol 18:3295–3301PubMedGoogle Scholar
  5. 5.
    Costantini M, Mencaglia E, Giulio PD, et al (2000) Cancer patients as ‘experts’ in defining quality of life domains. A multicentre survey by the Italian Group for the Evaluation of Outcomes in Oncology (IGEO). Qual Life Res 9:151–159CrossRefPubMedGoogle Scholar
  6. 6.
    Cella D, Lai JS, Chang CH, Peterman A, Slavin M (2002) Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 94:528–538CrossRefPubMedGoogle Scholar
  7. 7.
    Curt GA (2000) Impact of fatigue in quality of life in oncology patients. Semin Hematol 37 [Suppl 6]:14–17Google Scholar
  8. 8.
    Curt GA (2000) The impact of fatigue on patients with cancer: overview of FATIGUE 1 and 2. Oncologist 5 [Suppl 2]:9–12Google Scholar
  9. 9.
    Curt GA, Breitbart W, Cella D, et al (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 5:353–360CrossRefPubMedGoogle Scholar
  10. 10.
    Ahlberg K, Ekman T, Gaston-Johansson F, Mock V (2003) Assessment and management of cancer-related fatigue in adults. Lancet 362:640–650CrossRefPubMedGoogle Scholar
  11. 11.
    Gall H (1996) The basis of cancer fatigue: where does it come from? Eur J Cancer Care [Suppl] 5:31–34Google Scholar
  12. 12.
    Winningham ML, Nail LM, Burke MB, et al (1994) Fatigue and the cancer experience: the state of the knowledge. Oncol Nurs Forum 21:23–36PubMedGoogle Scholar
  13. 13.
    World Health Organization (1992) International statistical classification of diseases and related health problems, 1989 revision (pre-release draft, June 2003). World Health Organization, GenevaGoogle Scholar
  14. 14.
    National Cancer Institute (2004) Coping with cancer-fatigue (Fatigue PDQ(r) Guidelines). Accessed 20 April 2004Google Scholar
  15. 15.
    Portenoy RK, Miaskowski C (1998) Assessment and management of cancer-related fatigue. In: Berger AM, Portenoy RK, Weissman DE (eds) Principles and practice of supportive oncology. Lippincott-Williams & Wilkins, Philadelphia, pp 109–118Google Scholar
  16. 16.
    Cella D, Peterman A, Passik S, Jacobsen P, Breitbart W (1998) Progress toward guidelines for the management of fatigue. Oncology (Huntingt) 12:369–377Google Scholar
  17. 17.
    Centers for Disease Control (2003) International classification of diseases, 10th revision. Clinical modification (ICD-10-CM) (pre-release draft, June 2003). National Center for Heath Statistic. cm.htm. Accessed 9 September 2003Google Scholar
  18. 18.
    Portenoy RK, Itri LM (1999) Cancer-related fatigue: guidelines for evaluation and management. Oncologist 4:1–10PubMedGoogle Scholar
  19. 19.
    Cella DF, Tulsky DS, Gray G, et al (1993) The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579PubMedGoogle Scholar
  20. 20.
    Yellen S, Cella D, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms in the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 13:63–74CrossRefPubMedGoogle Scholar
  21. 21.
    Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334Google Scholar
  22. 22.
    Cella D (1998) Factors influencing quality of life in cancer patients: anemia and fatigue. Semin Oncol 25 [Suppl 7]:43–46Google Scholar
  23. 23.
    Stein KD, Tomlin RL, Cole BT (2001) Assessment and management of cancer-related fatigue? Home Health Consult 8:8–15Google Scholar
  24. 24.
    Miller M, Kearney N (2001) Nurses’ knowledge and attitudes towards cancer-related fatigue. Eur J Oncol Nurs 5:208–217; discussion 218–220CrossRefPubMedGoogle Scholar
  25. 25.
    Hwang SS, Chang VT, Kasimis BS (2003) A comparison of three fatigue measures in veterans with cancer. Cancer Invest 21:363–373CrossRefPubMedGoogle Scholar
  26. 26.
    Wu HS, McSweeney M (2001) Measurement of fatigue in people with cancer. Oncol Nurs Forum 28:1371–1386PubMedGoogle Scholar
  27. 27.
    Tchekmedyian NS, Kallich J, McDermott A, Fayers P, Erder MH (2000) The relationship between psychologic distress and cancer-related fatigue. Cancer 98:198–203CrossRefGoogle Scholar
  28. 28.
    Sadler IJ, Jacobsen PB, Booth-Jones M, et al (2002) Preliminary evaluation of a clinical syndrome approach to assessing cancer-related fatigue. J Pain Symptom Manage 23:406–416CrossRefPubMedGoogle Scholar
  29. 29.
    Mock V, Atkinson A, Barsevick A, et al (2000) NCCN practice guidelines for cancer-related fatigue. Oncology (Huntingt) 14:151–161Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Simon Van Belle
    • 1
    Email author
  • Robert Paridaens
    • 2
  • Georges Evers
    • 2
  • Joseph Kerger
    • 3
  • Dominique Bron
    • 4
  • Jan Foubert
    • 4
  • Gerrit Ponnet
    • 5
  • Didier Vander Steichel
    • 6
  • Christine Heremans
    • 7
  • Dominique Rosillon
    • 8
  1. 1.Medical OncologyUniversity Hospital GhentGentBelgium
  2. 2.University Hospital GasthuisbergLeuvenBelgium
  3. 3.Cliniques Universitaires Mont-GodinneU.C.L.BrusselsBelgium
  4. 4.University Hospital Jules BordetBrusselsBelgium
  5. 5.University Hospital VUBBrusselsBelgium
  6. 6.Féderation Belge contre le CancerBrusselsBelgium
  7. 7.Vlaamse Liga tegen KankerBrusselsBelgium
  8. 8.BiopharmaWavreBelgium

Personalised recommendations