One-item scale is valid for rapid screening of fatigue in thoracic oncology patients

Abstract

8078 Background: Although the NCCN recommends screening for fatigue with a one-item, 0–10 scale in clinical practice, little data exist to support the validity of this screening. This study investigates the validity of screening for fatigue with a one-item, 0–10 scale in a sample of thoracic oncology patients. Methods: One-hundred patients in a thoracic oncology clinic at a comprehensive cancer center were screened with a one-item, 0–10 scale for fatigue (“How would you rate your fatigue right now on a scale of 0–10, with ‘0’ being ‘no fatigue’ and ‘10’ being ‘the worst fatigue?’”) before a clinic visit. For convergent validity, participants completed two validated instruments for fatigue in people with cancer: Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-F) scale and the Fatigue Symptom Inventory (FSI). Participants responded to ten questions about their current functional abilities. Results: The one-item scale had a test-retest reliability of .93. The mean score was 3.26 (sd=2.82). The scale correlated with the FSI fatigue severity scale at 0.87 (p=.01) and negatively correlated with the FACIT-F at .73 (p=.01). These correlations are similar to the two validated instruments correlating with each other, -.85 (p=.01). Using NCCN-defined fatigue severity categories with cut-offs of 4 for moderate fatigue and 7 for severe fatigue, significant differences were found on measures of functioning: the FSI fatigue interference scale (p<.001), the FACIT-F functional well-being scale (p=.001), and reported abilities to walk one block (p=.033), walk two blocks (.001), and climb a flight of stairs (p=.011). To identify fatigue at least one standard deviation above the published mean on the FACIT-F, a cut-off score of 4 on the one-item scale had a sensitivity and specificity of .89 and .78. Conclusions: The one-item, 0–10 scale for fatigue has acceptable reliability and appears to have convergent validity with validated measures of fatigue in individuals with thoracic cancers. Analyses of functional impairment support the use of cut-off scores of 4 for moderate fatigue, requiring additional clinical assessment, and 7 for severe fatigue. No significant financial relationships to disclose.