Breast Cancer Research and Treatment

, Volume 136, Issue 1, pp 9–20

The Piper Fatigue Scale-12 (PFS-12): psychometric findings and item reduction in a cohort of breast cancer survivors

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


Brief, valid measures of fatigue, a prevalent and distressing cancer symptom, are needed for use in research. This study’s primary aim was to create a shortened version of the revised Piper Fatigue Scale (PFS-R) based on data from a diverse cohort of breast cancer survivors. A secondary aim was to determine whether the PFS captured multiple distinct aspects of fatigue (a multidimensional model) or a single overall fatigue factor (a unidimensional model). Breast cancer survivors (n = 799; stages in situ through IIIa; ages 29–86 years) were recruited through three SEER registries (New Mexico, Western Washington, and Los Angeles, CA) as part of the Health, Eating, Activity, and Lifestyle (HEAL) study. Fatigue was measured approximately 3 years post-diagnosis using the 22-item PFS-R that has four subscales (Behavior, Affect, Sensory, and Cognition). Confirmatory factor analysis was used to compare unidimensional and multidimensional models. Six criteria were used to make item selections to shorten the PFS-R: scale’s content validity, items’ relationship with fatigue, content redundancy, differential item functioning by race and/or education, scale reliability, and literacy demand. Factor analyses supported the original 4-factor structure. There was also evidence from the bi-factor model for a dominant underlying fatigue factor. Six items tested positive for differential item functioning between African-American and Caucasian survivors. Four additional items either showed poor association, local dependence, or content validity concerns. After removing these 10 items, the reliability of the PFS-12 subscales ranged from 0.87 to 0.89, compared to 0.90–0.94 prior to item removal. The newly developed PFS-12 can be used to assess fatigue in African-American and Caucasian breast cancer survivors and reduces response burden without compromising reliability or validity. This is the first study to determine PFS literacy demand and to compare PFS-R responses in African-Americans and Caucasian breast cancer survivors. Further testing in diverse populations is warranted.


Fatigue Breast cancer survivors Patient-reported outcomes Piper Fatigue Scale Psychometrics 


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Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Bryce B. Reeve
    • 1
    • 2
  • Angela M. Stover
    • 2
    • 3
  • Catherine M. Alfano
    • 4
  • Ashley Wilder Smith
    • 5
  • Rachel Ballard-Barbash
    • 5
  • Leslie Bernstein
    • 6
  • Anne McTiernan
    • 7
  • Kathy B. Baumgartner
    • 8
  • Barbara F. Piper
    • 9
  1. 1.Department of Health Policy & Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Office of Cancer Survivorship, Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  5. 5.Applied Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA
  6. 6.Division of Cancer Etiology, Department of Population SciencesBeckman Research Institute of the City of HopeDuarteUSA
  7. 7.Prevention CenterFred Hutchinson Cancer Research CenterSeattleUSA
  8. 8.Epidemiology and Population HealthUniversity of LouisvilleLouisvilleUSA
  9. 9.University of Arizona School of NursingScottsdaleUSA

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