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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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:
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1.
Significant fatigue
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2.
Diminished energy
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3.
Increased need to rest, disproportionate to any recent change in activity level
Plus five or more of the following complaints:
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4.
Complaints of generalized weakness, limb heaviness
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5.
Diminished concentration or attention
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6.
Decreased motivation or interest to engage in usual activities
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7.
Insomnia or hypersomnia
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8.
Experience of sleep as unrefreshing or non-restorative
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9.
Perceived need to struggle to overcome inactivity
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10.
Marked emotional reactivity (e.g. sadness, frustration, or irritability) to feeling fatigued
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11.
Difficulty completing daily tasks attributed to feeling fatigued
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12.
Perceived problems with short-term memory
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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:
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1.
Fatigue importante
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2.
Diminution de l’énergie
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3.
Augmentation du besoin de repos sans rapport avec une modification récente du niveau d’activité
plus 5 des éléments suivants ou plus
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4.
Plaintes de faiblesse généralisée, de lourdeur des membres
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5.
Diminution de la concentration ou de l’attention
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6.
Diminution de la motivation ou de l’intérêt pour les activités habituelles
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7.
Insomnie ou besoin excessif de sommeil
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8.
Le sommeil n’est pas ressenti comme revigorant ou réparateur
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9.
La sensation qu’il faut faire un gros effort pour surmonter l’inactivité
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10.
Réaction émotionnelle inhabituelle (par ex. Tristesse, frustration ou irritabilité) à la sensation de fatigue
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11.
La fatigue empêche de remplir les tâches quotidiennes
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12.
Problèmes de mémoire à court terme
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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:
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1.
Belangrijke vermoeidheid
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2.
Verminderde energie
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3.
Verhoogde behoefte aan rust die niet in verhouding staat tot een recente verandering in activiteitsniveau.
plus nog 5 of meer van de volgende:
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4.
Klachten over veralgemeende zwakte
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5.
Verminderde concentratie of aandacht
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6.
Verminderde motivatie of belangstelling voor de gebruikelijke activiteiten
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7.
Slapeloosheid of overmatige slaapbehoefte
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8.
Slaap wordt niet ervaren als verfrissend of herstellend
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9.
Het gevoel dat het overwinnen van de inactiviteit een grote inspanning vereist
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10.
Ongewone emotionele reactie (bijv. bedroefdheid, frustratie, of irriteerbaarheid) op het vermoeidheidsgevoel
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11.
Vermoeidheid belemmert het uitvoeren van dagelijkse taken
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12.
Problemen met het korte-termijngeheugen
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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