Fatigue Assessment Questionnaire Research Articles

Psychometric evaluation and validation of the Brain Fag Syndrome Scale among students at Bayero University Kano

Background: This study delved into the Psychometric Evaluation and Validation of the Brain Fag Syndrome Scale (BFSS) among students at Bayero University Kano. Documented extensively among African students, particularly in academic settings, Brain Fag Syndrome (BFS) is rooted in recurrent mental exhaustion impacting students emotionally and physically. As the concept of BFS as an exhaustion syndrome emerged, a thorough examination of its psychometric properties became essential. Methods: Employing a cross-sectional survey design, 625 3rd-year undergraduate students from Bayero University Kano were randomly selected, representing 89.3% of the intended sample size. Socio-demographic characteristics were explored, scale reliability was measured using Cronbach's alpha, and Exploratory Factor Analysis (EFA) was conducted to unveil the BFSS latent structure. The Brain Fag Syndrome and Fatigue Assessment Questionnaire development stemmed from identified components related to Fatigue and Exhaustion. Results: Analysis with SPSS v26 included all 625 participants with complete data. BFSS exhibited moderate to good reliability (Cronbach's alpha ≈ 0.738). EFA identified a distinct "Fatigue and Exhaustion Factor," strongly linked to fatigue and concentration challenges. A scree plot aided in retaining optimal factors, highlighting the dominance of the identified factor. Conclusion: This study significantly contributes to the validation of the Brain Fag Syndrome Scale (BFSS) and the derivation of a prototype questionnaire for fatigue and exhaustion syndrome. The identified factors align with the evolving understanding of BFS as an exhaustion syndrome, informing diagnostic criteria refinement and enriching the discourse on students' psychological well-being within a cultural context.

Adaptation and validation of the Turkish version of the alarm fatigue assessment questionnaire

ObjectiveAlarm fatigue may endanger the safety of patients by negatively affecting nurses' concentration and ability to provide effective care. Identifying alarm fatigue and taking appropriate measures are critical in preventing medical errors and for nurses to work with high motivation. This study aimed to test the psychometric properties of the Turkish version of the 23-item Alarm Fatigue Assessment Questionnaire (AFAQ). MethodThe study was conducted between February 2022 and April 2022 and included nurses with at least one year of clinical or intensive care experience. The data were collected via a web-based questionnaire. During the adaptation of AFAQ, language, content, and construct validity were evaluated; reliability was examined by internal consistency analysis. ResultsThe item and scale content validity index of AFAQ were found to be high (>0.80). The Kaiser–Meyer–Olkin measure of sampling adequacy indicated an adequate sampling (0.85); Bartlett's test of sphericity χ2 was 1935.074, p<0.001. Exploratory factor analysis (EFA) showed that the 21-item scale had a five-factor structure, explaining 51.606% of the total variance, and the factor loadings of the items were >0.30 (0.422−0.803). Confirmatory factor analysis (CFA) showed that the five-factor model had a good fit index (χ2/df=1.855, SRMR=0.039, RMSEA=0.048, CFI=0.915, and TLI=0.908) and appropriate factor loadings (>0.30). The internal consistency of AFAQ (Cronbach's alpha coefficient) was 0.85, and the corrected item-total correlations were between 0.32−0.55. ConclusionThe results indicated that the Turkish version of the Alarm Fatigue Assessment Questionnaire was sufficiently valid and reliable to measure alarm fatigue in nurses.

Cancer-related fatigue: Towards a more targeted approach based on classification by biomarkers and psychological factors.

Cancer-related fatigue is a frequent, burdensome and often insufficiently treated symptom. A more targeted treatment of fatigue is urgently needed. Therefore, we examined biomarkers and clinical factors to identify fatigue subtypes with potentially different pathophysiologies. The study population comprised disease-free breast cancer survivors of a German population-based case-control study who were re-assessed on average 6 (FU1, n = 1871) and 11 years (FU2, n = 1295) after diagnosis. At FU1 and FU2, we assessed fatigue with the 20-item multidimensional Fatigue Assessment Questionnaire and further factors by structured telephone-interviews. Serum samples collected at FU1 were analyzed for IL-1ß, IL-2, IL-4, IL-6, IL-10, TNF-a, GM-CSF, IL-5, VEGF-A, SAA, CRP, VCAM-1, ICAM-1, leptin, adiponectin and resistin. Exploratory cluster analyses among survivors with fatigue at FU1 and no history of depression yielded three clusters (CL1, CL2 and CL3). CL1 (n = 195) on average had high levels of TNF-α, IL1-β, IL-6, resistin, VEGF-A and GM-CSF, and showed high BMI and pain levels. Fatigue in CL1 manifested rather in physical dimensions. Contrarily, CL2 (n = 78) was characterized by high leptin level and had highest cognitive fatigue. CL3 (n = 318) did not show any prominent characteristics. Fatigued survivors with a history of depression (n = 214) had significantly higher physical, emotional and cognitive fatigue and showed significantly less amelioration of fatigue from FU1 to FU2 than survivors without depression. In conclusion, from the broad phenotype "cancer-related fatigue" we were able to delineate subgroups characterized by biomarkers or history of depression. Future investigations may take these subtypes into account, ultimately enabling a better targeted therapy of fatigue.

Adaptation and validation of the Turkish version of the alarm fatigue assessment questionnaire

ObjectiveAlarm fatigue may endanger the safety of patients by negatively affecting nurses' concentration and ability to provide effective care. Identifying alarm fatigue and taking appropriate measures are critical in preventing medical errors and for nurses to work with high motivation. This study aimed to test the psychometric properties of the Turkish version of the 23-item Alarm Fatigue Assessment Questionnaire (AFAQ). MethodThe study was conducted between February 2022 and April 2022 and included nurses with at least one year of clinical or intensive care experience. The data were collected via a web-based questionnaire. During the adaptation of AFAQ, language, content, and construct validity were evaluated; reliability was examined by internal consistency analysis. ResultsThe item and scale content validity index of AFAQ were found to be high (>0.80). The Kaiser–Meyer–Olkin measure of sampling adequacy indicated an adequate sampling (0.85); Bartlett's test of sphericity χ2 was 1935.074, p<0.001. Exploratory factor analysis (EFA) showed that the 21-item scale had a five-factor structure, explaining 51.606% of the total variance, and the factor loadings of the items were >0.30 (0.422−0.803). Confirmatory factor analysis (CFA) showed that the five-factor model had a good fit index (χ2/df=1.855, SRMR=0.039, RMSEA=0.048, CFI=0.915, and TLI=0.908) and appropriate factor loadings (>0.30). The internal consistency of AFAQ (Cronbach's alpha coefficient) was 0.85, and the corrected item-total correlations were between 0.32−0.55. ConclusionThe results indicated that the Turkish version of the Alarm Fatigue Assessment Questionnaire was sufficiently valid and reliable to measure alarm fatigue in nurses.

Polish Adaptation of the Alarm Fatigue Assessment Questionnaire as an Element of Improving Patient Safety.

Medical personnel, working in medical intensive care units, are exposed to fatigue associated with alarms emitted by numerous medical devices used for diagnosing, treating, and monitoring patients. Alarm fatigue is a safety and quality problem in patient care and actions should be taken to reduce this by, among other measures, building an effective safety culture. In the present study, an adaptation of a questionnaire to assess alarm fatigue was carried out. The study obtained good reliability of the questionnaire at Cronbach's alpha level of 0.88. The Polish research team has successfully adapted the Alarm Fatigue Assessment Questionnaire so that it can be used in healthcare settings as a tool to improve patient safety.

Screening of a Small Number of Italian COVID-19 Syndrome Survivors by Means of the Fatigue Assessment Scale: Long COVID Prevalence and the Role of Gender

Months after healing, a number of COVID-19 syndrome survivors are affected by both psychological and physical limitations. They are mainly troubled with long-term fatigue, which is a crucial aspect of Long Covid syndrome. This paper aims to investigate the level and persistency of fatigue among COVID-19 survivors from the first wave of the pandemic in Western Liguria and to elucidate the role of gender, age, and lifestyle. It also provides data to the scientific community to help drawing a consistent picture of Long Covid syndrome. The patients were requested to fill a Fatigue Assessment Questionnaire twice: (i) a few weeks after discharge from hospital or home confinement and (ii) a few months later. Statistical analysis was carried out on the global scores and on the score for every single item of the questionnaire. The outcome of the two questionnaires were analyzed separately and compared. Females are more affected by fatigue than males. This results holds for both physical and mental fatigue. All the males’ fatigue scores were reduced at the second control, while 40% of females worsened it. Home-confined patients showed a higher fatigue score at the first check. In the initial stages of the recovery, patients are more affected by physical, rather than mental, fatigue. This is worth of further investigation as well as the reasons leading to a higher initial fatigue score for home cared patients.

Effect of Acupressure Sessions on Dyspnea and Fatigue among Patients with Bronchial Asthma.

AbstractBronchial asthma is a syndrome characterized by airflow obstruction; Dyspnea and fatigue are the most disabling symptoms in asthma and the trigger point of physical inactivity with a consequent lower standard of quality of life. Acupressure is one of important non-pharmacological modalities which leads to reduction of asthma symptoms and ultimately enhances asthma control. This study aimed to evaluate the effect of acupressure sessions on dyspnea and fatigue among patients with bronchial asthma. Research design: A quasi experimental research design was conducted on sixty patients with bronchial asthma who were admitted to the Chest inpatient Unit of Alexandria Main University Hospital. Three tools were used for data collection: Tool I: Patients with bronchial asthma assessment. Tool II: Dyspnea Assessment questionnaire. Tool III: Fatigue Assessment questionnaire. Results of the present study revealed that there were significant differences between control and study group patients related to their grade of dyspnea and fatigue severity after application of acupressure sessions. Conclusion: acupressure may be effective as an adjuvant therapy to the traditional management for patients with bronchial asthma to improve dyspnea and fatigue syndromes. Recommendations of this study include, illustrated self-administered acupressure intervention booklets distributed to patients with bronchial asthma, could be of help, additionally, development and implementation of acupressure training program for nurses, about acupressure are advocated.

Physical activity and long-term fatigue among colorectal cancer survivors \u2013 a population-based prospective study

BackgroundEvidence suggests that physical activity (PA) is beneficial for reducing fatigue in colorectal cancer (CRC) survivors. However, little is known regarding long-term effects of PA on fatigue and whether pre-diagnosis PA is associated with less fatigue in the years after diagnosis. Our study aimed to investigate the association of pre- and post-diagnosis PA with long-term fatigue in CRC survivors.MethodsThis study used a German population-based cohort of 1781 individuals, diagnosed with CRC in 2003–2014, and alive at five-year follow-up (5YFU). Physical activity was assessed at diagnosis and at 5YFU. Fatigue was assessed by the Fatigue Assessment Questionnaire and the EORTC Quality of Life Questionnaire-Core 30 fatigue subscale at 5YFU. Multivariable linear regression was used to explore associations between pre- and post-diagnosis PA and fatigue at 5YFU.ResultsNo evidence was found that pre-diagnosis PA was associated with less fatigue in long-term CRC survivors. Pre-diagnosis work-related PA and vigorous PA were even associated with higher levels of physical (Beta (ß) = 2.52, 95% confidence interval (CI) = 1.14–3.90; ß = 2.03, CI = 0.65–3.41), cognitive (ß = 0.17, CI = 0.05–0.28; ß = 0.13, CI = 0.01–0.25), and affective fatigue (ß = 0.26, CI = 0.07–0.46; ß = 0.21, CI = 0.02–0.40). In cross-sectional analyses, post-diagnosis PA was strongly associated with lower fatigue on all scales.ConclusionsIn this study, pre-diagnosis PA does not appear to be associated with less fatigue among long-term CRC survivors. Our results support the importance of ongoing PA in long-term CRC survivors. Our findings might be used as a basis for further research on specific PA interventions to improve the long-term outcome of CRC survivors.

Can self-perceived easy fatigability be a predictor of vitamin D deficiency in young Indian women?

Background:Easy fatigability is a common presenting complaint in Indian women who visited primary care hospitals. Many medical conditions like cancer, chronic bronchial asthma, prolonged use of glucocorticosteroid, renal disorder, and hypothyroidism have been associated with low levels of vitamin D. Correction of vitamin D level improves the symptom of fatigue. Whether low vitamin D causes fatigue in otherwise healthy women is the subject of research.Aim:This prospective nonrandomized and therapeutic study observed the prevalence of hypovitaminosis D in women with fatigue and the effect of correction of vitamin D level in fatigue-like symptoms.Material and Methods:One thousand two hundred adult women, who presented in our primary care hospital with complaints of easy fatigue, otherwise no associated medical illness were included. They completed the fatigue assessment questionnaire (FAQ). Patients with hypovitaminosis D received cholecalciferol (60000 IU) therapy for 5 weeks. Scores of pre- and post-treatment FAQs were noted and compared.Results:The prevalence of low vitamin D was noted in 84.8% women who presented with main complaints of fatigue. After the correction of vitamin D level, fatigue symptom scores improved significantly (P < 0.001) in 82.6% of the women in all five-subscale categories of the FAQ.Conclusion:We observed a high prevalence of low serum vitamin D level in women who presents with fatigue with no medical illness. A significant improvement was noted in the severity of their fatigue symptoms after the correction of vitamin D levels with cholecalciferol therapy.

Climate conditions and work-related fatigue among professional drivers

The possible associations between climate parameters and drivers’ fatigue have not been subject to specific studies thus far. We have undertaken a study to investigate whether the particular climate parameters are related to fatigue perception by motor vehicle drivers. The study was performed from July to October. Each driver was surveyed four times: before and after workshift on a monotonous route outside the city center (MR), and on a heavy traffic route in the city center (HTR). The study was conducted among 45 city bus drivers aged 31–58 years (43.7 ± 7.9), seniority as driver 3–34 years (14.7 ± 8.6). Data on climate conditions (ambient temperature, air pressure, humidity, wind speed, precipitations) on particular study days was obtained from the Institute of Meteorology and Water Management, National Research Institute Warsaw, Poland. Fatigue was assessed using the Fatigue Assessment Questionnaire, developed at Nofer Institute of Occupational Medicine (Lodz, Poland). The total level of fatigue was significantly (p = 0.045) higher after driving on HTR than on MR. The number of symptoms was also significantly higher (p < 0.05) among drivers working on HTR. After MR, significant correlations were found between wind speed and heavy eyelid feeling, being prone to forgetting, eye strain, frequent blinking, and between ambient temperature and feeling thirsty. After HTR feeling thirsty, tiredness and difficulty in making decisions correlated with ambient temperature and feeling thirsty with wind speed. Climate conditions can modify the drivers fatigue; therefore, we should be aware of their impact on well-being.

Designing an Alarm Fatigue Assessment Questionnaire: Evaluation of the Validity and Reliability of an Instrument

Background In intensive care units (ICU), there should be some more facilities and equipment such as ventilators, monitors, suction pumps, etc. These devices are equipped with an alarm system in their settings. Sometimes, too many alarms cause alarm fatigue among nurses and consequently would jeopardize the safety of patients. Therefore, the current study aimed at designing a tool to assess the alarm fatigue among nurses.Methods In the current developmental, analytic study, using reliable databases, an alarm fatigue questionnaire was designed with 32 items. The content of the tool was measured by the panel of experts and its reliability was measured by Cronbach’s alpha. Data were analyzed with SPSS software version 21.Results The results showed that 9 out of 32 items of the questionnaire had low content validity index and ratio (CVI/CVR) and should be rejected; the index value of the questionnaire was 0.7 that was acceptable. The results showed that the final questionnaire was reliable (α = 0.806) with test-retest, which was repeatable.Conclusions Since the alarm fatigue can jeopardize the patients’ safety, it is required to use a reliable tool for its assessment. According to the obtained results in the current study, the present questionnaire had a relatively appropriate validity.

Determinants of physical, affective, and cognitive fatigue during breast cancer therapy and 12 months follow-up.

Fatigue is common in cancer survivors but often insufficiently treated. Due to its complexity a one-size-fits-all treatment seems not appropriate. To gain more information on influencing factors and sub-dimensions of fatigue we investigated potential determinants and correlates of physical, affective, and cognitive fatigue in breast cancer survivors during and after adjuvant therapy. Within the follow-up of two randomized controlled trials physical, affective, and cognitive fatigue were repeatedly assessed during and up to 12 months after cancer therapy with the 20-item Fatigue Assessment Questionnaire in 255 breast cancer survivors. Determinants of the different fatigue dimensions over time were explored with linear mixed models. Chemotherapy appeared as significant precipitating factor for physical fatigue. However, type of cancer therapy had no impact on fatigue one year post-treatment. Obesity was significantly associated with increased physical fatigue throughout all time points (Δ=15.5 at 12 months) whereas exercise appeared to be beneficial (Δ = -6.3). In contrast, affective fatigue was significantly associated with poor social support and worries about the future. In addition, poor sleep quality and previous use of psychopharmaceuticals were significantly associated with physical, affective, as well as cognitive fatigue. Further, hot flashes were associated with increased physical and cognitive fatigue. In conclusion, the broad diagnosis 'fatigue' in cancer survivors needs to be recognized as a diversity of symptoms determined by specific characteristics and likely different etiologies. Taking potential influencing factors such as obesity, physical inactivity, sleep problems, hot flashes, lack of social support, or psychological disorders into consideration might enable a better, individually-tailored fatigue treatment.

Inflammation and Resistance Exercise in Breast Cancer Patients undergoing Adjuvant Radiotherapy

PURPOSE: Exercise interventions have shown to reduce cancer-related fatigue and pain in breast cancer patients undergoing radiotherapy. Within a randomized controlled trial, we aimed to explore the mediating role of inflammatory parameters in the development of these symptoms during adjuvant radiotherapy and its mitigation by resistance exercise. METHODS: The randomized trial compared a 12-week progressive resistance exercise training (EX) with a 12-week relaxation control group. In 103 chemotherapy-naïve participants, interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) were measured in serum samples collected before, at the end, and 6-weeks post-radiotherapy. Fatigue was assessed with the multidimensional Fatigue Assessment Questionnaire (FAQ), and pain with the EORTC QLQ-C30. Analysis of covariance (ANCOVA) models, partial correlations, Freedman-Schatzkin tests, and R2 effect-size measures for mediation were calculated. RESULTS: The ANCOVA models revealed a significant intervention effect on IL-6 (p=0.010) and the IL-6/IL-1ra ratio (p=0.018), characterized by a marked increase during radiotherapy among controls, but no significant change in EX. IL-1ra did not change significantly in either group (p=0.88). Increased IL-6 and IL-6/IL-1ra levels at the end of radiotherapy were significantly associated with increased physical fatigue and pain 6 weeks post-radiation. The effect of resistance exercise on physical fatigue was significantly mediated by IL-6 and IL-6/IL-1ra, but not by IL-1ra. IL-6 and IL-6/IL-1ra mediated between 15% and 24% of the variance of physical fatigue and pain explained by the intervention. CONCLUSIONS: This randomized controlled trial showed a significantly increased pro-inflammatory cytokine level after adjuvant radiotherapy in breast cancer patients. This effect was counteracted by progressive resistance exercise training. IL-6 and the IL-6/IL-1ra ratio appeared to mediate the beneficial effect of exercise on physical fatigue and pain, but only to a small extent. Supported by Intramural Funding of the National Center for Tumor Diseases (NCT), Heidelberg, Germany.

Resistance Exercise and Inflammation in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: Mediation Analysis From a Randomized, Controlled Intervention Trial

To explore the mediating role of inflammatory parameters in the development of fatigue, pain, and potentially related depressive symptoms during radiation therapy for breast cancer and its mitigation by resistance exercise. Breast cancer patients scheduled for adjuvant radiation therapy were randomized to 12-week progressive resistance exercise training (EX) or a relaxation control group. Interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) were measured in serum samples collected before, at the end, and 6 weeks after radiation therapy from 103 chemotherapy-naïve participants. Fatigue was assessed with the multidimensional Fatigue Assessment Questionnaire, pain with the European Organization for Research and Treatment of Cancer QLQ-C30, and depressive symptoms with the Center for Epidemiologic Studies Depression Scale. Analysis of covariance models, partial correlations, Freedman-Schatzkin tests, and R(2) effect-size measures for mediation were calculated. The analysis of covariance models revealed a significant intervention effect on IL-6 (P=.010) and the IL-6/IL-1ra ratio (P=.018), characterized by a marked increase during radiation therapy among controls, but no significant change in EX. Interleukin-1 receptor antagonist did not change significantly in either group (P=.88). Increased IL-6 and IL-6/IL-1ra levels at the end of radiation therapy were significantly associated with increased physical fatigue and pain 6 weeks after radiation. We observed significant partial mediation by IL-6 and IL-6/IL-1ra of the effect of resistance exercise on physical fatigue (Freedman-Schatzkin P=.023 and P<.001) and pain (both P<.001). Hereby IL-6 and IL-6/IL-1ra mediated between 15% and 24% of the variance of physical fatigue and pain explained by the intervention. This randomized, controlled trial showed a significantly increased proinflammatory cytokine level after adjuvant radiation therapy in breast cancer patients. This effect was counteracted by progressive resistance exercise training. Interleukin-6 and the IL-6/IL-1ra ratio seemed to mediate the beneficial effect of exercise on physical fatigue and pain but only to a small extent.

Cancer-related fatigue shows a stable association with diurnal cortisol dysregulation in breast cancer patients

Fatigue is a major burden for breast cancer patients undergoing adjuvant therapy. Yet, its pathophysiology is still not well understood. Hypothesized mechanisms include dysregulations in the hypothalamic–pituitary–adrenal (HPA) axis, which may be reflected in alterations in the diurnal cortisol patterns. However, studies on the association between cortisol and fatigue during adjuvant cancer therapy are rare.We therefore assessed salivary cortisol at awakening, 0.5h post-awakening, noon, 5pm and 10pm/bedtime in 265 breast cancer patients undergoing adjuvant therapy at three timepoints. Cancer-related fatigue was assessed with the Fatigue Assessment Questionnaire (FAQ) covering the physical, affective, and cognitive fatigue dimensions. Multiple linear regression analyses were performed cross-sectionally at the three timepoints as well as longitudinally considering changes in cortisol and fatigue over time. The results showed that the physical dimension of cancer-related fatigue was significantly associated with increased evening cortisol levels and higher overall cortisol secretion. These associations were independent of depressive symptoms. Morning cortisol levels, the cortisol awakening response and the diurnal slope were not consistently associated with physical fatigue. Affective and cognitive fatigue showed no clear association with any of the cortisol parameters.In conclusion, the physical but not the affective or cognitive dimension of fatigue seems associated with cortisol dysregulations in breast cancer patients undergoing adjuvant therapy, characterized by an unaffected cortisol level in the morning but blunted decline to the evening level. Research focusing on disturbances of the cortisol rhythm and HPA dysregulations during and after cancer treatment may open new strategies to reduce cancer-related fatigue.

A survey of the relationship between work schedule and its effect on the fatigue of rescue personnel in Isfahan with a standard method of CIS202.

Context:Fatigue is a factor that can have negative effects on family life, social relationship and work. Work schedule is one of the affective factors on personnel's fatigue in different jobs. In this study, the work schedule and its effect on rescue personnel in Isfahan are explored.Aims:The purpose of this study was to investigate the relationship between work schedules and fatigue among rescue personnel.Settings and Design:This study is periodical and has been conducted on 72 employees of rescue personnel in Isfahan.Materials and Methods:Random sampling was done and the primary data that was collected through fatigue assessment questionnaire after being conducted as a pilot study on 10% of samples were collected to confirm the validity of this study. Finally, the data was given to SPSS11.5 software and were analyzed by descriptive statistics and linear digression.Results:The results showed that from the statistical point of view some parts of work schedules like work hours satisfaction, resting time and work order on total fatigue are effective in linear and inverse way but the item “predictibility of work conditions” does not have a meaningful relationship with total fatigue. Furthermore, the results showed that there is a meaningful and inverse relationship with work hours, resting time and work order with mental fatigue and also the work schedule has a meaningful, linear and inverse relation with mental fatigue and total fatigue.Conclusions:By increasing the satisfaction of working hours, increasing resting time and also with an increase of work order the total fatigue of rescue personnel will decrease.

The Minimally Important Difference for Patient-reported Outcomes in Spondyloarthropathies including Pain, Fatigue, Sleep, and Health Assessment Questionnaire

To study minimal important differences (MID) in spondyloarthropathies (SpA). MID are important in determining clinically relevant changes and for interpretation of trials and treating patients. MID have been widely studied in rheumatoid arthritis, but less so in SpA. Patients with SpA had to be seen for 2 consecutive visits and have completed the Health Assessment Questionnaire (HAQ) and 100 mm visual analog scale on both visits for fatigue, pain, sleep, and global assessment. At the second visit they had to answer a question regarding any change in their overall health (from last visit), responding with much better, better, same, worse, or much worse. The MID were the mean changes for those who were either better or worse. Our study involved 140 eligible patients with a SpA: 69% were men, the mean age was 45 years, and the mean disease duration was 14.5 years. Almost half the patients rated themselves as unchanged from the previous visit but the remainder were either better or worse, with a minority rating themselves as much better or much worse. The MID for better and worse outcomes were HAQ (-0.136; 0.220), pain (-6.93; 18.97), fatigue (-1.43; 14.42), and sleep (-2.23; 10.76). No gender differences were observed. Our results demonstrate that the MID vary depending on better versus worse (bidirectionally different). MID may be smaller in clinical practice than what is observed in trials.

Evaluating Cognitive, Emotional, and Physical Fatigue Domains in Daily Practice by Single-Item Questions in Patients With Advanced Cancer: A Cross-Sectional Pragmatic Study

To assess cancer-related fatigue (CRF), multidimensional questionnaires are required. The aim of this study was to evaluate single-item fatigue (SIF) screening questions—one for global fatigue and three for the fatigue domains (cognitive, emotional, and physical)—for their immediate use in daily oncology practice. Sixty-one fatigued patients with advanced cancer completed SIF assessments (visual analog scales for global fatigue and for fatigue in the cognitive, emotional, and physical domains, respectively), and the Brief Fatigue Inventory (BFI), the Fatigue Assessment Questionnaire (FAQ), the Hospital Anxiety and Depression Scale (HADS), and the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life-C30 (QLQ-C30). SIF-global correlated with BFI ( r = 0.51), and the domain-SIFs correlated with their respective FAQ domains (cognitive r = 0.59; affective r = 0.45; physical r = 0.33) and functional EORTC QLQ-C30 subscales ( r = 0.62; r = 0.42; r = 0.34). The SIF-emotional also correlated with HADS-Anxiety ( r = 0.43) and HADS-Depression ( r = 0.62). Principal component analysis (domain-SIF; respective FAQ and functional EORTC QLQ-C30 subscales) revealed three clusters and a two-factor model (cognitive/emotional, physical), explaining 74% of variability. Patients with one predominant SIF domain had more domain-tailored fatigue interventions than had patients with mixed SIFs. These data suggest that three simple SIF questions permit rapid assessment of the physical and cognitive and probably the emotional domains of CRF in patients with advanced cancer.

Fatigue in patients with adjuvant radiation therapy for breast cancer: long-term follow-up.

The aim of this study was to evaluate fatigue 2.5 years after adjuvant radiation therapy (RT) in patients with localized breast cancer and to assess its relation to pre- and immediate post-treatment fatigue values. The association of fatigue with psychological distress and functional impairment was analyzed as well as pretreatment predictors for chronic fatigue. Of a set of 41 patients whose fatigue was evaluated during adjuvant radiation therapy, 38 patients alive and free of cancer at 2.5 years (t2) after RT were assessed in this study. Patients received the Fatigue Assessment Questionnaire (FAQ), a visual analog scale on fatigue intensity (VAS-F) as well as on cancer-related distress (VAS-D), the Hospital Anxiety and Depression Scale (HADS), and three questions of the Short-Form 36-Item Health Survey (SF-36) per mail. All 38 patients returned their questionnaires. The values were compared to pretreatment (t0) and immediate post-treatment levels (2 months after RT, t1). There was no significant difference between chronic fatigue levels at 2.5 years after RT and pretreatment values. When compared to immediate post-treatment levels the FAQ global score and the HADS anxiety score displayed a significant increase. Cancer-related distress correlated closely with fatigue scores. Patients with functional impairment had slightly higher fatigue values. Age or hormonal therapy were not associated with chronic fatigue levels. Pretreatment fatigue and pretreatment HADS anxiety and depression scores were good predictors of fatigue at 2.5 years after RT explaining 60% (FAQ) and 49% (VAS-F) of its variance. Fatigue 2.5 years after RT did not increase above baseline levels before RT in conservatively operated breast cancer patients. Chronic fatigue correlated closely with psychological distress. Patients with pretreatment elevated fatigue, anxiety or depression levels are at risk for chronic fatigue.

Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer

Purpose: To assess the level of fatigue during the course of adjuvant radiotherapy (RT) of breast cancer patients and its relation to anxiety, depression, serum cytokines, and blood count levels.Methods and Materials: Forty-one patients who received adjuvant RT after breast-conserving surgery were prospectively studied. All patients underwent RT without concomitant chemotherapy. Patients rated their fatigue with two standardized self-assessment instruments, the Fatigue Assessment Questionnaire and a visual analog scale on fatigue intensity, before RT, during weeks 1–5 of RT, and 2 months after RT completion. In addition, the anxiety and depression levels were assessed with the Hospital Anxiety and Depression Scale. A differential blood cell count and the serum levels of the cytokines interleukin (IL)-1β, IL-6, and tumor necrosis factor-α were determined in parallel to the fatigue assessments.Results: Fatigue intensity as assessed with the visual analog scale increased (p <0.001) until treatment week 4 and remained elevated until week 5. Two months after RT, the values had fallen to the pretreatment levels. Fatigue measured with the Fatigue Assessment Questionnaire did not increase significantly during treatment, but the subscores on physical (p = 0.035) and cognitive (p = 0.015) fatigue were elevated during treatment weeks 4 and 5. Affective fatigue did not change significantly. Anxiety, as rated with the Hospital Anxiety and Depression Scale, declined during RT (p = 0.002), but the Hospital Anxiety and Depression Scale depression score did not change significantly. IL-1β, IL-6, and tumor necrosis factor-α levels did not change during therapy and did not correlate with fatigue. Peripheral blood cell levels declined significantly during therapy and were still low 2 months after treatment. Until treatment week 5, lymphocytes were reduced to almost 50% of their initial values. Hemoglobin levels did not correlate with fatigue.Conclusions: We observed an increase in fatigue during adjuvant RT of patients with breast cancer. Fatigue returned to pretreatment levels 2 months after treatment. No evidence was found that anxiety, depression, serum levels of IL-1β, IL-6, tumor necrosis factor-α, or declining hemoglobin levels were responsible for the treatment-induced fatigue.