Supportive Care in Cancer

, Volume 21, Issue 2, pp 413–419 | Cite as

Cancer-related fatigue in Italian cancer patients: validation of the Italian version of the Brief Fatigue Inventory (BFI)

  • Gianluca Catania
  • Carol Bell
  • Simona Ottonelli
  • Monia Marchetti
  • Jane Bryce
  • Alberto Grossi
  • Massimo Costantini
Original Article



Cancer-related fatigue (CRF) is one of the most common symptoms experienced by cancer patients (CPs). The Brief Fatigue Inventory (BFI) is a reliable instrument to assess CRF in CPs. The aim of this study was to evaluate the psychometric properties of the Italian version of the BFI (BFI-I).


The BFI-I was developed by using the forward–backward translation approach. The psychometric properties of the BFI-I were assessed in terms of acceptability, internal consistency, and validity. Outpatient CPs filled in BFI-I along with the Medical Outcome Study Quality of Life Short Form 36 (SF36). Demographic and health data were collected.


The BFI-I had an overall Cronbach alpha for the nine items of 0.94. The inter-item mean correlation was 0.64, and coefficients ranged from 0.47 to 0.81 for the nine items. The results of the factor analysis suggested a 1-factor solution explaining 68 % of the variance, supporting the hypothesis of unidimensionality of the BFI-I. The BFI-I score was compared to SF36 subscales score to evaluate concurrent validity. An expected inverse correlation between the BFI-I and the vitality subscale of the SF36 was observed (r = −0.67, 95 % confidence interval −0.73 to −0.59). The correlation with the other subscales of the SF36 ranged between −0.56 and −0.13. Discriminant validity analysis showed the BFI-I mean score significantly increased with increasing Eastern Cooperative Oncology Group values (p < 0.001).


BFI-I is a clinical instrument with satisfactory psychometric properties to assess CRF in Italian CPs.


Validation study Fatigue Neoplasm Symptom Assessment 


Conflict of interest

The authors have declared that no conflict of interest exists. The authors have full control of all primary data and agree to allow the Supportive Care in Cancer journal to review their data if requested.


  1. 1.
    National Comprehensive Cancer Network (NCCN) (2012) Clinical practice guidelines in oncology. Cancer-related fatigue. Accessed 09 May 2012
  2. 2.
    Laird BJ, Scott AC, Colvin LA, McKeon AL, Murray GD, Fearon KC, Fallon MT (2011) Pain, depression, and fatigue as a symptom cluster in advanced cancer. J Pain Symptom Manage 42(1):1–11PubMedCrossRefGoogle Scholar
  3. 3.
    Minton O, Stone P (2009) A systematic review of the scales used for the measurement of cancer-related fatigue (CRF). Ann Oncol 20(1):17–25PubMedCrossRefGoogle Scholar
  4. 4.
    Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR (2007) Cancer-related fatigue: the scale of the problem. Oncologist 12(Suppl 1):4–10PubMedCrossRefGoogle Scholar
  5. 5.
    Singer S, Kuhnt S, Zwerenz R, Eckert K, Hofmeister D, Dietz A, Giesinger J, Hauss J, Papsdorf K, Briest S, Brown A (2011) Age and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients. Br J Cancer 105(3):445–451PubMedCrossRefGoogle Scholar
  6. 6.
    Wang XS (2008) Pathophysiology of cancer-related fatigue. Clin J Oncol Nurs 12(Suppl 5):11–20PubMedCrossRefGoogle Scholar
  7. 7.
    Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH, Miaskowski C, Scherr SL, Portenoy RK, Vogelzang NJ (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist 5(5):353–360PubMedCrossRefGoogle Scholar
  8. 8.
    Potter J (2004) Fatigue experience in advanced cancer: a phenomenological approach. Int J Palliat Nurs 10(1):15–23PubMedGoogle Scholar
  9. 9.
    Barsevick A, Frost M, Zwinderman A, Hall P, Halyard M, GENEQOL Consortium (2010) I'm so tired: biological and genetic mechanisms of cancer-related fatigue. Qual Life Res 10:1419–1427CrossRefGoogle Scholar
  10. 10.
    Radbruch L, Strasser F, Elsner F, Gonçalves JF, Løge J, Kaasa S, Nauck F, Stone P, Research Steering Committee of the European Association for Palliative Care (EAPC) (2008) Fatigue in palliative care patients—an EAPC approach. Palliat Med 22(1):13–32PubMedCrossRefGoogle Scholar
  11. 11.
    Borneman T, Koczywas M, Sun VC, Piper BF, Uman G, Ferrell B (2010) Reducing patient barriers to pain and fatigue management. J Pain Symptom Manage 39(3):486–501PubMedCrossRefGoogle Scholar
  12. 12.
    Borneman T, Piper BF, Sun VC, Koczywas M, Uman G, Ferrell B (2007) Implementing the fatigue guidelines at one NCCN member institution: process and outcomes. J Natl Compr Canc Netw 5(10):1092–1101PubMedGoogle Scholar
  13. 13.
    Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, Huber SL (1999) The rapid assessment of fatigue severity in cancer patients. Cancer 85(5):1186–1196PubMedCrossRefGoogle Scholar
  14. 14.
    Yun YH, Wang XS, Lee JS, Roh JW, Lee CG, Lee WS, Lee KS, Bang SM, Mendoza TR, Cleeland CS (2005) Validation study of the Korean version of the brief fatigue inventory. J Pain Symptom Manage 29(2):165–172PubMedCrossRefGoogle Scholar
  15. 15.
    Lin CC, Chang AP, Chen ML, Cleeland CS, Mendoza TR, Wang XS (2006) Validation of the Taiwanese version of the Brief Fatigue Inventory. J Pain Symptom Manage 32(1):52–59PubMedCrossRefGoogle Scholar
  16. 16.
    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(2):106–117PubMedCrossRefGoogle Scholar
  17. 17.
    Mystakidou K, Tsilika E, Parpa E, Mendoza TR, Pistevou-Gombaki K, Vlahos L, Cleeland CS (2008) Psychometric properties of the brief fatigue inventory in Greek patients with advanced cancer. J Pain Symptom Manage 36(4):367–373PubMedCrossRefGoogle Scholar
  18. 18.
    Radbruch L, Sabatowski R, Elsner F, Everts J, Mendoza T, Cleeland C (2003) Validation of the German version of the Brief Fatigue Inventory. J Pain Symptom Manage 25(5):449–458PubMedCrossRefGoogle Scholar
  19. 19.
    Mendoza TR, Laudico AV, Wang XS, Guo H, Matsuda ML, Yosuico VD, Fragante EP, Cleeland CS (2010) Assessment of fatigue in cancer patients and community dwellers: validation study of the Filipino version of the Brief Fatigue Inventory. Oncology 79(1–2):112–117PubMedCrossRefGoogle Scholar
  20. 20.
    Apolone G, Mosconi P (1998) The Italian SF-36 health survey: translation, validation and norming. J Clin Epidemiol 51(11):1025–1036PubMedCrossRefGoogle Scholar
  21. 21.
    Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 5(6):649–655PubMedCrossRefGoogle Scholar
  22. 22.
    Dewolf L, Koller M, Velikova G, Johnson C, Scott N, Bottomley A, for EORTC Quality of life group: EORTC quality of life group translation procedure (2009) Third Editon Copyright EORTC Brussels. Accessed 09 May 2012
  23. 23.
    Fitzpatrick R, Davey C, Buxton MJ, Jones DR (1998) Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 2(14):1–74PubMedGoogle Scholar
  24. 24.
    Streiner DL, Norman GR (2008) Basic concepts. In: Streiner DL, Norman GR (eds) Health measurement scales, 4th edn. Oxford University Press, New York, pp 4–13CrossRefGoogle Scholar
  25. 25.
    Seyidova-Khoshknabi D, Davis MP, Walsh D (2011) A systematic review of cancer-related fatigue measurement questionnaires. Am J Hosp Palliat Care 28(2):119–129PubMedCrossRefGoogle Scholar
  26. 26.
    Borneman T, Koczywas M, Sun V, Piper BF, Smith-Idell C, Laroya B, Uman G, Ferrell B (2011) Effectiveness of a clinical intervention to eliminate barriers to pain and fatigue management in oncology. J Palliat Med 14(2):197–205PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Gianluca Catania
    • 1
  • Carol Bell
    • 2
  • Simona Ottonelli
    • 1
  • Monia Marchetti
    • 3
  • Jane Bryce
    • 4
  • Alberto Grossi
    • 5
  • Massimo Costantini
    • 1
  1. 1.U.O. Regional Palliative Care Network, IRCCS A.O.U. San Martino–IST Istituto Nazionale per la Ricerca sul CancroGenoaItaly
  2. 2.Stanford Comprehensive Cancer CenterStanfordUSA
  3. 3.Hematology UnitOspedale C. MassaiaAstiItaly
  4. 4.Clinical Trials Unit, National Cancer InstituteFondazione PascaleNaplesItaly
  5. 5.Hematology UnitIstituto Fiorentino di Cura e Assistenza (IFCA)FlorenceItaly

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