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Instruments for determining clinically relevant fatigue in breast cancer patients during radiotherapy

  • Fundagul AndicEmail author
  • Andrew H. Miller
  • Gabrielle Brown
  • Lena Chu
  • Jolinta Lin
  • Tian Liu
  • Yasar Sertdemir
  • Mylin A. Torres
Original Article

Abstract

Background

This study aimed to determine radiotherapy (RT)-related changes in cancer-related fatigue (CRF), using Multidimensional Fatigue Inventory-20 (MFI-20), and fatigue-intensity rating (FIR) instruments at three different timepoints and to identify the optimal thresholds of MFI-20 scores which would correlate with moderate-to-severe fatigue warranting an intervention in breast cancer patients treated with RT.

Methods

Eighty-eight breast cancer patients treated with surgery followed by RT were included in the study. CRF was assessed with both FIR and MFI-20 tools at three different timepoints: within the week prior to RT (pre-RT), last week of RT, and 6 weeks after RT completion (post-RT). Changes in measurements, correlations between measurements and optimal cutpoints of MFI-20 scores were analyzed.

Results

While FIR scores significantly changed over time (η2: 0.179), changes in MFI-20 scores were relatively small (η2: 0.076). Comparisons of the last week of RT versus post-RT scores showed small-to-moderate decrease for MFI-20 and FIR. FIR and MFI-20 scores were correlated at all timepoints and most correlated during and after RT (r = 0.525 95%CI 0.346–0.667, r = 0.791 95%CI 0.692–0.860 and r = 0.716 95%CI 0.589–0.808, respectively). Furthermore, the most correlated MFI-20 subscale with FIR was general fatigue (r = 0.603 95%CI 0.442–0.725, r = 0.821 95%CI 0.734–0.881 and r = 0.754 95%CI 0.641–0.835, respectively). Optimal cutpoints of the MFI-20 total scores corresponding to FIR scores ≥ 4 was 43.5 for all timepoints and the MFI total scores corresponding to FIR score ≥ 7 were 53.5, 52.5 and 60.5, respectively.

Conclusions

MFI-20 and FIR scores are highly correlated measures of CRF among breast cancer patients treated with RT. An MFI-20 score of ≥ 43.5 is suggested as a clinically significant score indicating moderate-to-severe fatigue, while an MFI score of ≥ 52.5 is indicative of severe fatigue.

Keywords

Cancer-related fatigue Multidimensional fatigue inventory Fatigue-intensity rating Breast cancer Radiotherapy 

Notes

Funding

This work was supported by National Institutes of Health, National Cancer Institute Grants R21CA155511, R03CA173770, R03CA183006, and P30CA138292. A seed Grant was also provided by the Radiation Therapy Oncology Group Community Clinical Oncology and Symptom Management Group. Funding was also provided by the Fred Cooper Family Foundation Breast Cancer Initiative and Robbins Scholar Award from the Winship Cancer Institute of Emory University.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no potential conflict of interest.

Ethical approval

All procedures performed in our study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    National Comprehensive Cancer Network (NCCN): Clinical practice guidelines in oncology: cancer-related fatigue. https://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf (2019). Last updated 12 Mar 2019.
  2. 2.
    Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the US. Support Care Cancer. 2008;16:791–801.CrossRefGoogle Scholar
  3. 3.
    Cella D, Davis K, Breitbart W, Curt G, Fatigue Coalition. Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol. 2001;19:3385–91.CrossRefGoogle Scholar
  4. 4.
    Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, et al. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer. 2006;106:751–8.CrossRefGoogle Scholar
  5. 5.
    Smets EM, Visser MR, Willems-Groot AF, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue and radiotherapy: (B) experience in patients 9 months following treatment. Br J Cancer. 1998;78:907–12.CrossRefGoogle Scholar
  6. 6.
    Broeckel JA, Jacobsen PB, Horton J, Balducci L, Lyman GH. Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. J Clin Oncol. 1998;16:1689–96.CrossRefGoogle Scholar
  7. 7.
    Browall M, Ahlberg K, Karlsson P, Danielson E, Persson LO, Gaston-Johansson F. Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal women. Eur J Oncol Nurs. 2008;12:180–9.CrossRefGoogle Scholar
  8. 8.
    Dow KH, Ferrell BR, Leigh S, Ly J, Gulasekaram P. An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Res Treat. 1996;39:261–73.CrossRefGoogle Scholar
  9. 9.
    Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer. 1999;85:1186–96.CrossRefGoogle Scholar
  10. 10.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.CrossRefGoogle Scholar
  11. 11.
    Geinitz H, Zimmermann FB, Thamm R, Keller M, Busch R, Molls M. Fatigue in patients with adjuvant radiation therapy for breast cancer: long-term follow-up. J Cancer Res Clin Oncol. 2004;130:327–33.CrossRefGoogle Scholar
  12. 12.
    de Souza Fêde AB, Bensi CG, Trufelli DC, de Oliveira Campos MP, Pecoroni PG, Ranzatti RP, et al. Multivitamins do not improve radiation therapy-related fatigue: results of a double-blind randomized crossover trial. Am J Clin Oncol. 2007;30:432–6.CrossRefGoogle Scholar
  13. 13.
    Biswal BM, Kumaraswamy N, Mukhtar F. Prevalence of fatigue among cancer patients undergoing external radiotherapy. Southeast Asian J Trop Med Public Health. 2004;35:463–7.Google Scholar
  14. 14.
    Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39:315–25.CrossRefGoogle Scholar
  15. 15.
    Smets EM, Garssen B, Cull A, de Haes JC. Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. Br J Cancer. 1996;73:241–5.CrossRefGoogle Scholar
  16. 16.
    Purcell A, Fleming J, Bennett S, Burmeister B, Haines T. Determining the minimal clinically important difference criteria for the Multidimensional Fatigue Inventory in a radiotherapy population. Support Care Cancer. 2010;18:307–15.CrossRefGoogle Scholar
  17. 17.
    Meek PM, Nail LM, Barsevick A, Schwartz AL, Stephen S, Whitmer K, et al. Psychometric testing of fatigue instruments for use with cancer patients. Nurs Res. 2000;49:181–90.CrossRefGoogle Scholar
  18. 18.
    Lin JM, Brimmer DJ, Maloney EM, Nyarko E, Belue R, Reeves WC. Further validation of the Multidimensional Fatigue Inventory in a US adult population sample. Popul Health Metr. 2009;7:18.  https://doi.org/10.1186/1478-7954-7-18.CrossRefGoogle Scholar
  19. 19.
    Morris SB, DeShon RP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods. 2002;7:105–25.CrossRefGoogle Scholar
  20. 20.
    Unal I. Defining an optimal cut-point value in roc analysis: an alternative approach. Comput Math Methods Med. 2017;2017:3762651.  https://doi.org/10.1155/2017/3762651.CrossRefGoogle Scholar
  21. 21.
    Williams LA, Agarwal S, Bodurka DC, Saleeba AK, Sun CC, Cleeland CS. Capturing the patient’s experience: using qualitative methods to develop a measure of patient-reported symptom burden: an example from ovarian cancer. J Pain Symptom Manag. 2013;46:837–45.CrossRefGoogle Scholar
  22. 22.
    Hickok JT, Morrow GR, Roscoe JA, Mustian K, Okunieff P. Occurrence, severity, and longitudinal course of twelve common symptoms in 1129 consecutive patients during radiotherapy for cancer. J Pain Symptom Manag. 2005;30:433–42.CrossRefGoogle Scholar
  23. 23.
    Smets EM, Visser MR, Willems-Groot AF, Garssen B, Oldenburger F, van Tienhoven G, et al. Fatigue and radiotherapy: (A) experience in patients undergoing treatment. Br J Cancer. 1998;78:899–906.CrossRefGoogle Scholar
  24. 24.
    Hickok JT, Morrow GR, McDonald S, Bellg AJ. Frequency and correlates of fatigue in lung cancer patients receiving radiation therapy: implications for management. J Pain Symptom Manag. 1996;11:370–7.CrossRefGoogle Scholar
  25. 25.
    Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993;68:220–4.CrossRefGoogle Scholar
  26. 26.
    Wang XS, Zhao F, Fisch MJ, O’Mara AM, Cella D, Mendoza TR, et al. Prevalence and characteristics of moderate to severe fatigue: a multicenter study in cancer patients and survivors. Cancer. 2014;120:425–32.CrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2019

Authors and Affiliations

  1. 1.Department of Radiation Oncology, Faculty of Medicine, Balcali HospitalCukurova UniversityAdanaTurkey
  2. 2.Department of Psychiatry and Behavioral SciencesEmory UniversityAtlantaUSA
  3. 3.Department of Radiation Oncology Winship Cancer InstituteEmory UniversityAtlantaUSA
  4. 4.Department of Biostatistics, Faculty of MedicineCukurova UniversityAdanaTurkey

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