Measurement of fatigue in cancer, stroke, and HIV using the Functional Assessment of Chronic Illness Therapy — Fatigue (FACIT-F) scale
Introduction
Fatigue is the most prevalent symptom among individuals with cancer and may be due to the disease itself, its treatment, and/or psychosocial variables [1]. Depending on the patient population and means of measuring fatigue, prevalence estimates among cancer patients are generally high, ranging from 60 to over 90% [1]. Patients may describe their experience of fatigue in terms of being exhausted, tired, weak, or slowed. Furthermore, in a large sample of patients with advanced cancer who have received chemotherapy, fatigue was spontaneously endorsed and ranked as the most important symptom that should be monitored [2]. Although common, cancer-related fatigue remains poorly understood [3]. In clinical practice, fatigue may be neglected or under-detected due to the fact that it is a subjective experience that is assessed by patient self-report. Treatment of cancer-related fatigue is further complicated by its multifactorial clinical manifestations, involving both psychological and physical components.
Stroke is the leading cause of disability in adults and often results in reduced functional status, impaired psychological well-being, and economic hardship [4]. Persistent fatigue is a common symptom following stroke [5], with prevalence estimates ranging from 23 to 75%, likely reflecting variations in measurement and sampling approaches [5], [6]. The frequency of self-reported fatigue is roughly twice as high in patients post stroke as it is in matched controls, and 27% of stroke survivors experience fatigue every day [7]. Little research has focused on how best to measure post-stroke fatigue quantitatively.
People with HIV infection have reported fatigue as one of their most frequent complaints, regardless of how advanced their HIV infection or their use of Highly Active Antiretroviral Therapy [8]. For example, a study of 317 men and women who had been diagnosed with HIV for several years found that the three most frequently reported symptoms, using the Memorial Symptom Assessment Scale, were all fatigue-related: “lack of energy” (65%); “feeling drowsy” (57%); and “difficulty sleeping” (56%) [9]. Furthermore, fatigue has been shown to affect the physical, social, familial, and psychological aspects of the lives of individuals with HIV [10]. Women and older persons with HIV infection have reported more fatigue than men and younger persons with HIV [11]. Despite the prevalence and impact of fatigue in the lives of people with HIV, family and physicians often do not acknowledge fatigue as a significant concern [12].
Fatigue may develop for different reasons in cancer, stroke, and HIV. However, given the importance of fatigue across these three chronic conditions, we sought to assess the measurement properties of a single, well-described fatigue scale in these populations. We hypothesized that the psychometric of the Functional Assessment of Chronic Illness Therapy — Fatigue subscale [13] would be favorable and that the scale could serve as a useful indicator of fatigue in clinical research across these populations.
Section snippets
Assessment of fatigue
All participants completed the Functional Assessment of Chronic Illness Therapy — Fatigue (FACIT-F) subscale [13]. The FACIT-F is a unidimensional [14], 13-item scale that asks respondents to rate statements regarding their fatigue experience and its impact on their daily life. Sample items include: “I feel fatigued”, “I feel weak all over”, and “I feel listless (washed out)”. All items are rated using a 5-point intensity rating scale. By scoring convention, after appropriate reverse scoring of
Results
Sociodemographic and clinical descriptions of the samples can be found in Appendix A. Patients with cancer, stroke, and HIV were all middle-aged or older. There was variability in the gender distribution within the samples, with HIV patients more likely to be male. Most participants were Caucasian (50–82.5%), with the second largest group being African-Americans (9.4–43.1%).
Most cancer patients had breast (34%) or colorectal (12.5%) cancer, with nearly equal numbers of patients with stage III
Discussion
Fatigue is a common concern for patients with a variety of chronic illnesses. Having a common metric that can be used across clinical studies has the potential advantage of increasing comparability across studies, while improving our understanding of mechanisms and potential interventions for this symptom. As an initial step towards that goal, we tested the reliability and validity of fatigue, as measured by the FACIT-Fatigue scale in samples of patients with cancer, HIV, and stroke. Our
Conflict of interest statement
The authors have no competing interests to report.
Acknowledgments
Deepa Rao's contribution is supported by NIH grant # K23 MH 084551.
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