Deriving clinically meaningful cut-scores for fatigue in a cohort of breast cancer survivors: a Health, Eating, Activity, and Lifestyle (HEAL) Study
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- Stover, A.M., Reeve, B.B., Piper, B.F. et al. Qual Life Res (2013) 22: 2279. doi:10.1007/s11136-013-0360-6
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To empirically determine clinically meaningful cut-scores on the 0–10 response scale of the revised Piper Fatigue Scale (PFS-R) and its shorter version (PFS-12). Breast cancer survivors were classified (i.e., none, mild, moderate, or severe fatigue) based on the cut-scores, and relationships between these cut-scores and decrements in health-related quality of life (HRQOL) were examined.
A total of 857 breast cancer survivors, stages in situ-IIIa, from the Health, Eating, Activity, and Lifestyle (HEAL) Study were eligible. Survivors completed the PFS-R, SF-36, and a sexual health scale approximately 3 years after diagnosis. Multivariate analysis of covariance was used to examine five fatigue severity cut-score models, controlling for demographics, clinical characteristics, comorbidity, and antidepressant use. Multivariate regression was used to examine HRQOL decrements by cut-score category.
Analyses supported two similar fatigue severity cut-score models for the PFS-R and PFS-12: ModelA.) none (0), mild (1–3), moderate (4–6), and severe (7–10); and ModelD.) none (0), mild (1–2), moderate (3–5), and severe (6–10). For every threshold increase in fatigue severity, clinically meaningful decrements in physical, mental, and sexual health scores were observed, supporting construct validity of the fatigue cut-scores.
Standardized fatigue cut-scores may enhance interpretability and comparability across studies and populations and guide treating planning.
KeywordsCancer-related fatigue Breast cancer survivors Measurement Piper Fatigue Scale Health-related quality of life
Body mass index
Cancer inventory for problem situations
Health, Eating, Activity, and Lifestyle Study
Health-related quality of life
Multivariate analysis of covariance
Mental Component Score for the SF-36
Physical Component Score for the SF-36
Piper Fatigue Scale-Revised
Piper Fatigue Scale-12
Surveillance, epidemiology, and end results (cancer registries)
Medical Outcomes Study Short Form-36