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Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool

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Abstract

The objective was to validate the use of the proposed International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) criteria for fatigue (P-ICD10) through comparison with the Functional Assessment of Cancer Therapy Fatigue (FACT-F) subscale and three visual analogue scale (VAS) qualities in cancer patients thought to be fatigued. Fatigue was assessed in 834 cancer patients at three clinical centres in Belgium, using P-ICD10, FACT-F, and VAS to assess: level of energy (VAS1), quality of life (VAS2), and ability to perform daily activities (VAS3). Of the 834 interviewed cancer patients, 54% were classified as fatigued by the P-ICD10 criteria. Internal consistency of P-ICD10 was very good (alpha coefficient 0.82). The principal component analysis corroborated good internal consistency with all variables included in the first component; a second component was used to identify psychological fatigue (concentration and short-term memory disabilities). An abridged set of screening tools based on the first three general symptoms of the P-ICD10 is proposed with 100% specificity and 86% specificity, respectively. There was a marked decrease in FACT-F and VAS1 scores in patients diagnosed as fatigued by the P-ICD10 (mean±SD, FACT-F 20±9 vs 39±8, VAS1 34±21 vs 61±21). A logistic regression model between P-ICD10 criteria diagnosis and FACT-F (VAS1) identified a score of 34 (61) on the FACT-F scale as a proposed cut-off point for the diagnosis of fatigue. The ICD-10 criteria can be recommended as a diagnostic tool, whereas the FACT-F scale and the level of energy 100-mm VAS assess the intensity of fatigue, and are more suitable for follow-up of cancer-related fatigue.

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Acknowledgement

The authors want to thank the nursing staff for their assistance in screening the patients.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Simon Van Belle.

Additional information

Professor Evers passed away suddenly. The authors will always remember his enthusiastic collaboration, wise counsel, and powerful vision.

This work was supported by an unrestricted grant from Janssen-Cilag Belgium.

Appendix

Appendix

English language version of the ICD-10 criteria for cancer-related fatigue

One of the following symptoms have been present every or nearly every day during a 2-week period in the last month:

  1. 1.

    Significant fatigue

  2. 2.

    Diminished energy

  3. 3.

    Increased need to rest, disproportionate to any recent change in activity level

Plus five or more of the following complaints:

  1. 4.

    Complaints of generalized weakness, limb heaviness

  2. 5.

    Diminished concentration or attention

  3. 6.

    Decreased motivation or interest to engage in usual activities

  4. 7.

    Insomnia or hypersomnia

  5. 8.

    Experience of sleep as unrefreshing or non-restorative

  6. 9.

    Perceived need to struggle to overcome inactivity

  7. 10.

    Marked emotional reactivity (e.g. sadness, frustration, or irritability) to feeling fatigued

  8. 11.

    Difficulty completing daily tasks attributed to feeling fatigued

  9. 12.

    Perceived problems with short-term memory

  10. 13.

    Post-exertional fatigue lasting several hours

French language version of the ICD-10 criteria for cancer-related fatigue

Un des symptômes suivant s’est produit tous les jours ou presque tous les jours pendant une période de deux semaines au cours du mois dernier:

  1. 1.

    Fatigue importante

  2. 2.

    Diminution de l’énergie

  3. 3.

    Augmentation du besoin de repos sans rapport avec une modification récente du niveau d’activité

plus 5 des éléments suivants ou plus

  1. 4.

    Plaintes de faiblesse généralisée, de lourdeur des membres

  2. 5.

    Diminution de la concentration ou de l’attention

  3. 6.

    Diminution de la motivation ou de l’intérêt pour les activités habituelles

  4. 7.

    Insomnie ou besoin excessif de sommeil

  5. 8.

    Le sommeil n’est pas ressenti comme revigorant ou réparateur

  6. 9.

    La sensation qu’il faut faire un gros effort pour surmonter l’inactivité

  7. 10.

    Réaction émotionnelle inhabituelle (par ex. Tristesse, frustration ou irritabilité) à la sensation de fatigue

  8. 11.

    La fatigue empêche de remplir les tâches quotidiennes

  9. 12.

    Problèmes de mémoire à court terme

  10. 13.

    La fatigue ressentie après un effort dure au moins 2 heures

Dutch language version of the ICD-10 criteria for cancer-related fatigue

Eén van de volgende symptomen zijn elke dag of bijna elke dag opgetreden binnen een periode van twee weken gedurende de voorbije maand:

  1. 1.

    Belangrijke vermoeidheid

  2. 2.

    Verminderde energie

  3. 3.

    Verhoogde behoefte aan rust die niet in verhouding staat tot een recente verandering in activiteitsniveau.

plus nog 5 of meer van de volgende:

  1. 4.

    Klachten over veralgemeende zwakte

  2. 5.

    Verminderde concentratie of aandacht

  3. 6.

    Verminderde motivatie of belangstelling voor de gebruikelijke activiteiten

  4. 7.

    Slapeloosheid of overmatige slaapbehoefte

  5. 8.

    Slaap wordt niet ervaren als verfrissend of herstellend

  6. 9.

    Het gevoel dat het overwinnen van de inactiviteit een grote inspanning vereist

  7. 10.

    Ongewone emotionele reactie (bijv. bedroefdheid, frustratie, of irriteerbaarheid) op het vermoeidheidsgevoel

  8. 11.

    Vermoeidheid belemmert het uitvoeren van dagelijkse taken

  9. 12.

    Problemen met het korte-termijngeheugen

  10. 13.

    Vermoeidheid na een inspanning duurt minstens 2 uren

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Van Belle, S., Paridaens, R., Evers, G. et al. Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool. Support Care Cancer 13, 246–254 (2005). https://doi.org/10.1007/s00520-004-0734-y

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  • DOI: https://doi.org/10.1007/s00520-004-0734-y

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