The validity of EORTC QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors

Abstract

Fatigue is a major complaint among advanced cancer patients. Several instruments are available for measuring fatigue. The EORTC QLQ-C30 is one of the most frequently used health-related quality of life (HRQOL) instruments, and it includes a three-item fatigue subscale. Limited knowledge exists about the validity, performance and sensitivity of EORTC QLQ-C30 fatigue scale as compared with a fatigue-specific instrument. The aim of the present study was to validate the EORTC QLQ-C30 fatigue scale (FA) against the Fatigue Questionnaire (FQ). The FQ is frequently used and was developed to measure fatigue in both cancer and noncancer populations. The FQ measures physical (PF, seven items) and mental fatigue (MF, four items). The study population included two different cohorts: A) patients with advanced metastatic cancer included in a prospective randomized study of palliative radiotherapy (n = 238); B) patients with leukaemia and malignant lymphoma curatively treated with stem-cell transplantation and high-dose chemotherapy (n = 128). The analysis demonstrated that the FA correlated higher with the PF scale (r = 0.67–0.75) as compared with the MF scale (r = 0.49–0.61). The item–scale correlations between FA items and the PF scale were consistently higher than between FA items and the MF scale. A factor analysis including all the items within the FA and the FQ identified two factors. All FA items loaded on a PF factor (0.70–0.85). A floor/ ceiling effect, indicating a high number of respondents with lowest, respectively, highest scores was observed more frequently in the FA as compared with the FQ. The PF discriminated better between diagnostic groups with different levels of fatigue than the FA did. In conclusion, the EORTC QLQ-C30 fatigue scale is measuring physical fatigue. A floor/ ceiling effect seems to appear for the EORTC QLQ-C30 fatigue scale. The validity of the EORTC QLQ-C30 fatigue scale is to be questioned for use in palliative care patients. In studies with fatigue as a defined end point, a domain-specific instrument should, therefore, be added.

Keywords

cancer fatigue quality of life validity

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References

Loge JH , Ekeberg O , Kaasa S . Fatigue in the general Norwegian population: normative data and associations. J Psychosom Res 1998; 45: 53–65.

Pawlikowska T , Chalder T , Hirsch SR , Wallace P , Wright DJ , Wessely SC . Population based study of fatigue and psychological distress [see comments]. BMJ 1994; 308: 763–766.

Denburg SD , Carbotte RM , Denburg JA . Psychological aspects of systemic lupus erythematosus: cognitive function, mood, and self-report. J Rheumatol 1997; 24: 998–1003.

Krupp LB , LaRocca NG , Muir-Nash J , Steinberg AD . The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121–1123.

Swain MG . Fatigue in chronic disease. Clin Sci (Colch) 2000; 99: 1–8.

Cauch-Dudek K , Abbey S , Stewart DE , Heathcote EJ . Fatigue in primary biliary cirrhosis. Gut 1998; 43: 705–710.

Smets EM , Garssen B , Schuster-Uitterhoeve AL , de Haes JC . Fatigue in cancer patients. Br J Cancer 1993; 68: 220–224.

Stone P , Richards M , Hardy J . Fatigue in patients with cancer [see comments]. Eur J Cancer 1998; 34: 1670–1676.

Glaus A , Crow R , Hammond S . A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals [see comments]. Support Care Cancer 1996; 4: 82–96.

10.

Vogelzang NJ , Breitbart W , Cella D , et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 1997; 34: 4–12.

11.

Curt GA , Breitbart W , Cella D , et al. Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 2000; 5: 353–360.

12.

Ford H , Trigwell P , Johnson M . The nature of fatigue in multiple sclerosis [see comments]. J Psychosom Res 1998; 45: 33–38.

13.

Wysenbeek AJ , Leibovici L , Weinberger A , Guedj D . Fatigue in systemic lupus erythematosus. Prevalence and relation to disease expression. Br J Rheumatol 1993; 32: 633–635.

14.

Bloom JR , Fobair P , Gritz E , et al. Psychosocial outcomes of cancer: a comparative analysis of Hodgkin’s disease and testicular cancer. J Clin Oncol 1993; 11: 979–988.

15.

Joly F , Henry-Amar M , Arveux P , et al. Late psychosocial sequelae in Hodgkin’s disease survivors: a French population-based case-control study. J Clin Oncol 1996; 14: 2444–2453.

16.

Loge JH , Abrahamsen AF , Ekeberg O , Kaasa S . Hodgkin’s disease survivors more fatigued than the general population. J Clin Oncol 1999; 17: 253–261.

17.

Chalder T , Berelowitz G , Pawlikowska T , et al. Development of a fatigue scale. J Psychosom Res 1993; 37: 147–153.

18.

Lewis G , Wessely S . The epidemiology of fatigue: more questions than answers. J Epidemiol Community Health 1992; 46: 92–97.

19.

Shapiro CM . Fatigue: how many types and how common? J Psychosom Res 1998; 45: 1–3.

20.

Smets EM , Garssen B , Bonke B , de Haes JC . The Multidimensional Fatigue Inventory (MFI) psycho-metric qualities of an instrument to assess fatigue. J Psychosom Res 1995; 39: 315–325.

21.

Wessely S . Chronic fatigue: symptom and syndrome. Ann Intern Med 2001; 134: 838–843.

22.

Aaronson NK , Ahmedzai S , Bergman B , et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–376.

23.

Aaronson NK , Ahmedzai S , Bullinger M , et al. The EORTC Core Quality of Life Questionnaire: interim results of an international field study. In Osoba D ed. Effect of cancer on quality of life. Boston: CRS Press, 1991: 185–203.

24.

Kaasa S , Bjordal K , Aaronson N , et al. The EORTC core quality of life questionnaire (QLQ-C30): validity and reliability when analysed with patients treated with palliative radiotherapy. Eur J Cancer 1995; 31A: 2260–2263.

25.

Pater JL , Zee B , Palmer M , Johnston D , Osoba D . Fatigue in patients with cancer: results with National Cancer Institute of Canada Clinical Trials Group studies employing the EORTC QLQ-C30. Support Care Cancer 1997; 5: 410–413.

26.

Stone P , Hardy J , Broadley K , Tookman AJ , Kurowska A , A’Hern R . Fatigue in advanced cancer: a prospective controlled cross-sectional study. Br J Cancer 1999; 79: 1479–1486.

27.

Stone P , Hardy J , Huddart R , A’Hern R , Richards M . Fatigue in patients with prostate cancer receiving hormone therapy. Eur J Cancer 2000; 36: 1134–1141.

28.

Kaasa S , Loge JH . Quality of life assessment in palliative care. Lancet Oncol 2002; 3: 172–182.

29.

Hjermstad MJ , Evensen SA , Kvaloy SO , Fayers PM , Kaasa S . Health-related quality of life 1 year after allogeneic or autologous stem-cell transplantation: a prospective study. J Clin Oncol 1999; 17: 706–718.

30.

Fayers PM , Machin D . Quality of life. Assessment, analysis and interpretation. West Sussex, UK: John Wiley & Sons Ltd., 2000: 66–71.

31.

Bjordal K , Kaasa S . Psychometric validation of the EORTC Core Quality of Life Questionnaire, 30-item version and a diagnosis-specific module for head and neck cancer patients. Acta Oncol 1992; 31: 311–321.

32.

Bjordal K , Hammerlid E , Ahlner-Elmqvist M , et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire = H&N35. J Clin Oncol 1999; 17: 1008–1019.

33.

Irvine DM , Vincent L , Bubela N , Thompson L , Graydon J . A critical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nurs 1991; 14: 188–199.

34.

Cull A , Hay C , Love SB , Mackie M , Smets E , Stewart M . What do cancer patients mean when they complain of concentration and memory problems? Br J Cancer 1996; 74: 1674–1679.

35.

Klepstad P , Hilton P , Moen J , Fougner B , Borchgrevink PC , Kaasa S . Self-reports are not related to objective assessments of cognitive function and sedation in patients with cancer pain admitted to a palliative care unit. Palliat Med 2002; 16: 513–519.

36.

World Health Organization . WHO handbook for reporting results of cancer treatment. Geneva: WHO Offset Publication, 1979.

37.

National Cancer Institute, National Institutes of Health Department of Health and Human Services . Cancer therapy evaluation program common toxicity criteria, Version 2.0, 30 April 1999. 30-5-0001. US: The Cancer Information Service, National Cancer Institute.

38.

Loge JH , Kaasa S , Hjermstad MJ , Kvien TK . Translation and performance of the Norwegian SF-36 Health Survey in patients with rheumatoid arthritis. I. Data quality, scaling assumptions, reliability, and construct validity. J Clin Epidemiol 1998; 51: 1069–1076.

39.

Ware JE Jr , Bjorner JB , Kosinski M . Practical implications of item response theory and computerized adaptive testing: a brief summary of ongoing studies of widely used headache impact scales. Med Care 2000; 38: II73–II82.