Supportive Care in Cancer

, Volume 15, Issue 7, pp 891–896 | Cite as

Assessment of clinical relevant fatigue level in cancer

  • Yoon Jung Chang
  • Jung Suk Lee
  • Chang Geol Lee
  • Won Sup Lee
  • Keun Seok Lee
  • Soo-Mee Bang
  • Xin Shelley Wang
  • Tito R. Mendoza
  • Charles S. Cleeland
  • Young Ho Yun
Original Article


Goals of work

Fatigue is highly prevalent in cancer and greatly inferences with daily life. The goal of this study was to identify the most informative score in the Brief Fatigue Inventory and to define cut points for “mild,” “moderate,” and “severe” fatigue based on their relevance to quality of life (QOL).

Patients and methods

We surveyed cancer patients at five hospitals in Korea with self-administrated questionnaires. The patients were older than 18 years, have a histological diagnosis of malignancy, gave informed consent to participate, and were able to understand the questionnaires. We analyzed 150 cancer patients who reported fatigue.

Main result

“Usual fatigue” was a sensitive and reliable indicator of fatigue severity and was defined as mild (1–3), moderate (4–7), or severe (8–10) because it had the strongest correlation with the functional interference, symptoms, depression, and QOL.


These cutpoints might be useful in clinical evaluation of fatigue in cancer. Our findings suggest a simple technique for the rapid screening of fatigue and for evaluating its impact on the symptoms and daily functioning of cancer patients.


Fatigue severity Cancer fatigue Functional interference 


  1. 1.
    Diane I, Leslie V, Jahe EG et al (1994) The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. Cancer Nurs 17:367–378Google Scholar
  2. 2.
    Respini D, Jacobsen PB, Thors C, Tralongo P, Balducci L (2003) The prevalence and correlates of fatigue in older cancer patients. Crit Rev Oncol/Hematol 47:273–279CrossRefGoogle Scholar
  3. 3.
    Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer fatigue forum. Ann Oncol 11:971–975PubMedCrossRefGoogle Scholar
  4. 4.
    Richardson A (1995) Fatigue in cancer patients: a review of the literature. Eur J Cancer Care 4:20–32Google Scholar
  5. 5.
    Vogelzang N, Breitbart W, Cella D et al (1997) Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tri-part assessment survey. Semin Hematol 34:4–12PubMedGoogle Scholar
  6. 6.
    Vainio A, Auvinen A (1996) Prevalence of symptoms among patients with advanced cancer: an international collaborative study. Symptom prevalence group. J Pain Symptom Manage 12:3–10PubMedCrossRefGoogle Scholar
  7. 7.
    Blesch KS, Paice JA, Wickham R et al (1991) Correlates of fatigue in people with breast or lung cancer. Oncol Nurs Forum 18:81–87PubMedGoogle Scholar
  8. 8.
    Okuyama T, Wang XS, Akechi T, Mendoza TR, Hosaka T, Cleeland CS, Uchitomi Y (2003) Validation study of the Japanese version of the Brief Fatigue Inventory. J Pain Symptom Manage 25:106–117PubMedCrossRefGoogle Scholar
  9. 9.
    Hwang SS, Chang VT, Cogswell J, Kasimis BS (2002) Clinical relevance of fatigue levels in cancer patients at a veterans administration medical center. Cancer 94:2481–2489PubMedCrossRefGoogle Scholar
  10. 10.
    Irvine D, Vincent L, Graydon JE et al (1994) The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy: A comparison with the fatigue experienced by healthy individuals. Cancer Nurs 17:367–378PubMedCrossRefGoogle Scholar
  11. 11.
    Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS (1995) When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61:277–287PubMedCrossRefGoogle Scholar
  12. 12.
    Yun YH, Wang XS, Lee JS et al (2005) Validation study of the Korean version of the Brief Fatigue Inventory. J Pain Symptom Manage 29:165–172PubMedCrossRefGoogle Scholar
  13. 13.
    Wang XS, Hao XS, Wang Y et al (2004) Validation study of the Chinese version of the Brief Fatigue Inventory (BFI-C). J Pain Symptom Manage 27:322–332PubMedCrossRefGoogle Scholar
  14. 14.
    Morrow GR, Andrews PLR, Hickok JT, Roscoe JA, Matteson S (2002) Fatigue associated with cancer and its treatment. Support Care Cancer 10:389–398PubMedCrossRefGoogle Scholar
  15. 15.
    Lesage P, Portenoy R (2002) Management of fatigue in the cancer patient. Oncology 16:373–389PubMedGoogle Scholar
  16. 16.
    DeVita VT, Hellman S, Rosenberg SA (eds) (2005) Clinical oncology, 3rd edn. Williams & Wilkins, PhiladelphiaGoogle Scholar
  17. 17.
    Mendoza TR, Wang XS, Cleeland CS et al (1999) The rapid assessment of fatigue severity in cancer patients. Cancer 85:1186–1196PubMedCrossRefGoogle Scholar
  18. 18.
    Aaronson NK, Ahmedzai S, Dergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedCrossRefGoogle Scholar
  19. 19.
    Yun YH, Park YS, Lee ES et al (2004) Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res 13:863–868PubMedCrossRefGoogle Scholar
  20. 20.
    Bech P (1981) Rating scales for affective disorders: Their validity and consistency. Acta Psychiatr Scand Suppl 295:1–101PubMedGoogle Scholar
  21. 21.
    Hahn HM, Yum TH, Shin YH et al (1986) A standardization study of Beck Depression Inventory in Korea. Journal of Korean Neuropsychiatric Association 25:487–502Google Scholar
  22. 22.
    Cleeland CS, Mendoza TR, Wang XS et al (2000) Assessing symptom distress in cancer: The M.D. Anderson Symptom Inventory. Cancer 89:1634–1646PubMedCrossRefGoogle Scholar
  23. 23.
    Yun YH, Mendoza TR, Kang IO et al (2006) Validation study of the Korean version of the M. D. Anderson Symptom Inventory. J Pain Symptom Manage 31(4):345–352PubMedCrossRefGoogle Scholar
  24. 24.
    National Comprehensive Cancer Network (2006) Cancer-related fatigue. Available from: URL: /fatigue.pdf

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Yoon Jung Chang
    • 1
  • Jung Suk Lee
    • 2
  • Chang Geol Lee
    • 3
  • Won Sup Lee
    • 4
  • Keun Seok Lee
    • 5
  • Soo-Mee Bang
    • 6
  • Xin Shelley Wang
    • 7
  • Tito R. Mendoza
    • 7
  • Charles S. Cleeland
    • 7
  • Young Ho Yun
    • 2
  1. 1.Research Institute for National Cancer Control and EvaluationNational Cancer CenterGoyangSouth Korea
  2. 2.Chief, Quality of Cancer Care Branch, Research Institute for National Cancer Control and Evaluation and HospitalNational Cancer CenterGoyangSouth Korea
  3. 3.Yonsei Cancer Center, Department of Radiation OncologyYonsei University College of MedicineSeoulSouth Korea
  4. 4.Department of Internal MedicineGyeong-Sang National University HospitalJinjuSouth Korea
  5. 5.Breast Cancer Branch, Research Institute and HospitalNational Cancer CenterGoyangSouth Korea
  6. 6.Department of Internal Medicine, Gachon Medical SchoolGhil Medical CenterIncheonSouth Korea
  7. 7.M. D. Anderson Cancer Center, Department of Symptom ResearchUniversity of TexasHoustonUSA

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