Brief Fatigue Inventory Score Research Articles

The Effect of Expressive Art on Fatigue in Palliative Medicine Fellows (S715)

1.Identify qualities of fatigue in clinicians of palliative medicine.2.Describe benefits of expressive art and art therapy on fatigue.3.Identify the role of expressive art in fatigue for clinicians of palliative medicine. Physicians in palliative medicine are subject to fatigue. Many studies exist that look at the fatigue of patients, but little research is done for the clinicians who take care of them. There have been no studies addressing fatigue in fellows training in palliative medicine. Expressive art and art therapy are methods that have a positive effect on fatigue. To examine the effect of expressive art on fatigue in a group of palliative medicine fellows. Six palliative medicine fellows were recruited to participate in the study. The fellows participated in four 60-minute sessions over 4 weeks. The Brief Fatigue Inventory (BFI) and the Pittsburg Sleep Quality Index (PSQI) were administered prior to each of these sessions. Fellows participated in an expressive art activity during Sessions 1 and 3. The BFI was administered again immediately after. Differences in the BFI and PSQI scores were examined across the four sessions using a general linear model for repeated measures. The effect of expressive art on fatigue in Sessions 1 and 3 was examined using factorial repeated measures on evaluation time (2 [Session 1 and Session 3]) and intervention (2 levels: pre-session and post-session). Two-thirds of the pre-session PSQI scores were greater than five, associated with poor sleep quality. This was unchanged across the study period. Pre-session BFI scores were below seven, indicating moderately severe fatigue. This was unchanged across the study period. BFI scores showed a significant decrease in fatigue immediately following the art sessions (F 1, 5 = 26.96, p = 0.003). Expressive art had an immediate salutary effect on fellows’ fatigue.

Examination of the Association of Diet and Persistent Cancer-Related Fatigue: A Pilot Study

To examine associations between diet and persistent cancer-related fatigue (PCRF) in cancer survivors. A cross-sectional pilot study. A university cancer center in Michigan. 40 adult cancer survivors who were recruited from July 2007 to August 2008 and had completed all cancer treatments at least 12 weeks prior to recording their dietary intakes and fatigue severity. Participants' fatigue was assessed with the Brief Fatigue Inventory (BFI). Based on the BFI score, participants were placed into one of three fatigue levels: no fatigue, moderate fatigue, or severe fatigue. Dietary data were collected using a four-day food diary and analyzed using Nutrition Data System for Research software. Diet data were collected during the same week that fatigue was measured. Fatigue and dietary intake. Mean daily intake of whole grains, vegetables, and, in particular, green leafy vegetables and tomatoes were significantly higher in the nonfatigued group compared to fatigued cancer survivors. Also, cancer survivors reporting no fatigue had significantly higher intakes of certain anti-inflammatory and antioxidant nutrients. Increased consumption of whole grains, vegetables, and foods rich in certain anti-inflammatory nutrients was associated with decreased levels of PCRF. Additional rigorous studies are required to investigate possible mechanisms and causal relationships regarding the benefits of particular diets on PCRF. Nurses, as one of the main providers of care to cancer survivors, should continue to follow National Comprehensive Cancer Network recommendations until additional data on diet and fatigue are evaluated. Nurses should be aware of national guidelines for nutritional recommendations for treating cancer-related fatigue. In addition, nurses should ask about and record the cancer survivor's typical dietary intake. Referrals to registered dietitians, in accordance with national guidelines for cancer survivors, should be considered when advising a fatigued patient.

EEG for evaluation of “chemobrain.”

1076 Background: Cognitive impairment is a poorly understood and worrisome potential complication of adjuvant chemotherapy (CT). We sought to evaluate electroencephalography (EEG) as a means to measure neurophysiologic function in women receiving CT for early breast cancer. Methods: Women planning to undergo CT for operable breast cancer and age-similar controls were evaluated at baseline, during CT and at 1 year with neurophysiologic assessments. Testing included a brief fatigue inventory (BFI), brief mental fatigue assessment (BMF), Processing Speed Index (PSI) derived from Digit Symbol Coding and Symbol Search subtests of the Wechsler Adult Intelligence Scale, and a sustained elbow flexion physical task (PT). EEG recordings were obtained at rest and after the cognitive and physical tasks. Data were analyzed using repeated measures of analysis of variance. Results: Eight patient/control pairs completed baseline and on-treatment evaluations; 7 pairs also completed the 1 year assessment (1 pair withdrawn due to a second malignancy). Subjective mental fatigue measured by BMF is similar for patients and controls at baseline but BMF scores increase significantly during CT for patients relative to controls (p=0.033), recovering to no difference at one year. Differences in PSI are not observed between patients and controls or at the different time points. BFI scores are greater in patients at all 3 time points but endurance on the PT is no different from controls. During chemotherapy EEG total spectrum amplitudes in patients are greater than in controls at rest (p=0.05) and following both the cognitive (p<0.001) and physical (p<0.001) tasks. EEG activity prior to chemotherapy and at one year is not different between patients and controls. For patients but not controls EEG readings after the cognitive task demonstrate greater amplitude than pre-task readings during the time of CT treatment only (p=0.012) with a similar trend seen for the physical task (p=0.06). Conclusions: Patient-perceived mental and physical fatigue during chemotherapy correspond to significant changes in EEG brain activity patterns but not to cognitive testing or physical endurance testing. EEG may offer a sensitive means to measure alterations in brain function associated with CT.

‘Dead-tired’ – a novel MDT approach to fatigue management for patients with advanced disease

IntroductionFatigue is a common and distressing symptom for patients with malignant and non-malignant disease.1 The importance of specific training programmes for managing fatigue have been cited.2 The authors describe an...

Validation of a Four Item Fatigue Screen (FIFS) in Cancer-Related Fatigue (CRF) (708)

1.Assess the Four Item Fatigue Scale relative to the Brief Fatigue Inventory.2.Be able to see the relationship of the Four Item Fatigue Scale and the ICD-10 criterion for fatigue. Questionnaires for CRF are long & burdensome. A FIFS questionnaire was tested for content validity and sensitivity with the Brief Fatigue Inventory (BFI) and ICD10 criteria. Cancer patients completed BFI & FIFS in random order. FIFS included 4 questions: 1. Do you have fatigue:never, sometimes, usually, or always 2. On a scale of 0–10 (0: no fatigue 10: severe fatigue) how would you rate fatigue now 3. What is the level of your fatigue now: none, mild, moderate, severe 4. Is your fatigue over the last day: worse, the same, better. ICD10 criteria were completed by investigators. 1 week later, both tools were completed in opposite order. 65 patients were needed for 80% power for Pearson's correlation of 0.7. Bonferroni corrections were made for multiple variables; P < 0.0035 was significant. 65 completed ICD-10, BFI & FIFS days 1 & 7. Spearman correlation was 0.7 (0.52–0.88) day 1, 0.73 (0.55 0.91) day 7;0.59 (0.38–0.80) for change over time. BFI score correlated with ICD10-1, 3, 7, 10B.BFI regression analysis on day 7 correlated with ICD10-1, ICD10-7 & ICD10-10 (P = 0.024, 0.026, 0.045 respectively), these disappear when adjusted for BFI on day 1 (P = 0.10, 0.99, 0.12 respectively). For changes in BFI from day 1 to 7, only ICD10-5 criteria was significant (P = 0.019) & drops out of the model when adjusted for day 1. For FIFS, ICD10-7 (P = 0.003) & ICD10-10 (P = 0.04) were significant & persisted after adjustment for baseline FIFS scores. Several ICD10 factors were heavily represented (A, 1, 3, 8, B, C). FIFS & BFI correlated well in time & modestly over time. FIFS is valid for CRF. Certain ICD-10 items better predict fatigue severity.

Variation in Health-Related Quality of Life by ECOG Performance Status and Fatigue Among Patients with Chronic Lymphocytic Leukemia

Abstract 4591 Introduction:Clinicians and investigators appreciate the value of measuring HRQOL for monitoring CLL and the impact of treatments, and commonly use ECOG performance status (PS) and clinician-reported patient fatigue as surrogates for HRQOL in clinical practice. However, limited data exist on the relationships between PS, fatigue, and HRQOL in CLL patients (pts) undergoing treatment in clinical practices. We examined the associations between these measures and 3 psychometrically validated, patient-reported, HRQOL instruments: the Brief Fatigue Inventory (BFI), EQ-5D, and Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu). Methods:Data were collected as part of Connect CLL®, a prospective observational registry initiated in March 2010 involving US practices. Data on pt demographics and clinical characteristics were provided by clinicians. HRQOL was self-reported by pts at enrollment using the BFI, EQ-5D, and FACT-Leu. Mean BFI, EQ-5D and FACT-Leu scores were analyzed by ECOG PS and clinician-reported fatigue. Differences in HRQOL scores between sub-cohorts were assessed by ANOVA. Results:HRQOL data were reported by 604 pts enrolled from 10 academic, 148 community, and 3 government centers. Pts were predominantly male (62%) and white (90%); mean age was 70 (standard deviation 11) years. BFI data (scale: 0 [no fatigue] - 10 [worst fatigue]) indicated that on average pts report that global fatigue, fatigue severity and fatigue-related interference worsen by ECOG severity (Table 1) and are statistically associated with clinician-reported fatigue (Table 2). Mean EQ-5D overall HRQOL as measured by a Visual Analogue Scale (VAS) from 0 (worst) to 100 (best) worsens by ECOG severity and is significantly worse in pts with fatigue. Mean EQ-5D domain scores (scale: 1 [no problem], 2 [some problems], 3 [incapacity]) indicated that pain/discomfort, mobility and usual activities increase in severity as ECOG worsens and in pts with fatigue. FACT-Leu domains except social/family were statistically worse with worse ECOG PS and in pts with fatigue.Table 1Baseline HRQOL by ECOG PSHRQOL ScoresECOG PSP-valueECOG 0 (n=218)ECOG 1 (n=221)ECOG 2-4 (n=34)BFI, mean(SD)Global3.5(2.2)4.8(2.4)5.4(2.6)<.0001Severity4.2(2.5)5.6(2.6)6.6(3.0)<.0001Interference3.1(2.3)4.4(2.5)4.8(2.9)<.0001EQ-5DVAS Scale, mean(SD)75.4(21.3)67.8(21.1)60.8(20.7)<.0001Mobility, mean(SD)1.1(0.4)1.3(0.5)1.7(0.6)<.0001Self Care, mean(SD)1.0(0.1)1.1(0.2)1.3(0.5)<.0001Usual Activities, mean(SD)1.3(0.4)1.5(0.5)1.9(0.7)<.0001Pain/Discomfort, mean(SD)1.3(0.5)1.5(0.5)1.6(0.6)<.0001Anxiety/Depression, mean(SD)1.3(0.5)1.3(0.5)1.4(0.5)0.2084FACT-LEU, mean(SD)Physical24.3(3.3)21.6(4.7)18.8(5.9)<.0001Social/Family23.8(5.2)23.2(5.1)21.4(7.2)0.0546Emotional19.4(3.3)19.3(3.8)17.7(4.6)0.0536Functional21.8(5.2)19.0(6.0)15.8(5.5)<.0001CLL subscale Score51.8(8.5)46.8(10.3)43.3(12.0)<.0001FACT-G Total89.3(11.6)83.1(14.3)73.4(18.0)<.0001FACT-LEU Total141.0(17.6)129.9(22.2)116.4(26.8)<.0001Table 2Baseline HRQOL Scores by Clinician-Reported Constitutional Symptom: FatigueHRQOL ScoresFatigueYes (n=318)No (n=286)P-valueBFI, mean(SD)Global5.0(2.4)3.6(2.3)<.0001Severity5.9(2.5)4.1(2.5)<.0001Interference4.5(2.5)3.3(2.5)<.0001EQ-5DVAS Scale, mean(SD)66.5(20.5)75.0(21.1)<.0001Mobility, mean(SD)1.4(0.5)1.2(0.4)<.0001Self Care, mean(SD)1.1(0.3)1.0(0.2)0.0151Usual Activities, mean(SD)1.5(0.6)1.3(0.5)<.0001Pain/Discomfort, mean(SD)1.5(0.5)1.4(0.5)0.0288Anxiety/Depression, mean(SD)1.4(0.5)1.3(0.5)0.0408FACT-LEU, mean(SD)Physical21.3(4.7)23.6(4.3)<.0001Social/Family23.1(5.0)23.7(5.7)0.1524Emotional18.8(3.8)19.4(3.4)0.0951Functional18.8(5.9)20.9(6.0)<.0001CLL subscale Score46.2(10.0)51.4(10.0)<.0001FACT-G Total82.0(14.2)87.7(14.2)<.0001FACT-LEU Total128.3(21.9)139.1(21.8)<.0001 Conclusions:Initial results from Connect CLL® indicate that HRQOL worsens with worsening ECOG PS, especially in physical / functioning domains, pain/discomfort, and mobility, and worsens across multiple domains among pts whose physicians reported fatigue. Future analyses should be conducted on how HRQOL, PS and fatigue may change over time with changes in CLL, and how they are influenced by therapies. These results may serve as baseline reference. Disclosures:Pashos:Celgene: Membership on an entity's Board of Directors or advisory committees. Flowers:Genentech/Roche (unpaid): Consultancy; Celgene: Consultancy; Millennium/Takeda: Research Funding; Wyeth: Research Funding; Novartis: Research Funding. Weiss:Celgene: Membership on an entity's Board of Directors or advisory committees. Lamanna:Celgene: Membership on an entity's Board of Directors or advisory committees. Farber:Celgene: Membership on an entity's Board of Directors or advisory committees. Kipps:Igenica: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Research Funding; Abbot Industries: Research Funding; Pharmacyclics: Membership on an entity's Board of Directors or advisory committees; Genentech: Research Funding; GSK: Research Funding; Gilead Sciences: Consultancy, Research Funding; Amgen: Research Funding. Lerner:Celgene: Membership on an entity's Board of Directors or advisory committees. Kay:Celgene: Membership on an entity's Board of Directors or advisory committees. Sharman:Celgene: Membership on an entity's Board of Directors or advisory committees. Grinblatt:Celgene: Membership on an entity's Board of Directors or advisory committees. Flinn:Celgene: Membership on an entity's Board of Directors or advisory committees. Kozloff:Celgene: Membership on an entity's Board of Directors or advisory committees. Swern:Celgene Corporation: Employment, Equity Ownership. Kahn:Celgene Corporation: Employment, Equity Ownership. Street:Celgene: Employment, Equity Ownership. Sullivan:Celgene: Employment, Equity Ownership. Keating:Celgene: Membership on an entity's Board of Directors or advisory committees.

Variation in Health-Related Quality of Life by Age Among Patients with Chronic Lymphocytic Leukemia

Abstract 2085 Introduction.Although advanced patient age is commonly used as a factor in selecting therapy for patients with chronic lymphocytic leukemia (CLL), based on presumed associations with functional status, limited data exist regarding the relationships between age and physical, emotional, social, and functional well being. We examined the relationships between age and these domains of health-related quality of life (HRQOL) for CLL patients treated in US community practices. Methods.Baseline data were collected as part of Connect CLL®, a prospective observational registry initiated in March 2010 involving centers in the US. Data on patient demographics and clinical characteristics were provided by clinicians. HRQOL was self-reported by patients in the clinic at enrollment. Patients completed 3 psychometrically validated instruments: the Brief Fatigue Inventory (BFI), EQ-5D, and Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu). Standard analyses were conducted of each instrument given clinical characteristics at that time. Reported mean BFI, EQ-5D and FACT-Leu scores were analyzed by age group (<65, 65–74, >74). Statistical significance of score differences among sub-cohorts was ascertained by ANOVA using SAS 9.1. Results.Baseline HRQOL data were reported by 604 patients, enrolled from 161 centers. Patients were predominantly male (62%) and white (90%) with mean age at 69.9 (standard deviation [SD] 11.2) yrs. HRQOL scores by age group are presented:Baseline HRQOL by Age GroupHRQOL ScoresAge <65 (n=197)Age 65–74 (n=185)Age >= 75 (n=222)P-valueBFI Mean(SD)Global4.4 (2.5)4.1 (2.3)4.5 (2.5)0.2738Severity4.9 (2.6)4.9 (2.6)5.3 (2.8)0.1536Interference4.1 (2.6)3.7 (2.4)4.1 (2.6)0.2795EQ-5DVAS Scale Mean(SD)71.4 (19.7)71.4 (22.5)68.6 (21.2)0.3501Mobility Mean(SD)1.2 (0.4)1.2 (0.4)1.4 (0.5)<.0001Self Care Mean(SD)1.1 (0.2)1.0 (0.2)1.1 (0.3)0.0724Usual Activities Mean(SD)1.4 (0.5)1.3 (0.5)1.5 (0.6)0.0164Pain/Discomfort Mean(SD)1.4 (0.6)1.3 (0.5)1.6 (0.5)0.0002Anxiety/Depression Mean(SD)1.3 (0.5)1.3 (0.5)1.3 (0.5)0.7725FACT-LEU Mean(SD)Physical21.7 (5.2)23.0 (4.2)22.4 (4.5)0.0365Social/Family23.2 (5.1)23.7 (5.1)23.3 (5.8)0.7227Emotional18.6 (3.8)19.3 (3.4)19.3 (3.7)0.1059Functional19.5 (5.7)20.4 (6.0)19.5 (6.3)0.2185CLL subscale Score48.5 (10.6)50.0 (9.6)47.4 (10.6)0.0634FACT-G Total83.0 (15.1)86.5 (13.6)84.5 (14.6)0.0830FACT-LEU Total131.5 (23.5)136.5 (20.7)132.1 (22.7)0.0846There were no significant differences between the age groups in fatigue as measured by the BFI, or differences in overall HRQOL as measured by the EQ-5D Visual Analogue Scale (VAS) or the FACT-G. Anxiety/depression and self care are EQ-5D domains that also did not vary by age. Although mobility was most impaired in the oldest age group compared to the two younger groups, usual activities and pain/discomfort were worse in both the younger and older cohorts compared to those 65–74 years of age. FACT-Leu results indicated that the social/family domain scores did not vary by age, but that physical, emotional, and functional domains did vary statistically with the oldest typically doing better than the 65–74 year olds, but not necessarily better than those <65. Conclusions.Initial results from the Connect CLL® Registry indicate that HRQOL does not worsen monotonically with older age. In this cohort, both the youngest and oldest age groups had worse HRQOL in certain domains, presenting an inverted v-shaped relationship. Future analyses should be conducted on: (1) how HRQOL may be affected over time with changes in disease; and, (2) how HRQOL may be influenced by alternative therapies. Results reported here should serve as a useful baseline reference. Disclosures:Pashos:Celgene: Membership on an entity's Board of Directors or advisory committees. Flowers:Genentech/Roche (unpaid): Consultancy; Celgene: Consultancy; Millennium/Takeda: Research Funding; Wyeth: Research Funding; Novartis: Research Funding. Weiss:Celgene: Membership on an entity's Board of Directors or advisory committees. Lamanna:Celgene: Membership on an entity's Board of Directors or advisory committees. Farber:Celgene: Membership on an entity's Board of Directors or advisory committees. Kipps:Igenica: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Research Funding; Abbot Industries: Research Funding; Pharmacyclics: Membership on an entity's Board of Directors or advisory committees; Genentech: Research Funding; GSK: Research Funding; Gilead Sciences: Consultancy, Research Funding; Amgen: Research Funding. Lerner:Celgene: Membership on an entity's Board of Directors or advisory committees. Kay:Celgene: Membership on an entity's Board of Directors or advisory committees. Sharman:Celgene: Membership on an entity's Board of Directors or advisory committees. Grinblatt:Celgene: Membership on an entity's Board of Directors or advisory committees. Flinn:Celgene: Membership on an entity's Board of Directors or advisory committees. Kozloff:Celgene: Membership on an entity's Board of Directors or advisory committees. Swern:Celgene Corporation: Employment, Equity Ownership. Kahn:Celgene Corporation: Employment, Equity Ownership. Street:Celgene: Employment, Equity Ownership. Sullivan:Celgene: Employment, Equity Ownership. Keating:Celgene: Membership on an entity's Board of Directors or advisory committees.

Association between quality of life and clinical parameters in patients with myeloproliferative neoplasms

The Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) is a validated quality of life (QoL) instrument. In our Swedish cohort of 114 patients the symptomatic burden was found to be severe, with fatigue reported in 88% of the patients and reduced QoL in the majority of patients. Patients with primary myelofibrosis had the highest scores, low QoL, for most MPN-SAF items, compared to patients with polycythemia vera and essential thrombocythemia. Higher age showed significant associations with the BFI (Brief Fatigue Inventory) score, early satiety, concentration problems, dizziness, insomnia, cough and weight loss. Blood values, disease duration and myelosuppressive treatment did not significantly associate with any of the MPN-SAF items, with the exception of higher hemoglobin, which correlated with sad mood. Male patients with MPN scored significantly higher as regards sexual problems and weight loss compared to female patients. Overall, the MPN-SAF was found to be a valid instrument for assessing symptomatic burden among this population.

Objective measures of physical fatigue in women undergoing adjuvant therapy for early-stage breast cancer.

e19680 Background: Cancer-related fatigue (CRF) is prevalent with cancer diagnosis and treatment, and its subjective nature has made it difficult to characterize and treat. To help address this issue, we evaluated objective measures of these parameters and correlated the results with the self-reported measurement of fatigue. Methods: Women with stage I-III breast cancer receiving dose dense doxorubicin and cyclophosphamide (AC) were recruited. Participants were tested at baseline and week 2 after cycle 4 of AC. The assessment included a 6 Minute Walk (6MW), Jamar dynamometer (grip strength), and self-report Brief Fatigue Inventory (BFI). In addition, total daily energy expenditure (TEE) was measured using the Bodybugg (BB) armband for 1 week prior to chemotherapy and week 2 of cycle 4. Results: To date, 20 of the planned 25 participants have been enrolled in the clinical trial and 15 have completed pre and post chemotherapy assessments. The mean change in BFI score was +1.8 (increased fatigue). While all measures of physical function decreased (mean): TEE (-4.4%), dominant hand grip strength (-2.7%), 6MW (-3.7%), correlations with BFI were weak (|r|<0.1) for all measures other than TEE (r=-0.321) and 6MW (r=-0.312). Conclusions: The self-report of fatigue may be associated with objective tests of total daily energy expenditure and 6 minute walk, and continued accrual is warranted. Change in study measures in patient sample (post assessment – pre assessment). Pt BFI TEE (%) Hand grip strength (%) 6MWORK* (%) Dominant Nondominant 1 + 4.0 + 5.7 + 5.9 - 30.9 - 21.5 2 - 1.1 - 16.3 - 39.4 - 7.1 - 5.6 3 + 0.0 + 3.5 + 0.0 + 0.0 + 9.1 4 + 2.2 - 4.2 - 12.8 - 8.6 - 19.9 5 + 5.9 - 14.6 - 5.6 + 32.0 + 3.7 6 - 1.2 + 26.7 + 0.0 + 9.1 + 1.0 7 + 0.0 - 9.1 + 0.0 + 0.0 - 9.7 8 - 0.9 + 14.3 + 19.0 - 16.7 - 1.4 9 + 4.7 - 8.4 + 0.0 - 8.0 + 3.2 10 + 4.3 - 15.3 + 5.9 - 5.9 - 8.7 11 - 1.2 - 28.8 + 5.0 + 11.1 + 1.2 12 + 5.9 - 12.6 - 15.0 - 5.0 - 15.4 13 - 1.1 + 4.0 + 3.0 + 16.0 + 3.1 14 + 5.0 - 9.2 + 0.0 + 0.0 + 1.0 15 - 0.1 - 2.2 - 6.7 + 3.1 + 4.6 Mean + 1.8 - 4.4 - 2.7 - 0.7 - 3.7 * 6MWORK (kg-m) = patient’s weight (kg) × distance traveled (m).

Acupuncture for chemotherapy-induced fatigue: A randomized controlled trial.

9029 Background: Many cancer patients continue to experience chronic fatigue after the completion of chemotherapy even when no medical etiology can be identified. Currently there is no reliable treatment for chemotherapy induced chronic fatigue. In a previous single armed study, acupuncture appeared to reduce fatigue in this population of patients.The primary objective of this trial is to determine whether acupuncture reduces chronic fatigue after chemotherapy more effectively than placebo. Methods: A randomized sham-controlled trial comparing true acupuncture with sham acupuncture. Treatment regimen is once weekly for six weeks. Brief Fatigue Inventory (BFI), Hospital Anxiety and Depression Scale and Functional Assessment of Cancer Treatment Scale were evaluated before, during and after the treatment period. Results: A total of 97 patients received either true or sham acupuncture treatment. Seventy four patients (40 in the sham group and 34 in the acupuncture group) were evaluable for the primary endpoint. In both groups, BFI scores fell by about 1 point between baseline and follow-up, with no statistically significant differences between groups. The upper bound of the 95% confidence interval for acupuncture effect is 0.7 points. As such, we can rule out acupuncture having an effect much above placebo for the treatment of chronic post-chemotherapy fatigue. Conclusions: Acupuncture treatment regimen used in this trial does not reduce post-chemotherapy chronic fatigue more than sham acupuncture.

Effects of adjuvant chemotherapy on fatigue and cognitive function.

e19533 Background: Understanding of fatigue and cognitive dysfunction, common complaints with chemotherapy (CT), is often limited by lack of baseline assessments, appropriate controls and correlative neurophysiologic (NP) measurements. This pilot study seeks a means to assess physical and mental fatigue associated with CT for breast cancer (BC). Methods: Patients undergoing CT for early BC and age-similar controls underwent NP assessment at baseline, during CT (after 3-4 cycles), and at one year. Testing at each time point included a brief fatigue inventory (BFI), brief mental fatigue assessment (BMF), cognitive testing including Digit Symbol Coding (DS) and Symbol Search (SS) subtests of the Wechsler Adult Intelligence Scale as well as a physical task requiring sustained elbow flexion with assessment of endurance time and perceived effort. Electroencephalogram (EEG) and surface electromyogram (EMG) recordings were obtained during the cognitive and physical tasks respectively. Data were analyzed using repeated measures analysis of variance. Results: Eight pairs completed the first two evaluations and 7 pairs completed all 3 (1 pair withdrawn due to second malignancy). BFI scores demonstrate a trend toward greater fatigue in patients than controls at baseline (p=0.08). BFI is significantly greater for patients during CT (p<0.001) and remains greater at 1 year (p=0.016). BFI is also greater among patients during CT than at baseline (p=0.037). Physical endurance and perception of effort do not change significantly in either group at the different time points. Subjective mental fatigue, measured by BMF, is similar for the two groups at baseline; BMF scores increase significantly during CT for patients relative to controls (p=0.033) but recover to no difference at one year. Objective cognitive function measured by Processing Speed Index (incorporating DS and SS results) remains stable at all three time points for both groups. Conclusions: CT is associated with significant changes in subjective physical and mental fatigue, while objective performance on physical and mental tasks is relatively preserved. Mental fatigue improved by one year, but perception of physical fatigue persisted. EEG and EMG analyses are under way.

Fatigue assessment and rehabilitation outcomes in patients with brain tumors

This study seeks to investigate the fatigue severity and the relationship among fatigue and other associated factors in patients with brain tumors, and to evaluate the rehabilitation outcome on fatigue. We assessed 25 patients in whom brain tumors had been resected and transferred to the rehabilitation department of our hospital. Patients were evaluated for fatigue severity using the Piper Fatigue Scale (PFS) and the Brief Fatigue Inventory (BFI), for mood using the Beck Depression Inventory, for motor function using the Motricity Index (MI), for functional status using the Karnofsky Performance Status (KPS) scale and the Modified Barthel Index (MBI), and for quality-of-life using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (EORTC QLQ-C30). We also measured the levels of serum hemoglobin, C-reactive protein, albumin, and creatine kinase; and anthropometric variables before and 4weeks after rehabilitation. Of the 25 patients, 21 (84.0%) reported fatigue during the previous week. The average PFS score was 4.6 ± 1.8 and the average BFI score 5.2 ± 2.2, indicating the moderate level of fatigue. Patients with recurrent tumors had significantly higher PFS scores than did those with initial tumors. Fatigue correlated significantly with the KPS, MBI, and EORTC QLQ-C30 physical functioning and insomnia scales. In addition, insomnia was a significant predictor of fatigue before rehabilitation, and the baseline fatigue scales, MBI, MI, and EORTC QLQ-C30 physical functioning scale were the important independent predictors of fatigue after rehabilitation. During rehabilitation, the KPS, MBI, and MI scores improved significantly, whereas total PFS and BFI scores did not change. These findings suggest that patients with brain tumors commonly complain of moderate level of fatigue, which may reduce daily functioning and quality of life, with sleep disturbance being a significant predictor of fatigue. During rehabilitation, functional outcomes and motor power showed improvements in those patients, not aggravating fatigue.

Changes in Energy Expenditure, Physical Activity, and Hemoglobin Measures Associated with Fatigue Reports During Radiation Treatment for Breast Cancer: A Descriptive and Correlation Study

Introduction: Radiation related fatigue is assessed through subjective evaluations that may not adequately describe the fatigue experience. This study measured changes in energy expenditure (Kcals/day), steps per day (SPD), and hemoglobin (Hb) in women undergoing radiation for breast cancer and evaluated correlations with fatigue reports. Subjects: 17 females [51.2 (10.3) years of age] scheduled to receive radiation for breast cancer. Methods/Materials: A prospective, repeated measures design measured Kcals/day and SPD during the first, fourth, and sixth weeks of radiation using the SenseWear© Body Monitoring System. Fatigue reports were assessed weekly using the Brief Fatigue Inventory (BFI), and Hb was measured the first and sixth weeks of treatment. Friedman's Analysis of Variance assessed differences over time and Pearson's Product Moment determined correlations between variables with p ≤ .05 considered significant. Results: Energy expenditure was similar between weeks one [2164 (317) Kcals/day] and 4 [2198 (424) Kcals/day] but declined significantly (p = .012) at week 6 [2103 (390) Kcals/day] by 4.3%. Steps per day were similar between weeks one [7382 (3768)] and 4 [7407 (5079)], but declined significantly (p = .014) by 14.02% by week 6 [6369 (4156)]. The BFI scores gradually increased by 43.31%; changes were not statistically significant (p = .145). Correlations were significant between Kcals/day and BFI (r = -.346, p = .011), between Hb and Kcals/day (r = .458; p = .003), and between Hb and SPD (r = .426; p = .006). Conclusions: The study found an inverse correlation between energy expenditure and fatigue scores and a positive correlation between Hb and Kcals/day as well as SPD. Women with the highest fatigue scores had the lowest Kcals/day, SPD, and Hb; therefore, maintaining healthy activity levels and monitoring Hb may reduce fatigue reports and preserve function during radiation for breast cancer.

Cancer‐related fatigue: the impact of skeletal muscle mass and strength in patients with advanced cancer

BackgroundAlthough exertional fatigue is directly and negatively related to skeletal muscle mass and strength, it is currently unknown if these variables are associated with cancer-related fatigue (CRF). Therefore, the purpose of this study was to determine if CRF is associated with measures of appendicular lean muscle mass and strength in advanced cancer patients (ACP).Methods and resultsEighty-four patients (48 men, 36 women aged 61.6 ± 13.2 year) newly diagnosed (≤6 months) with inoperable (Stages III–IV) gastrointestinal or non-small cell lung cancer participated in this study. All patients completed the Brief Fatigue Inventory (BFI). Handgrip (HGS) and quadriceps (QS) strength were assessed using isometric and isokinetic dynamometry, respectively. Skeletal muscle mass index (SMMI) was calculated from the appendicular lean mass measured via dual-energy X-ray absorptiometry divided by body height squared. Univariate analysis showed BFI to be significantly associated with body mass index, weight loss, anemia, hypoalbuminemia, activity level, pain, depression, and sarcopenia along with SMMI, HGS, and QS. HGS (r = −0.34; p = 0.018), QS (r = −0.39; p = 0.024), and SMMI (r = −0.60; p < 0.001) were negatively correlated with BFI total scores in men but not in women. When adjusted for sex, age, diagnosis, survival, along with the above characteristics, multivariate analyses showed that BFI scores were negatively associated with HGS (B = −0.90; 95% CI −1.5:−0.3), QS (−0.2; −0.3:−0.01), and SMMI (−7.5; −13.0:−2.0). There was a significant sex × SMMI interaction (10.8; 1.2:20.5), where BFI decreased with increasing SMMI in men, but did not change with SMMI in women.ConclusionThese results suggest that in ACP, CRF is related to muscle mass and strength, which may provide targets for future interventions.

Decreased health-related quality of life in disease-free survivors of differentiated thyroid cancer in Korea

BackgroundConcern regarding the health-related quality of life (HRQOL) of long-term survivors of thyroid cancer has risen due to the rapid increase in the incidence of thyroid cancer, which generally has an excellent prognosis. The aim of this study was to evaluate the status of HRQOL in disease-free survivors of differentiated thyroid carcinoma (DTC) and to evaluate the important determinants of HRQOL.MethodsThis was a cross-sectional study in which we interviewed consecutive disease-free survivors of DTC. Three different validated questionnaires ("EORTC QLQ-C30" for various functional domains, the "brief fatigue inventory (BFI)" and the "hospital anxiety and depression scale" (HADS)) were used. Data from a large, population based survey of 1,000 people were used as a control.ResultsThe response rate for the questionnaires was 78.9% (316/401). Disease-free survivors of DTC showed a decreased HRQOL in all five functional domains (physical, role, cognitive, emotional, and social) on the EORTC QLQ-C30 compared with controls (P < 0.01). BFI and HADS-anxiety scores also showed greater distress in disease-free survivors of DTC than in controls (P < 0.05). A multiple regression analysis for the determinants of HRQOL showed that the HADS-anxiety, HADS-depression, and BFI scores were the most significant components of decreased HRQOL.ConclusionsAlthough disease-free survivors of DTC are expected to have disease-specific survival comparable to the general population, they experience a significantly decreased HRQOL. Anxiety, depression, and fatigue were the major determinants of the decreased HRQOL. Supportive psychological care should be integrated into the management of long-term survivors of DTC.

High serum levels of TNF-α and IL-6 predict the clinical outcome of treatment with human recombinant erythropoietin in anaemic cancer patients

BackgroundA number of anaemic cancer patients are not responsive to treatment with recombinant human erythropoietin (rHuEPO). The aim of the present study is to investigate whether serum levels of tumour necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6 and additional laboratory parameters, together with clinical variables, can predict the clinical outcome of treatment with rHuEPO in anaemic cancer patients. Patients and methodsThirty-five cancer patients and 25 healthy controls were enrolled in this study. Patients were treated with epoetin alfa at the dose of 150 IU/kg s.c. three times a week for 12 weeks. If the haemoglobin (Hb) level failed to improve at least 2 g/dl above baseline by week 6 of treatment, dose was increased to 300 IU/kg s.c. for the remainder of the treatment period. All patients filled out the Brief Fatigue Inventory (BFI), a questionnaire for the self-evaluation of cancer-related fatigue. Serum samples from patients and control groups were frozen at -80°C and TNF-α, IL-1β and IL-6 were later examined by enzyme-linked immunosorbent assay. ResultsFatigued cancer patients had significant higher levels of circulating TNF-α, IL-1β and IL-6 than healthy controls. Responders (Rs) to erythropoietin had significant lower medium levels of TNF-α and IL-6 than nonresponders (NRs). Fatigued patients with a general BFI score ≥6 presented higher medium level of cytokines than nonfatigued patients (general BFI score <6), but each group responded similarly to treatment with rHuEPO. ConclusionsHigh serum levels of TNF-α and IL-6 at the baseline are significantly correlated with a negative response to administration with rHuEPO. Thus, pretreatment evaluation of TNF-α and IL-6 serum levels can help to select those patients who are most likely to benefit from treatment with rHuEPO. On the contrary, Hb level, red blood cell count, lactate dehydrogenase and BFI score do not predict the outcome of treatment with rHuEPO.

Neurophysiology of chemotherapy-associated physical and mental fatigue: A study of chemobrain.

e19609 Background: Chemotherapy treatment (CT) commonly results in physical and mental fatigue. Better understanding of the neurophysiology of these conditions should lead to improved treatments. Methods: Women undergoing CT for early stage breast cancer and age-similar female controls underwent neurophysiologic assessment prior to and during CT. Testing at the two time points included a brief fatigue inventory (BFI), brief mental fatigue assessment (BMF), formal cognitive testing including Digit Symbol Coding (DS) and Symbol Search (SS) subtests of the Wechsler Adult Intelligence Scale as well as a physical task (PT) requiring sustained elbow flexion with assessment of endurance time and perceived effort during the PT. Electroencephalogram (EEG) and surface electromyogram (EMG) recordings were obtained during the cognitive and physical tasks respectively. To evaluate feasibility in this pilot study, data from the first 12 subjects were analyzed. Wilcoxon rank sum test was used to compare findings between controls and patients. Results: Six patients and 6 controls were evaluated at baseline and following 3 to 4 cycles of CT. BFI scores demonstrate a trend toward greater subjective fatigue in patients than controls at baseline (p=0.08) and this worsened with treatment for patients (p=0.05). Endurance time did not decline for either group, although there is a trend among patients toward greater perceived effort after CT (p=0.06). BMF scores are similar for the two groups at baseline; this measure of subjective mental fatigue worsened for patients only during CT (p=0.012). Cognitive function measured by Processing Speed Index (incorporating DS and SS results) remained stable before and after CT for both groups, although there was a trend toward a decline in the DS subscale result for patients with a slight improvement in controls (p=0.06). Analyses of electrophysiologic measurements are underway. Conclusions: CT was associated with significant changes in subjective physical and mental fatigue as well as perceived effort. Objective performance on physical and mental tasks was relatively preserved. EEG and EMG analyses should provide further information regarding differences in mental processing and muscle reserve. No significant financial relationships to disclose.

Cancer-Related Fatigue: Central or Peripheral?

To evaluate cancer-related fatigue (CRF) by objective measurements to determine if CRF is a more centrally or peripherally mediated disorder, cancer patients and matched noncancer controls completed a Brief Fatigue Inventory (BFI) and underwent neuromuscular testing. Cancer patients had fatigue measured by the BFI, were off chemotherapy and radiation (for more than four weeks), had a hemoglobin level higher than 10 g/dL, and were neither receiving antidepressants nor were depressed on a screening question. The controls were screened for depression and matched by age, gender, and body mass index. Neuromuscular testing involved a sustained submaximal elbow flexion contraction (SC) at 30% maximal level (30% maximum elbow flexion force). Endurance time (ET) was measured from the beginning of the SC to the time when participants could not maintain the SC. Evoked twitch force (TF), a measure of muscle fatigue, and compound action potential (M-wave), an assessment of neuromuscular-junction transmission were performed during the SC. Compared with controls, the CRF group had a higher BFI score ( P < 0.001), a shorter ET ( P < 0.001), and a greater TF with the SC (CRF > controls, P < 0.05). This indicated less muscle fatigue. There was a greater TF ( P < 0.05) at the end of the SC, indicating greater central fatigue, in the CRF group, which failed to recruit muscle (to continue the SC), as well as the controls. M-Wave amplitude was lower in the CRF group than in the controls ( P < 0.01), indicating impaired neuromuscular junction conduction with CRF unrelated to central fatigue (M-wave amplitude did not change with SC). These data demonstrate that CRF patients exhibited greater central fatigue, indicated by shorter ET and less voluntary muscle recruitment during an SC relative to controls.

A randomized control trial of a supervised versus a self‐directed exercise program for allogeneic stem cell transplant patients

To determine if therapist supervision of an exercise program produced better functional outcomes in allogeneic stem cell transplant patients than a patient-directed exercise program. Sixty-one patients who were less than 6 months post allogeneic stem cell transplant were randomly assigned to either a therapist supervised training group (supervised) or a patient-directed training group (Self-directed). Training consisted of aerobic exercises (treadmill, bicycle ergometer versus walking) and resistance exercises (free weights, weight machines versus resistive band activities). Subjects completed physical performance tests (50-foot fast walk, 6-min walk, forward reach, repeated sit-to-stand, uniped stance) and the Brief Fatigue Inventory (BFI) before and after 4 weeks of training. Pre- and post-training outcomes and group differences were analyzed by a Student t-test. Patients in both groups were similarly deconditioned at baseline. Training increased the 6-min walk distance and 50-foot walk in the supervised group by 12 and 14%, respectively, and increased the 6-min walk distance by 10% in the Self-directed group (p<0.05). BFI score for worst level of fatigue declined in both groups but not significantly. These results demonstrate that allogeneic transplant patients derive functional benefits from short-term exercise training regardless of how the training program is supervised. Determining (1) the reasons for the low participation rate (28%), (2) the patient-preferred characteristics of each exercise supervision style and (3) how best to match patient preference to exercise supervision style remain significant issues in this area of patient delivery services.

Fatigue in the General Korean Population: Application and Normative Data of the Brief Fatigue Inventory

The purpose of this study was to provide normative data for the Brief Fatigue Inventory (BFI) in the general Korean population so that the results for the general population could be compared with those for patients. We constructed a questionnaire that included the BFI and items on demographic characteristics and conducted a population-based, cross-sectional survey in 1,000 individuals. We used multivariate logistic analysis to investigate factors associated with “usual” and “worst” fatigue. The internal consistency was very high (Cronbach's alpha = 0.96) and construct validity was confirmed by factor analysis. All patients had a mean ± SD BFI score of 4.33 ± 2.48 for “worst” fatigue and of 4.07 ± 2.27 for “usual” fatigue, and the global BFI score was 3.44 ± 2.05. The prevalence of each moderate-to-severe fatigue type was similar in severity of fatigue, with 55.2% in “usual” fatigue, and 57.3% in “worst” fatigue. Among the types of fatigue, the prevalence of severe fatigue was lowest for “usual” fatigue (16.5%). In multivariate analyses, the group aged 40–59 years had greater levels of “usual” and “worst” fatigue compared with the group aged 20–29 years. Poor general health and the presence of comorbidities were also associated with increased “usual” and “worst” fatigue. Regular physical activity was associated with reduced levels of “worst” fatigue. The normal values of BFI with proper psychometric properties may help us to better understand the correlates of fatigue in the general population and patients. Our findings indicate that comorbidities should be considered when comparing fatigue data from the general population with data from patients.