Fatigue Symptom Inventory Research Articles

Tai Chi Exercise for Cancer-Related Fatigue in Patients With Lung Cancer Undergoing Chemotherapy: A Randomized Controlled Trial

ContextTai Chi is a traditional Chinese health-promoting exercise. It has been shown to enhance mental health and improve psychological condition. ObjectivesWe aimed to assess the effectiveness of Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy. MethodsWe conducted a randomized trial of Tai Chi exercise as compared with low-impact exercise as a control intervention. Exercises were practiced every other day, a one-hour session for 12 weeks for each of the study groups. The primary end point was a change in total score of the Multidimensional Fatigue Symptom Inventory–Short Form (MFSI-SF). Secondary end points were changes in five subscale scores of the MFSI-SF. All assessments were repeated at three time points, T0: before first course of chemotherapy; T1: before third course of chemotherapy; and T2: at the end of the fourth course of chemotherapy. ResultsBetween January 2012 and December 2014, 96 patients were enrolled in this trial. At six and 12 weeks, the Tai Chi group had a lower MFSI-SF total score compared with the control group (59.5 ± 11.3 vs. 66.8 ± 11.9, P < 0.05; 53.3 ± 11.8 vs. 59.3 ± 12.2, P < 0.05). At six weeks, the Tai Chi group had lower MFSI-SF general subscale scores (18.1 ± 4.6 vs. 20.4 ± 4.5, P < 0.05) and physical subscale scores (17.5 ± 4.4 vs. 19.1 ± 4.5, P < 0.05), and higher MFSI-SF vigor subscale scores (14.5 ± 3.3 vs. 11.6 ± 3.4, P < 0.05), compared with the control group. But no significant differences were found in emotional subscale (20.2 ± 3.6 vs. 20.0 ± 3.5, P > 0.05) and mental subscale (18.2 ± 4.0 vs. 18.9 ± 3.9, P > 0.05) scores between the Tai Chi group and the control group. At 12 weeks, the MFSI-SF subscale scores showed the same trends as at six weeks. ConclusionTai Chi is an effective intervention for managing cancer-related fatigue in patients with lung cancer undergoing chemotherapy, especially for decreasing general fatigue and physical fatigue, and increasing vigor.

Fatigue screening in breast cancer patients: identifying likely cases of cancer-related fatigue.

For clinical and research purposes, efficient identification of cases of cancer-related fatigue (CRF) is important, as CRF can be persistent and interfere with usual functioning. While various fatigue-screening instruments are available, no brief screening indices have been developed using formally diagnosed CRF cases as the criterion. Breast cancer patients (n = 385) completed a fatigue diagnostic interview and self-report fatigue measures (Profile of Mood States-fatigue subscale, Fatigue Symptom Inventory, and SF-36 vitality subscale), after initial adjuvant therapy (post-treatment (post-Tx) 1 assessment), after completion of radiotherapy for women receiving chemotherapy + radiotherapy (post-Tx 2 assessment), and 6 months after completion of all adjuvant therapy (6-month post-Tx assessment). CRF cases were identified using specific diagnostic criteria. ROC analyses identified screening indices, which could accurately identify CRF cases after initial adjuvant therapy. Screening indices were cross-validated using post-Tx 2 and 6-month follow-up assessment data. A total of 104 women (27%) met CRF criteria after initial adjuvant therapy. Six two-item screening indices were identified. For all indices, area under the curve exceeded 0.80, sensitivity exceeded 0.80, and specificity exceeded 0.57. Cross-validation suggested that, except for the index based on SF-36, all the indices continued to accurately identify CRF cases at the post-Tx 2 and 6-month post-Tx assessments. Overall, a two-item composite index based on Fatigue Symptom Inventory 'most severity' and 'work interference' items performed best. Breast cancer patients and survivors meeting CRF diagnostic criteria can be accurately identified using brief screening indices derived from common self-report fatigue measures.

Adjuvant effects of fermented red ginseng extract on advanced non-small cell lung cancer patients treated with chemotherapy.

To investigate the adjuvant therapeutic effects of fermented red ginseng (FRG) extract on non-small cell lung cancer (NSCLC) patients treated with chemotherapy. A total of 60 patients with advanced NSCLC were divided into two groups using a random number table, i.e., the gemcitabine plus cisplatin (GP) chemotherapy alone group (26 patients) and the FRG + GP chemotherapy group (34 patients), for 60-day treatment. Patients were then assessed according to the Fatigue Symptom Inventory, Chinese medicine symptoms score, Self-Rating Anxiety Scale, Self-Rating Depression Scale, Karnofsky Performance Status Scale, and Functional Assessment of Cancer Therapy-Lung. In addition, chemotherapy toxicity and tumor biomarkers were measured. For NSCLC patients after chemotherapy, FRG extract significantly improved the FSI score, CM symptoms score, psychological status, physical conditions, and quality of life and reduced chemotherapy toxicity, but the expression levels of carcinoembryonic antigen, cytokeratin-19 fragments, and neuron-specific enolase were not significantly different between the chemotherapy alone and the FRG + chemotherapy groups or between pre- and post-treatments. This study demonstrated that FRG extract had an adjuvant effect on advanced NSCLC patients treated with chemotherapy. Further studies with a larger sample size will verify the current findings.

Abstract P2-12-08: Chemotherapy-induced fatigue and mitochondrial function in early stage breast cancer

Abstract Introduction Patients with early stage breast cancer receiving chemotherapy (CT) may experience persistent fatigue. The mechanisms for fatigue are not well understood. We hypothesized that CT-induced fatigue may involve perturbations in mitochondrial function. We therefore examined the development of fatigue in patients during adjuvant or neoadjuvant CT and measured mitochondrial function in their peripheral blood mononuclear cells (PBMCs). Methods Females with Stage I-III breast cancer patients, ages 35-75 years, were enrolled in an IRB-approved study. Patients with coexisting illnesses associated with chronic fatigue were excluded. Patients self-reported fatigue severity using the 14-question Fatigue Symptom Inventory (FSI) that rates fatigue intensity on a 10-point scale. Data [FSI and PBMCs] were collected prior to CT, mid-point in the course of CT, 2 - 3 weeks after completion of CT, and 3 and 6 months later. Mitochondrial function in PBMCs from patients was measured using a Seahorse Bioscience XF24 analyzer at corresponding times. Results Results on CT-induced fatigue are available for 67 patients. The overall fatigue score for each patient was measured as the sum of the scores for all 14 questions in the FSI. The average fatigue score for the 67 patients prior to chemotherapy was 20. Baseline fatigue scores for patients who had adjuvant CT were much greater than for patients receiving neoadjuvant CT (R2=1). Patient fatigue scores doubled after starting chemotherapy (average score 40, p &amp;lt; 0.001). Even though fatigue scores improved after treatment completion (average score 26 at 6 months), the scores did not return to baseline 6 months later (p=0.02). In our population, CT-induced fatigue did not correlate with patient age regardless of the CT regimen [r=0.3 and r= -.2, for doxorubicin plus cyclophosphamide (AC) vs docetaxel plus cyclophosphamide (TC) groups, respectively)] or a decrease in hemoglobin (r= -.3 and r=0.03, for AC and TC, respectively). None of these correlations could explain more than 9% of the change in treatment-induced fatigue (p=0.2). Preliminary analysis of mitochondrial function in 12 patients shows that 9 patients had a decrease in mitochondrial reserve capacity with an increase in CT-induced fatigue following completion of 4 cycles of CT. 3 patients had a decrease in mitochondrial reserve capacity but reported no significant change in their fatigue scores. Mitochondrial function data on all patients have been collected and are presently being analyzed. Conclusion Our study shows that early stage breast cancer patients treated with adjuvant or neoadjuvant CT may experience fatigue that can persist for months after completion of treatment and cannot be explained by the CT regimen, age, or anemia. Our initial results suggest a link between CT-induced fatigue and changes in mitochondrial function in some patients. Mitochondrial function analysis and its correlation with fatigue for all 67 patients will be completed and reported at SABCS. Mitochondrial function may prove to be a biomarker for CT-induced fatigue in certain patients and may help identify patients for whom interventions that stimulate mitochondria biogenesis, including pharmacologic agents and exercise, may be beneficial in ameliorating this side-effect. Citation Format: Kanchana Herath, Brian P Dranka, George M Lessmann, Donna McAllister, Raymond G Hoffmann, Balaraman Kalyanaraman, Christopher R Chitambar, Namrata I Peswani. Chemotherapy-induced fatigue and mitochondrial function in early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-08.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning

ObjectiveTo determine the impact of postpolio-syndrome on quality of life in polio survivors. MethodsForty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. ResultsTotal manual muscle testing score was 26.19±13.24 (median: 29) in postpolio-syndrome group and 30.08±8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. ConclusionsPostpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

Effects of a selective educational system on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan.

ObjectiveThe aim of the study reported here was to clarify the effects of academic pressure on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan.MethodsThis cross-sectional study enrolled 757 senior high school adolescents who were classified into four groups: Grade 1 (n=261), Grade 2 (n=228), Grade 3T (n=199; Grade 3 students who had another college entrance test to take), and Grade 3S (n=69; Grade 3 students who had succeeded in their college application). Fatigue, sleep quality, daytime sleepiness, and depression were assessed using the Chinese version of the Multidimensional Fatigue Symptom Inventory – Short Form, Pittsburgh Sleep Quality Index-Taiwan Form, the Chinese version of the Epworth Sleepiness Scale, and the Chinese version of the Beck Depression Inventory®-II (BDI-II), respectively.ResultsPhysical, emotional, and mental fatigue scores were all higher in higher-grade groups. The Grade 3T (test) students had the worst fatigue severity, and the Grade 3S (success) students had the least fatigue severity. More than half of the students (60.9%) went to bed after 12 am, and they had on average 6.0 hours of sleep per night. More than 30% of the students in Grade 2 (37.3%) and Grades 3T/S (30.2%/30.4%) possibly had daily sleepiness problems. The students in Grade 3T had the worst BDI-II score (13.27±9.24), and the Grade 3S students had a much lower BDI-II score (7.91±6.13).ConclusionRelatively high proportions of fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents were found in our study. The severities of fatigue, sleep problems, and depression were significantly diminished in the group under less academic stress (Grade 3S). Our findings may increase the understanding of the mental health of senior high school students under academic pressure in Taiwan. Further large sample size and population-based study should be done for better understanding about this topic.

Qualidade de vida relacionada com a saúde em sobreviventes turcos da pólio: impacto pós‐pólio na saúde relacionada com a qualidade de vida em termos de estado funcional, gravidade da dor, fadiga e funcionamento social e emocional

ObjectiveTo determine the impact of postpolio‐syndrome on quality of life in polio survivors. MethodsForty polio survivors were included in the study. Twenty‐one patients fulfilling the Halstead's postpolio‐syndrome criteria participated in postpolio‐syndrome group. The remaining nineteen patients formed non‐postpolio‐syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. ResultsTotal manual muscle testing score was 26.19±13.24 (median: 29) in postpolio‐syndrome group and 30.08±8.9 (median: 32) in non‐postpolio‐syndrome group. Total manual muscle testing scores of non‐postpolio‐syndrome group were significantly higher than that of postpolio‐syndrome group. Patients with postpolio‐syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio‐syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio‐syndrome, non‐postpolio‐syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. ConclusionsPostpolio‐syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio‐syndrome patients may result in an improvement in their quality of life.

Effective Factors on Fatigue Rate in Type Two Diabetes Patients: An Investigation

Background: Complications and diabetes-related difficulties such as fatigue are among the major hindrances in improving health behaviors such as the participation in diabetes self-care programs. Objectives: This study investigates the factors influencing fatigue levels in type two diabetes patients given the significance of fatigue and its consequences on controlling diabetes as well as regarding the significant role of the community health nurses in treating and educating patients. Patients and Methods: The present study is a quantitative research with a descriptive design. The participants of the study were 195 patients with type two diabetes supported by Isfahan Endocrine and Metabolism Research Centre. They were selected via available sampling method. The instrument of data collection was a written questionnaire that consists of two-part demographic information section and a short form of the Multidimensional Fatigue Symptom Inventory (MFSI-SF). The collected data were analyzed using SPSS (ver 16). The significance value for all the tests in the study was P ˂ 0.05. Results: There were significant statistical differences (P ˂ 0.05) between the mean fatigue scores for females (23.22 ± 17.49) and males (13.24 ± 17.73). Among the investigated factors, there was a significant statistical association among the fatigue mean total score and body mass index, (F = 9.521, df = 2, P ˂ 0.05), physical activity (t = 3.90, df = 190, P ˂ 0.05), and complications such as nephropathy, neuropathy, and foot ulcer history. Conclusions: Fatigue in diabetes is a complex and multifaceted phenomenon, which can be controlled and treated effectively, if it is evaluated appropriately, and the factors that cause it are investigated.

Cancer-related fatigue and depression in breast cancer patients postchemotherapy: Different associations with optimism and stress appraisals.

Symptoms of depression and cancer-related fatigue (CRF) are common among breast cancer patients postchemotherapy and may seriously impair quality of life (QoL). This study aimed to assess the relationship between depression and CRF in breast cancer patients postchemotherapy and to examine their relationships to optimism and to threat and challenge appraisals. Participants included 95 breast cancer patients (stages 1-3) 1 to 6 months after completion of chemotherapy. Patients submitted personal and medical details and completed the following: physical symptom questionnaires (EORTC QLQ-C30, and QLQ-BR23), a symptoms of depression questionnaire (CES-D), the Fatigue Symptom Inventory (FSI), the Life Orientation Test (LOT-R), and a stress appraisals questionnaire. We found levels of depression, CRF, and appraisals of cancer as a threat to bemoderate and levels of optimism and appraisals of cancer as a challenge to be high. Depression and CRF were positively associated. A multivariate regression analysis revealed that 51% of the CRF variancewas explained; physical symptoms and threat appraisal were significantly associated with CRF. A 67% of the CRF variance of depression was explained; challenge and threat appraisals were significantly associated with depression [corrected]. Although CRF and depression were often experienced simultaneously and both were found to be higher among individuals who gave higher appraisals of cancer as a threat, only depression was related to optimism and challenge appraisals, while CRF was related mainly to intensity of physical symptoms. The different pattern of associations between optimism and appraisals warrants further clinical attention as well as future study.

Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer.

To examine whether day-to-day variations in sleep behaviors, ongoing sleep disturbance, and fatigue predict the cortisol diurnal rhythm in women recently diagnosed as having early-stage breast cancer. Women (N = 130, mean [standard deviation] age = 55.6 [9.4] years) collected saliva 5×/day/2 days for cortisol. Diaries were used to assess prior-day nap duration, nocturnal awakenings, sleep latency, and morning restfulness. Ongoing fatigue and sleep disturbance were measured using the Multidimensional Fatigue Symptom Inventory and the Pittsburg Sleep Quality Inventory. Data were analyzed using a multilevel growth curve modeling. Greater ongoing fatigue (b = 0.035, p = .032), or sleep disturbance (b = 0.026, p = .006) predicted a slower cortisol decline. Greater ongoing fatigue also predicted higher awakening cortisol (b = 0.154, p = .030) and lower cortisol awakening response (CAR; b = -0.146, p = .005). Longer prior-day naps predicted higher CAR (b = 0.042, p = .050) and a steeper cortisol decline (b = -0.035, p = .003). Longer sleep latency predicted both a greater cortisol linear decline (b = -0.013, p < .001) and a greater quadratic slope curvature (b = 0.0007, p < .001). Feeling less rested in the morning predicted lower awakening cortisol (b = -0.187, p = .004), higher CAR (b = 0.124, p = .016), and a slower cortisol decline (b = 0.023, p = .042). Both daily variations in sleep behaviors and ongoing sleep disturbance and fatigue are associated with a disrupted cortisol rhythm. In contrast, prior-day napping is associated with a more robust cortisol rhythm. These findings are particularly relevant to women with breast cancer who often experience sleep disturbance and fatigue. Additional research is needed to determine causal pathways between sleep disturbance and dysregulation of the hypothalamic-pituitary-adrenal axis in patients with breast cancer.

Fatigue in the Presence of Coronary Heart Disease

Fatigue is a prevalent and disabling symptom associated with many acute and chronic conditions, including acute myocardial infarction and chronic heart failure. Fatigue has not been explored in patients with stable coronary heart disease (CHD). The purpose of this partially mixed sequential dominant status study was to (a) describe fatigue in patients with stable CHD; (b) determine if specific demographic (gender, age, education, income), physiological (hypertension, hyperlipidemia), or psychological (depressive symptoms) variables were correlated with fatigue; and (c) determine if fatigue was associated with health-related quality of life. The theory of unpleasant symptoms was used as a conceptual framework. Patients (N = 102) attending two cardiology clinics completed the Fatigue Symptom Inventory, Patient Health Questionnaire-9, and Medical Outcomes Study Short Form-36 to measure fatigue, depressive symptoms, and health-related quality of life. Thirteen patients whose interference from fatigue was low, moderate, or high participated in qualitative interviews. Forty percent of the sample reported fatigue more than 3 days of the week lasting more than one half of the day. Lower interference from fatigue was reported on standardized measures compared with qualitative interviews. Compared with men, women reported a higher fatigue intensity (p = .003) and more interference from fatigue (p = .007). In regression analyses, depressive symptoms were the sole predictor of fatigue intensity and interference. Patients with stable CHD reported clinically relevant levels of fatigue. Patients with stable CHD may discount fatigue as they adapt to their symptoms. Relying solely on standardized measures may provide an incomplete picture of fatigue burden in patients with stable CHD.

Sleep Quality and Fatigue after a Stress Management Intervention for Women with Early-Stage Breast Cancer in Southern Florida

Sleep disruption and fatigue are ubiquitous among cancer patients and are sources of stress that may compromise treatment outcomes. Previously, we showed that a cognitive behavioral stress management (CBSM) intervention reduced anxiety and other stress-related processes in women undergoing primary treatment for breast cancer. This study examined secondary outcomes from a CBSM intervention trial for women with early-stage breast cancer to test if CBSM would improve sleep quality and fatigue among these patients at a single site in southern Florida. CBSM-related effects have already been demonstrated for indicators of psychosocial adaptation (e.g., general and cancer-related anxiety). Patients were randomized to CBSM (n= 120) or a 1-day psychoeducation control group (n= 120). The Pittsburgh Sleep Quality Index (PSQI) and Fatigue Symptom Inventory were completed prior to randomization and 6 and 12months after the baseline assignment. In latent growth analyses, women in CBSM reported greater improvements in PSQI sleep quality scores than controls, although there were no significant differences between conditions on PSQI total scores. Women in CBSM also reported greater reductions in fatigue-related daytime interference than controls, though there were no significant differences in changes in fatigue intensity. Changes in sleep quality were associated with changes in fatigue. Future work may consider integrating sleep and fatigue content into stress management interventions for women with early-stage breast cancer.

Sleep, Fatigue, and Functional Health in Psychotic Patients

This study sought to examine the association between sleep, fatigue, and functional health in psychotic patients. Participants included 93 psychotic inpatients (n = 67 with schizophrenia) who completed the Chalder Fatigue Scale (ChFS), the Fatigue Symptom Inventory (FSI), the Pittsburgh Sleep Quality Index (PSQI), and the SF36 Health Survey. Patients were classified on the basis of their performance on sleep and fatigue measures: 60% reported significant levels of fatigue and 67% significant sleep disturbances. 28.4% reported both, suggesting that fatigue and sleep dysfunctions do not necessarily cooccur. A closer examination of patterns showed that fatigue was only related to qualitative aspects of sleep and not quantifiable aspects of sleep disturbances. The results also showed that functional health was the lowest in patients with high levels of fatigue, compared to patients with sleep problems only or patients with neither symptom. A regression analysis further showed that the size of the contribution of fatigue onto functional health was twice as much as that of sleep dysfunctions. In conclusion, the results show that (i) dissatisfaction with sleep—and not sleep itself—is related to fatigue symptoms and that (ii) fatigue is particularly detrimental to functional health, regardless of the presence of sleep dysfunctions.

PC-FACS

PC-FACS

Fatigue and circadian activity rhythms in breast cancer patients before and after chemotherapy: a controlled study

Background: Breast cancer (BC) patients often experience cancer-related fatigue (CRF) before, during, and after their chemotherapy. Circadian rhythms are 24-hour cycles of behavior and physiology that are generated by internal pacemakers and entrained by zeitgebers (e.g., light). A few studies have suggested a relationship between fatigue and circadian rhythms in some clinical populations. Methods: One hundred and forty-eight women diagnosed with stage I–III breast cancer and scheduled to receive at least four cycles of adjuvant or neoadjuvant chemotherapy, and 61 controls (cancer-free healthy women) participated in this study. Data were collected before (Baseline) and after four cycles of chemotherapy (Cycle-4). Fatigue was assessed with the Short Form of Multidimensional Fatigue Symptom Inventory (MFSI–SF); circadian activity rhythm (CAR) was recorded with wrist actigraphy (six parameters included: amplitude, acrophase, mesor, up-mesor, down-mesor and F-statistic). A mixed model analysis was used to examine changes in fatigue and CAR parameters compared to controls, and to examine the longitudinal relationship between fatigue and CAR parameters in BC patients. Results: More severe CRF (total and subscale scores) and disrupted CAR (amplitude, mesor and F-statistic) were observed in BC patients compared to controls at both Baseline and Cycle-4 (all p's < 0.05); BC patients also experienced more fatigue and decreased amplitude and mesor, as well as delayed up-mesor time at Cycle-4 compared to Baseline (all p's < 0.05). The increased total MFSI–SF scores were significantly associated with decreased amplitude, mesor and F-statistic (all p's < 0.006). Conclusion: CRF exists and CAR is disrupted even before the start of chemotherapy. The significant relationship between CRF and CAR indicate possible underlying connections. Re-entraining the disturbed CAR using effective interventions such as bright light therapy might also improve CRF.

Fatigue, Distress, and Quality of Life As Covariates for Early-Stage Chronic Lymphocytic Leukemia

Abstract 2075 Objectives of the studyDespite the prevalence of Chronic lymphocytic leukemia (CLL) among the leukemias (American Cancer Society, 2012), little research has examined the psychological and quality of life correlates of this disease. Virtually no research has focused on these factors as related to the experiences of monitoring through active surveillance. Further, it is unknown if the psychological distress of these patients covaries with their reports of symptoms and signs associated with this disease. Research shows that cancer diagnosis is associated with significant distress and immunologic perturbations (Andersen et al., 1998). We hypothesize that the unique nature of coping with CLL diagnosis yet receiving no subsequent therapy may be associated with increased uncertainty, worry, and other symptoms of distress. The present study is one of the first to examine adjustment and quality of life in untreated CLL. MethodologyThis cross-sectional study examined correlates of physical and psychological quality of life in 115 early-stage untreated CLL patients. Eligibility for this ongoing trial included patients with stage 0–2 disease aged 20 through 80 (inclusive) with no history of treatment for a prior cancer. Patients were accrued through the OSU James Division of Hematology oncology clinic. Following consent, participants completed a 45-minute telephone assessment using standardized and validated measures of psychological and physical symptoms associated with their CLL and general health. Measures included the following: Center for Epidemiological Studies-Depression Scale (CESD; Radloff, 1977) assessed depressive symptomatology; Medical Outcomes Study (MOS) SF-36 Short-Form Health Survey (SF-36; Ware et al., 1993) examined overall physical and mental quality of life. Measures of anxiety and stress were also examined. The Health Anxiety Questionnaire (HAQ; Lucock & Morley, 1996) assessed overall health-related anxiety and the Impact of Events Scale (IES; Horowitz, Wilner, & Alvarez, 1979; Weiss & Marmar, 1996) examined stress specifically related to CLL. The Fatigue Symptom Inventory (FSI; Hann et al., 1998) assessed fatigue. Hierarchical linear regression was conducted bidirectionally to examine the covarying relationship between fatigue, psychological distress, and quality of life. Results and ConclusionsThe demographic characteristics of this sample were similar to those found in patients participating in CLL clinical trials at the authors’ institution. The majority of the sample was male (55%) with a median age of 62 (range: 37–76 years) and 100% Caucasian. Most participants in the sample had stage 0 (61.4%) disease. Mean time since diagnosis was 4.7 years (range: 0–17 years). Sociodemographic and disease variables were examined to identify appropriate statistical control variables. Age and time since diagnosis were significantly correlated with the physical and psychological variables examined. Hierarchical linear regression demonstrated that fatigue predicted greater depressive symptoms (p<.01), health anxiety manifest through worry (p<.01) and reassurance seeking (p<.05), and CLL-specific stress (p<.01). Fatigue also predicted worse physical (p<.01) and mental (p<.01) quality of life. Each regression was statistically significant when tested bidirectionally; results demonstrated the significance of distress and quality of life predicting fatigue. SignificanceEarly-stage patients are mostly asymptomatic by definition. As such, these results highlight the importance of identifying the subset of early-stage patients for whom significant physical symptoms may be accompanied by greater distress and poorer quality of life. The bidirectional nature of the present results suggests a covariation of distress and physical symptoms, replicating previous research with other cancer patient groups. These finding also support future longitudinal research to better determine the temporal relationship of physical symptoms and distress. Identification of such predictors of worse adjustment better inform patient care both during active surveillance and treatment. These preliminary data are compelling in that they provide a perspective on the biopsychosocial characteristics of this understudied population. Further exploration on these characteristics of quality of life, distress, and physical functioning is warranted. Disclosures:No relevant conflicts of interest to declare.

Comparing the Retrospective Reports of Fatigue Using the Fatigue Symptom Index With Daily Diary Ratings in Women Receiving Chemotherapy for Gynecologic Cancer

ContextFatigue, one of the most common side effects of chemotherapy, is typically assessed via retrospective recall (e.g., over the past week). It is unknown how such retrospective recall of fatigue correlates with daily ratings among people receiving chemotherapy. ObjectivesThe current study compared fatigue recorded in daily diaries with retrospective ratings using the Fatigue Symptom Inventory (FSI) in patients receiving chemotherapy for gynecologic cancer. MethodsDuring the week before and the week after their first infusion of chemotherapy, patients completed daily diaries at 10 AM, 2, and 6 PM and the FSI at the end of each week. ResultsFSI and diary ratings of peak, lowest, and average fatigue were significantly correlated (P < 0.001). When peak, end, average, and variance diary ratings were regressed separately on the average FSI item, each was significant pre-chemotherapy (P < 0.01) and post-chemotherapy (P < 0.05). However, when entered into a stepwise regression model, only the average fatigue diary rating was retained, explaining 52% of the variance pre-chemotherapy and 54% of the variance post-chemotherapy average FSI item (P < 0.001). ConclusionThe FSI keyed to the past week accurately reflects daily ratings of fatigue among patients receiving chemotherapy. This study has important implications, as completing retrospective ratings of fatigue may be less burdensome for cancer patients than daily assessments.

Validation of the Modified Brief Fatigue Inventory in Head and Neck Cancer Patients

The aim of this study is to validate the Modified Brief Fatigue Inventory (MBFI). This is the first instrument designed to measure intensity and frequency of fatigue specifically in head and neck cancer patients, potentially allowing objective measurement in addressing this common symptom in a concise yet thorough fashion. Survey validation. Academic tertiary medical center. The 9-item MBFI was administered to 52 consecutive cancer patients and 57 consecutive controls. Demographics, comorbidities, cancer site, and cancer stage were recorded. Psychometric properties and predictors of the MBFI were analyzed. The MBFI 1-week test-retest reliability was excellent (r = 0.800, P < .001). Internal consistency was also excellent (Cronbach's α = 0.938). Construct validity of the MBFI compared with the previously validated Multidimensional Fatigue Symptom Inventory-Short Form was excellent (r = 0.814, P < .001). Discriminant validity of cancer patients vs controls was significant (P = .027). Predictors of increased MBFI score included American Society of Anesthesiologists (comorbidity) score (bivariate analysis, r = 0.287, P = .039), cancer stage (analysis of variance, P = .007), and adjuvant radiotherapy (t test, P = .016). Cancer stage and comorbidity were further correlated with a multiple regression linear model. No significant relationship was found with age, sex, marital status, education, ethnicity, feeding tube, tracheostomy, or laryngectomy. The MBFI is a reliable and valid tool for measuring fatigue levels in head and neck cancer patients. In the context of initial assessment or posttreatment trending, this brief survey can be rapidly administered, providing valuable objective data on a very common and potentially debilitating symptom.

Modified Brief Fatigue Inventory in Head and Neck Cancer

Objective: The aim of this study is to validate the Modified Brief Fatigue Inventory (MBFI). This is the first instrument designed to measure intensity and frequency of fatigue specifically in head and neck cancer patients, potentially allowing objective measurement in addressing this common symptom in a concise yet thorough fashion. Method: The 9-item MBFI was administered to 52 consecutive cancer patients and 57 consecutive controls from the outpatient otolaryngology clinic of an academic tertiary medical center. Subject demographics, co-morbidities, cancer site, and cancer stage were recorded. Psychometric properties and predictors of the MBFI were analyzed. Results: MBFI 1-week test-retest reliability was excellent ( r = 0.800, P &lt; .001). Internal consistency was also excellent (Cronbach’s α = .938). Construct validity of the MBFI compared to the previously validated Multidimensional Fatigue Symptom Inventory Short Form was excellent ( r = 0.814, P &lt; .001). Discriminant validity of cancer versus controls was significant ( P = .027). Predictors of increased MBFI score included 1) American Society of Anesthesiologists (comorbidity) score (bivariate analysis r = 0.287, P = .039), 2) cancer stage (analysis of variance P = .007), and 3) adjuvant radiotherapy ( t test P = .016). No significant relationship was found with age, gender, marital status, education, ethnicity, feeding tube, tracheostomy, or laryngectomy. Conclusion: The MBFI is a reliable and valid tool for measuring fatigue levels in head and neck cancer patients. In the context of initial assessment or posttreatment trending, this brief survey can be rapidly administered, providing valuable objective data on a very common and potentially debilitating symptom.

Quality of life in poor prognosis patients with locally advanced non-small cell lung cancer (LA-NSCLC) undergoing a phase II study of concurrent cetuximab and definitive thoracic radiotherapy followed by docetaxel and cetuximab.

e17559 Background: A single institution prospective clinical trial was conducted to examine the safety and efficacy of concurrent cetuximab and definitive thoracic radiotherapy followed by docetaxel plus cetuximab. Quality of life (QOL) was assessed as a secondary endpoint. Survival and toxicity data are presented separately. Methods: Eligible pts with unresectable stage IIA or IIIB LA-NSCLC, who also had ECOG PS 2 OR weight loss ≥5% in 3 months OR age &gt;70, completed QOL measures at baseline, after concurrent cetuximab/radiotherapy (recovery), and after docetaxol/cetuximab (consolidation). Scores were calculated for Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Fatigue Symptom Inventory (FSI) worst fatigue, FSI fatigue interference, and Functional Assessment of Cancer Therapy – Lung Trial Outcome Index (FACT-L TOI). FACT-L TOI assessed physical (e.g., nausea) and functional (e.g., difficulty sleeping) well-being as well as lung cancer specific symptoms (e.g., shortness of breath, cough). Descriptive and t-test results are presented. Results: Pts (N = 27) were primarily male (67%) and non-Hispanic Caucasian (96%) with mean age of 73 years. High attrition between recovery (N = 22) and consolidation (N = 10) occurred. Compared to baseline, pts reported higher levels of worst fatigue (p &lt; .03) and fatigue interference (p = .01) at recovery. There was a decline in IADLs (p = .01) but no significant difference in ADLs or FACT-L TOI. Further examination of FACT subscales revealed declines in physical (p &lt; .0001) and functional (p = .02) well-being but improvement in lung cancer specific symptoms (p &lt; .0001). A similar pattern is found for comparisons between baseline and consolidation (ps &lt; .05). There were no significant differences between recovery and consolidation. Conclusions: Although pts experienced declines in QOL across most domains after concurrent cetuximab and radiotherapy, there was improvement in lung cancer specific symptoms. Pts were also able to maintain their ability to perform ADLs. High attrition after recovery is a notable limitation.