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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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
- 3.Scott, J. A., Lasch, K., Barsevick, A., & Piault-Louis, E. (2011). Patient-reported outcomes of fatigue consortium (PROOF-C). Patients’ experiences with cancer-related fatigue: A systematic review and synthesis of qualitative research. Oncology Nursing Forum, 38, E191–E203.PubMedCrossRefGoogle Scholar
- 5.Mitchell, S. (2010). Cancer-related fatigue: State of the science. Physical Medicine and Rehabilitation, 2, 364–383.Google Scholar
- 10.The Cancer-Related Fatigue Guidelines (Version 4.2007) in The Complete Library of NCCN Clinical Practice Guidelines in Oncology [CD-ROM] Jenkintown, Pennsylvania: © 2006 National Comprehensive Cancer Network, Inc.; Mar, 2008. To view the most recent and complete version of the guideline, go to www.nccn.org.
- 12.Mitchell, S. A., Beck, S. L., & Eaton, L. H. (2009). ONS putting evidence into practice (PEP): fatigue. In L. H. Eaton & J. M. Tipton (Eds.), Putting evidence into practice. Pittsburgh: Oncology Nursing Society.Google Scholar
- 13.Cella, D., Davis, K., Breitbart, W., Curt, G., for the Fatigue Coalition. (2001). Cancer-related fatigue: Prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. Journal of Clinical Oncology, 19, 3385–3391.Google Scholar
- 25.Cullum, J. L., Wojciechowski, A. E., & Simpson, J. S. A. (2004). Bupropion sustained release treatment reduces fatigue in cancer patients. Canadian Journal of Psychiatry, 49, 139–144.Google Scholar
- 27.Jean-Pierre, P., Morrow, G. R., Roscoe, J. A., Heckler, C., Mohile, S., Janelsins, M., et al. (2010). A phase 3 randomized, placebo-controlled, doubleblind, clinical trial of the effect of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy: A University of Rochester cancer center community clinical oncology program research base study. Cancer, 116, 3513–3520.PubMedCrossRefGoogle Scholar
- 29.Nering, M. L., & Ostini, R. (Eds.). (2010). Handbook of polytomous item response theory models. New York, NY: Routledge.Google Scholar
- 34.Fobair, P., & Spiegel, D. (2010). Concerns about sexuality after breast cancer. In V. T. Devita, T. S. Lawrence, & S. A. Rosenberg (Eds.), Cancer principles and practice of oncology: Annual advances in oncology (pp. 7–14). Philadelphia, PA: Lippincott Williams & Wilkins.Google Scholar
- 36.Rubin, P. (2001). Clinical oncology: A multidisciplinary approach for physicians and students (8th ed.). Philadelphia: W. B. Saunders Company.Google Scholar
- 43.Bjorner, J. B., Wallenstein, G. V., Martin, M. C., Lin, P., Piech Blaisdell-Gross, C. T., et al. (2007). Interpreting score differences in the SF-36 Vitality scale: Using clinical conditions and functional outcomes to define the minimally important difference. Current Medical Research and Opinions, 23, 731–739.CrossRefGoogle Scholar
- 50.Davies, N., Gibbons, E., Mackintosh, A., Fitzpatrick, R. On behalf of the Oxford Patient-Reported Outcomes Measurement Group (2009). A structured review of patient-reported outcome measures (PROMs) for women with breast cancer. Oxford: University of Oxford.Google Scholar
- 55.Day, R., Ganz, P. A., Costantino, J. P., Cronin, W. M., Wickerman, D. L., & Fisher, B. (1999). Health-related quality of life and tamoxifen in breast cancer prevention: A report from the national surgical adjuvant breast and bowel project P-1 study. Journal of Clinical Oncology, 17, 2659–2669.PubMedGoogle Scholar
- 57.Lin, N. U., Vanderplas, A., Hughes, M. E., Theriault, R. L., Edge, S. B., Wong, Y.-N., et al. (2012). Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the national comprehensive cancer network. Cancer, 118, 5463–5472.PubMedCrossRefGoogle Scholar
- 59.Anderson, W. F., Chu, K. C., Chatterjee, N., Brawley, O., & Brinton, L. A. (2001). Tumor variants by hormone receptor expression in white patients with node-negative breast cancer from the surveillance, epidemiology, and end results database. Journal of Clinical Oncology, 19, 18–27.PubMedGoogle Scholar