Fatigue and physical performance in children and adolescents receiving chemotherapy. Psychometric testing of fatigue instruments for use with cancer patients. Pilot Study of Massage to Improve Sleep and Fatigue in Hospitalized Adolescents With Cancer. Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. The Development and Testing of an Instrument for Perceived Self-efficacy for Fatigue Self-management Promising insights into the health related quality of life for children with severe obesity Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide. Yoga for Children and Adolescents After Completing Cancer Treatment Fatigue, psychological distress, coping and quality of life in patients with uterine cancer. Changes in children's fatigue during the course of treatment for paediatric cancer. The validity of EORTC QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors Self‐reported fatigue in children with advanced cancer: Results of the PediQUEST study RESTORE: an exploratory trial of an online intervention to enhance self-efficacy to manage problems associated with cancer-related fatigue following primary cancer treatment: study protocol for a randomized controlled trial Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early-stage breast cancer. Epoetin alfa treatment results in clinically significant improvements in quality of life in anemic cancer patients when referenced to the general population. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Utility of the PedsQL Rheumatology Module as an Outcome Measure in Juvenile Fibromyalgia Quality of life in stage II breast cancer: an instrument for clinical trials. L-carnitine supplementation for the management of fatigue in patients with cancer: an eastern cooperative oncology group phase III, randomized, double-blind, placebo-controlled trial. Evaluation of a comprehensive rehabilitation program for post-treatment patients with cancer. Fatigue in patients with cancers of the breast or prostate undergoing radical radiotherapy. A pilot study of the effects of programmed aerobic exercise on the severity of fatigue in cancer patients during external radiotherapy. A randomized, double-blind, placebo-controlled trial assessing the impact of dexamphetamine on fatigue in patients with advanced cancer.
PURPOSE / OBJECTIVES To examine the relationship between physical performance and fatigue in child and adolescent cohorts during the first three cycles of chemotherapy . DESIGN Prospect i ve , observational design . SETTING Two pediatric cancer centers in the upper Midwest region of the United States . SAMPLE 16 children and 14 adolescents newly diagnosed with cancer . METHODS St and ardized instruments were administered during the first and third cycles of chemotherapy . Instruments included  physical performance tests ( Timed Up and Down Stairs [ TUDS ] and the 6-Minute Walk Test [ 6MWT ] ) and a self-report fatigue scale .  MAIN RESEARCH VARIABLES Fatigue and physical performance . FINDINGS In the child cohort , physical performance appeared to improve and fatigue diminished from cycle 1 to 3 of chemotherapy . When time on TUDS decreased , fatigue tended to decrease ; when 6MWT distance increased , fatigue decreased . In the adolescent cohort , fatigue seemed to decrease but physical performance measures evidence d little change . Correlations between changes in the physical performance variables and fatigue were not significant . CONCLUSIONS Fatigue may decrease early in treatment as disease symptoms resolve . Fatigue in the child cohort was related to physical performance , which is consistent with previous studies that defined fatigue in children as primarily a physical sensation . Findings in the adolescent cohort support research that defined adolescent fatigue as more complex with mental , emotional , and physical components . IMPLICATION S FOR NURSING Knowing how fatigue relates to physical performance in children and adolescents informs the nurse in educating patients and families about symptom management BACKGROUND Cancer treatment-related fatigue ( CRF ) is a common side effect of cancer treatment . A problem identified in most review s of CRF is lack of sound approaches to measurement that are congruent with the conceptualization of CRF as a self-perceived state . The diversity of instruments available to measure fatigue and the lack of comprehensive testing of several promising instruments with cancer patients undergoing treatment provided the rationale for this study . The purpose of this article is to report the results of psychometric testing of several fatigue instruments in patients undergoing cancer treatment . OBJECTIVES The aims of this study were to determine the reliability , validity , and responsiveness of each instrument and to determine the ability of each instrument to capture CRF . METHODS Existing fatigue instruments with published psychometric information that indicated suitability for further testing were selected and included the Profile of Mood States Short Form fatigue subscale ( F_POMS-sf ) ,  Multidimensional Assessment of Fatigue ( MAF ) ,  Lee Fatigue Scale ( LFS ) , and the  Multidimensional Fatigue Inventory ( MFI ) . Data were collected at a university-based clinical cancer center and a freest and ing comprehensive cancer center . Subjects completed all study instruments , which were presented in r and om order , at a time when CRF was expected to be high and again when it was expected to be low . A subset of subjects completed the instruments within 48 hours of one of the data collection points when CRF was expected to be relatively unchanged to provide stability data . RESULTS Reliability estimates using Cronbach 's alpha indicated that all instruments examined had good internal consistency . Test-retest correlations showed good stability for total scores on all the instruments , but some subscales of the LFS and MFI had marginal stability . Factor analysis of all instruments indicated that only the LFS and the F_POMS-sf fully supported their construct validity . All of the instruments showed responsiveness to changes in CRF related to treatment . CONCLUSIONS The results of the study provide research ers and clinicians with detailed comparisons of the performance of established fatigue measures in cancer patients undergoing treatment to use when selecting measures of CRF BACKGROUND Adolescents with cancer experience many troubling symptoms , including sleep disruptions that can affect mood and quality of life .  Massage is a safe and popular intervention that has demonstrated efficacy in pediatric and adult patients with cancer . This study aim ed to assess the feasibility of conducting a massage intervention to help with sleep in hospitalized adolescent oncology patients . PROCEDURE Adolescents ages 12 - 21 with cancer who were expected to be hospitalized for at least four consecutive nights were recruited from the inpatient unit at Children 's National Health System and r and omized to either massage intervention or a waitlist control . Patients in the intervention group received one massage per night , for two or three nights . Sleep was measured with actigraphy and patient and proxy reported instruments were used to measure fatigue , mood , and anxiety . RESULTS The majority ( 78 % ) of patients approached for the study consented , and almost all patients in the intervention group ( 94 % ) received at least one massage , 69 % received two , and rates of completion of instruments among adolescents were high demonstrating feasibility . There were trends toward increased night time and overall sleep in the intervention group compared with st and ard of care , but no differences between groups in the patient reported outcome measures . Participant and parent feedback on the intervention was positive and was the impetus for starting a clinical massage service at the hospital . CONCLUSIONS Massage for hospitalized adolescents with cancer is feasible , well received , and can potentially improve patients ' sleep . A r and omized multicenter efficacy study is warranted In this paper the psychometric properties of the multidimensional fatigue inventory ( MFI-20 ) are established further in cancer patients . The MFI is a 20-item self-report instrument design ed to measure fatigue . It covers the following dimensions : general fatigue , physical fatigue , reduced activity , reduced motivation and mental fatigue . The instrument was used in a Dutch and Scottish sample of cancer patients receiving radiotherapy .  The dimensional structure was assessed using confirmatory factor analyses ( Lisrel 's unweighted least-squares method ) . The hypothesised five-factor model appeared to fit the data in both sample s ( adjusted goodness of fit ; AGFI : 0.97 and 0.98 ) . Internal consistency of the separate scales was good in both the Dutch and Scottish sample s with Cronbach 's alpha coefficients ranging from 0.79 to 0.93 . Construct validity was assessed by correlating the MFI-20 to activities of daily living , anxiety and depression . Significant relations were assumed . Convergent validity was investigated by correlating the MFI scales with a visual analogue scale measuring fatigue and with a fatigue-scale derived from the Rotterdam Symptom Checklist . Results support the validity of the MFI-20 . The highly similar results in the Dutch and Scottish sample suggest that the portrayal of fatigue using the MFI-20 is quite robust Background : Persons with chronic illness commonly report fatigue . Measurement of perceived self-efficacy for fatigue self-management ( PSEFSM )  is essential if fatigue is to be monitored and enhanced to improve physical functional status . Objective : The objective of the study was to describe the development and testing of the PSEFSM instrument . Methods : The PSEFSM instrument was incorporated into 2 r and omized controlled trials for secondary analysis ( N = 298 ) : 63 persons with lung cancer and 235 persons with other cancer diagnoses undergoing a course of chemotherapy .  Results : Evidence for construct validity and generalizability was supported through hypotheses testing of the mediation pathway from fatigue to physical functional status through PSEFSM , with results indicating support for partial mediation . Structural modeling indicated a good model fit that further supported the construct validity of the PSEFSM instrument . Conclusions : The instrument provides a reliable and valid measure of PSEFSM that could be used in research to facilitate the development of interventions to increase perceived self-efficacy to achieve optimal symptom self-management . Implication s for Practice : The PSEFSM instrument is brief and easy to complete , which results in a low response burden for persons who are already fatigued , providing for regular use in transdisciplinary research and practice setting s. This is important because the use of this instrument can impact how we partner with our patients to better underst and how to manage this troublesome symptom , fatigue Background Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents . The Patient Reported Outcomes Measurement Information System ( PROMIS ) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents . The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity . Methods The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index ( BMI ) greater than the 85th percentile in a design to establish known-group validity . The children completed the  depressive symptoms , anxiety , anger , peer relationships , pain interference , fatigue , upper extremity , and mobility PROMIS domains utilizing a computer interface . PROMIS domains and individual items were administered in r and om order and included a total of 95 items . Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile . Results 136 participants were recruited and had all necessary clinical data for analysis . Of the 136 participants , 5 % ended the survey early result ing in missing domain scores at the end of survey administration . In multivariate analysis , patients with BMI ≥ 99th percentile had worse scores for depressive symptoms , anger , fatigue , and mobility ( p < 0.05 ) . Parent-reported exercise was associated with better scores for depressive symptoms , anxiety , and fatigue ( p < 0.05 ) . Conclusions Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting . In the 5 % with missing domain scores , the missing scores were consistently found in the domains administered last , suggesting the length of the assessment is important . The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity . We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life PURPOSE / OBJECTIVES To examine the influence of the proposed symptom cluster of fatigue , nausea and vomiting , and sleep disturbances on clinical outcomes defined as behavior changes , depression , and performance status in children and adolescents before and after receiving cisplatin , doxorubicin , or ifosfamide chemotherapy .  DESIGN A prospect i ve , descriptive , within-group , before- and -after-chemotherapy design was used . SETTING Two major childhood cancer treatment hospitals in the United States . SAMPLE 67 patients aged 7 - 18 years who were receiving chemotherapy courses of cisplatin , doxorubicin , or ifosfamide .  METHODS Fatigue , depression , behavior , and performance assessment s were completed on the first day of cisplatin , doxorubicin , or ifosfamide therapy and one week later . Patients wore a  wrist actigraph on the nondominant h and during the course of therapy and for 48 hours after discharge from the hospital . Nausea and vomiting were measured every 24 hours during the course of therapy and for 48 hours after discharge . A linear mixed model was used to evaluate the influence of the symptom cluster . Regression analysis was used to examine the associations between performance status and the symptom cluster . Principal component analysis with varimax rotation was used to produce the correlation of sleep symptoms . MAIN RESEARCH VARIABLES Fatigue , nausea and vomiting , sleep disturbances , behavior , depression , and performance . FINDINGS Adolescents with the cluster of increased fatigue and sleep disturbances  experienced more depressive symptoms and behavior changes . Children with higher levels of fatigue had increased depressive symptoms . The more fatigue parents perceived in their children or adolescents , the more behavior and emotional difficulties were reported . CONCLUSIONS Fatigue , sleep disturbance , and nausea and vomiting , when clustered , impacted depressive symptoms and behavior changes in adolescents after chemotherapy . In children , fatigue alone impacted depressive symptoms and behavior changes . IMPLICATION S FOR NURSING Symptom clusters can have a significant impact on children 's and adolescents ' quality of life during cancer treatment . Early recognition and intervention for these symptoms are an important nursing role Survivors of childhood cancer may experience persistent symptoms , including  fatigue , sleep disturbance , and balance impairment .  Yoga is a complementary therapy that improves fatigue , sleep , and quality of life in adult cancer survivors . Using a one group , repeated measures design , we evaluated the feasibility of a yoga program and assessed if cancer survivor participants ages 10 to 17 years ( n = 13 ) had significantly less fatigue and anxiety , and better balance and sleep , after a 6-week yoga intervention compared with a 6-week pre-intervention wait period . Study recruitment was challenging with a 32 % enrollment rate ;  yoga attendance was 90 % . None of the scores for anxiety , fatigue , sleep , and balance had significant changes during the wait period . After the 6-week yoga program , children ( n = 7 ) had a significant decrease in anxiety score ( P = .04 ) while adolescent scores ( n = 7 ) showed a decreasing trend ( P = .10 ) . Scores for fatigue , sleep , and balance remained stable post-intervention . Fatigue and balance scores were below norms for health children/adolescents while sleep and anxiety scores were similar to healthy peers BACKGROUND Cancer-related fatigue ( CRF ) is a subjectively experienced symptom that is multidimensional and multifactorial . Patients with cancer have identified fatigue as one of the major troubling symptoms and the primary cause of distress in their lives . AIMS The major aim of the study was to examine how patients diagnosed with uterine cancer describe their experience of fatigue , psychological distress , coping re sources and quality of life . A secondary aim was to describe the relationship between selected variables . METHOD A descriptive and correlational design was used and the study was conducted at a university hospital in Sweden . The study population consisted of women , diagnosed with uterine cancer , who where scheduled to receive curative external radiation therapy . Sixty women participated in the study and data were collected through self-report instruments . Demographic and clinical data were extracted from patient records . The data were collected during year 2000 - 2002 . The Conceptual Model of Symptom Management was used as a framework to guide the study . FINDINGS Patients experienced a low grade of fatigue and psychological distress , but their functional status and global quality of life was high . Significant correlations were found between general fatigue and anxiety and also between general fatigue and depression . There was a significant negative correlation between general fatigue and coping re sources . Depression explained 44 % of the variance in general fatigue . CONCLUSIONS The findings provide knowledge about predictors of CRF in women with uterine cancer , and can serve as a basis for future longitudinal studies in which different prophylactic strategies against therapy-related fatigue are prospect ively studied BACKGROUND Fatigue is described as one of the most distressing symptoms of cancer therapy ; yet it has received limited clinical attention . Children are suffering from a symptom that is under-diagnosed during their treatment . AIM The aim of this study is : ( a ) to assess the change in fatigue scores during cancer treatment according to children 's perspectives , and ( b ) to describe the possible causes of fatigue from children 's points of view . SAMPLE AND METHODS The present study is part of an ongoing prospect i ve study . The research group consisted of 40 ( n = 40 ) children aged 7 - 12 years with cancer who are being followed up in the oncology clinic of a Greek children 's hospital . After parental consent was obtained , data were collected using the Child Fatigue Scale and a sociodemographic data form . RESULTS The children with cancer reported a statistically significant increase in fatigue scores during their treatment ( F = 6.846 , P = 0.003 ) . Gender was the only demographic factor associated with a significant increase in the fatigue scores ( F = 4.857 , P = 0.034 ) . CONCLUSIONS Cancer treatment was found significantly to increase children 's fatigue levels . Medical procedures and the hospital environment seemed to be major causative factors of the fatigue experienced by children with cancer during their treatment 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 vali date the EORTC QLQ-C30 fatigue scale ( FA ) against the Fatigue Question naire ( FQ ) . The FQ is frequently used and was developed to measure fatigue in both cancer and noncancer population s. 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 prospect i ve r and omized 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 question ed for use in palliative care patients . In studies with fatigue as a defined end point , a domain-specific instrument should , therefore , be added Pediatric cancer‐related fatigue is prevalent and significantly impairs health‐related quality of life , yet its patterns and correlates are poorly understood . The objectives of this study were to describe fatigue as prospect ively reported by children with advanced cancer and to identify the factors associated with fatigue and associated distress Background There are over 25 million people worldwide living with or beyond cancer and this number is increasing . Cancer survivors face a range of problems following primary treatment . One of the most frequently reported and distressing symptoms experienced by cancer survivors is fatigue . There is growing support for survivors who are experiencing problems after cancer treatment to engage in supported self-management . To date there is some evidence of effective interventions to manage fatigue in this population ; however , to our knowledge there are no online re sources that draw on this information to support self-management of fatigue . This paper describes the protocol for an exploratory r and omized controlled trial of an online intervention to support self-management of cancer-related fatigue after primary cancer treatment . Methods / design This is a parallel-group two-armed ( 1:1 ) exploratory r and omized controlled trial including 125 cancer survivors experiencing fatigue ( scoring ≥4 on a unidimensional 11-point numeric rating scale for fatigue intensity ) within five years of primary treatment completion with curative intent . Participants will be recruited from 13 NHS Trusts across the UK and r and omized to either the online intervention ( RESTORE ) , or a leaflet comparator ( Macmillan Cancer Backup , Coping with Fatigue ) . The primary outcome is a change in Perceived Self-Efficacy for Fatigue Self-Management ( as measured by the Perceived Self-Efficacy for Fatigue Self-Management Instrument ) . Secondary outcomes include impact on perception and experience of fatigue ( measured by the Brief Fatigue Inventory ) , and quality of life ( measured by the Functional Assessment of Cancer Therapy - General and the Personal Wellbeing Index ) . Outcome measures will be collected at baseline , 6 weeks ( completion of intervention ) , and 3 months . Process evaluation ( including telephone interviews with recruiting staff and participants ) will determine acceptability of the intervention and trial processes . Discussion Data from this trial will be used to refine the intervention and contribute to the design of an effectiveness trial . This intervention will be exp and ed to address other cancer-related problems important to cancer survivors following primary cancer treatment . Trial registration IS RCT PURPOSE To evaluate the efficacy of a psychoeducational intervention in improving cancer-related fatigue .  PATIENTS AND METHODS This r and omized controlled trial involved 109 women commencing adjuvant chemotherapy for stage I or II breast cancer in five chemotherapy treatment centers . Intervention group patients received an individualized fatigue education and support program delivered in the clinic and by phone over three 10- to 20-minute sessions 1 week apart . Instruments included a numeric rating scale assessing confidence with managing fatigue ; 11-point numeric rating scales measuring fatigue at worst , average , and best ; the Functional Assessment of Cancer Therapy-Fatigue and Piper Fatigue Scales ; the Cancer Self-Efficacy Scale ; the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ; and the Hospital Anxiety and Depression Scale . For each outcome , separate analyses of covariance of change scores between baseline ( T1 ) and the three follow-up time points ( T2 , T3 , and T4 ) were conducted , controlling for the variable 's corresponding baseline value . RESULTS Compared with the intervention group , mean difference scores between the baseline ( T1 ) and immediate after the test ( T2 ) assessment s increased significantly more for the control group for worst and average fatigue , Functional Assessment of Cancer Therapy-Fatigue , and Piper fatigue severity and interference measures . These differences were not observed between baseline and T3 and T4 assessment s. No significant differences were identified for any pre- or post-test change scores for confidence with managing fatigue , cancer self-efficacy , anxiety , depression , or quality of life . CONCLUSION Preparatory education and support has the potential to assist women to cope with cancer-related fatigue in the short term . However , further research is needed to identify ways to improve the potency and sustainability of psychoeducational interventions for managing cancer-related fatigue PURPOSE Anemia , highly common among cancer patients , is often an underlying cause of cancer-related fatigue and other quality -of-life ( QOL ) deficits . Although r and omized clinical trials have shown that treatment with epoetin alfa increases hemoglobin levels , reduces fatigue , lessens transfusion requirements , and improves overall QOL , cancer-related anemia and fatigue remain undertreated . This is , in part , because scales and measures of QOL are still relatively unfamiliar to most clinicians and because population -based reference ranges are lacking , thus making clinical trial results difficult to interpret . METHODS To aid in the interpretation of QOL results from clinical trials , we administered the Functional Assessment of Cancer Therapy-Anemia ( FACT-An ) QOL instrument to a nationally representative sample of 1,400 people using an Internet survey panel in the United States . We then compared the FACT-An data from the Internet survey with the QOL data of a 375-patient r and omized , double-blind clinical trial evaluating epoetin alfa versus placebo in anemic cancer patients . RESULTS FACT-An , as administered to the survey population , displayed good psychometric properties and was able to discriminate between respondents with histories of specified illnesses , including anemia and cancer , and those without . Comparison of the population norm and clinical trial data showed that treatment with epoetin alfa result ed in clinical ly meaningful as well as statistically significant improvements in QOL ( P < .01 ) . CONCLUSION Reliable population norm data are now available to aid in the interpretation of clinical trial results where the FACT-An question naire is administered . In the clinical trial , treatment with epoetin alfa overcame much of the QOL deficit seen in anemic cancer patients compared with the norm population sample Fatigue is the most prevalent and debilitating symptom experienced by breast cancer patients receiving adjuvant chemotherapy or radiation therapy and few evidence -based treatments are available to manage this distressing side-effect . The purpose of this multi-institutional r and omized controlled trial was to determine the effects of exercise on fatigue levels during treatment for breast cancer . Sedentary women ( N=119 ) with Stage 0-III breast cancer receiving outpatient adjuvant chemotherapy or radiation therapy were r and omized to a home-based moderate-intensity walking exercise program or to usual care for the duration of their cancer treatment . Of participants r and omized to exercise , 72 % adhered to the exercise prescription ; 61 % of the usual care group adhered . The intention-to-treat analysis revealed no group differences in part because of a dilution of treatment effect as 39 % of the usual care group exercised and 28 % of the exercise group did not . When exercise participation was considered using the data analysis method of instrumental variables with principal stratification , a clinical ly important and statistically significant ( p=0.03 ) effect of exercise on pretest-to-posttest change in fatigue levels was demonstrated . Adherence to a home-based moderate-intensity walking exercise program may effectively mitigate the high levels of fatigue prevalent during cancer treatment The PedsQL rheumatology module is currently the only available measure of disease‐specific quality of life for children and adolescents with juvenile fibromyalgia ( FM ) , but limited information has been published about the psychometric properties of the instrument , specifically in juvenile FM . The objective of this study was to assess the reliability , validity , and sensitivity to change of the 5 scales ( pain and hurt , daily activities , treatment , worry , and communication ) of the patient and parent proxy versions of the PedsQL rheumatology module in the context of a r and omized controlled trial in juvenile FM A question naire has been developed for use as an outcome measure in clinical trials of adjuvant chemotherapy in women with stage II breast cancer . The selection of items for this Breast Cancer Chemotherapy Question naire ( BCQ ) was based on the problems and experiences felt to be most important by women undergoing adjuvant chemotherapy .  The BCQ consists of 30 questions that focus on loss of attractiveness , fatigue , physical symptoms , inconvenience , emotional distress , and feelings of hope and support from others . The BCQ , other instruments that evaluate quality -of-life ( Spitzer , Karnofsky , and R and ) , and patient and physician global assessment s were administered serially to 418 patients taking part in a r and omized trial comparing a 12-week regimen and a 36-week regimen of adjuvant chemotherapy .  The validity of the BCQ is supported by its correlation with the R and Emotional ( r = .58 ) , R and Physical ( r = .60 ) , and Spitzer ( r = .62 ) question naires . The BCQ correlated more strongly with global ratings of both physical and emotional function by the patients and their physicians than the other instruments . A comparison of the quality -of-life outcomes of patients in the two treatment groups in the period beyond 3 months after initiation of treatment , when one group had completed the treatment course and the other was still on treatment , revealed that the BCQ and Karnofsky were the only instruments able to demonstrate differences between the groups ( P less than .0001 ) . Hence , the BCQ is a valid and responsive method of assessing treatment-related morbidity in patients receiving adjuvant chemotherapy for stage II breast cancer PURPOSE L-carnitine , a popular complementary and alternative medicine product , is used by patients with cancer for the treatment of fatigue , the most commonly reported symptom in this patient population . The purpose of this study was to determine the efficacy of L-carnitine supplementation as a treatment for fatigue in patients with cancer . PATIENTS AND METHODS In this double-blind , placebo-controlled trial , patients with invasive malignancies and fatigue were r and omly assigned to either 2 g/d of L-carnitine oral supplementation or matching placebo . The primary end point was the change in average daily fatigue from baseline to week 4 using the Brief Fatigue Inventory ( BFI ) . RESULTS Three hundred seventy-six patients were r and omly assigned to treatment with L-carnitine supplementation or placebo . L-carnitine supplementation result ed in significant carnitine plasma level increase by week 4 . The primary outcome , fatigue , measured using the BFI , improved in both arms compared with baseline ( L-carnitine : -0.96 , 95 % CI , -1.32 to -0.60 ; placebo : -1.11 , 95 % CI -1.44 to -0.78 ) . There were no statistically significant differences between arms ( P = .57 ) . Secondary outcomes , including fatigue measured by the Functional Assessment of Chronic Illness Therapy-Fatigue instrument , depression , and pain , did not show significant difference between arms . A separate analysis of patients who were carnitine-deficient at baseline did not show statistically significant improvement in fatigue or other outcomes after L-carnitine supplementation . CONCLUSION Four weeks of 2 g of L-carnitine supplementation did not improve fatigue in patients with invasive malignancies and good performance status PURPOSE / OBJECTIVES To evaluate the effects of a rehabilitation program on quality of life , fatigue , fear of movement ( kinesiophobia ) , distress , anxiety , depression , and physical condition . DESIGN Pretest/post-test . SETTING An outpatient rehabilitation setting in the Oncology Centre at the University Hospital Brussels in Belgium . SAMPLE 36 patients who had completed cancer treatment with a curative potential . METHODS Participants completed a question naire and underwent a physical test at baseline and at the end of the program . The measurement instruments used included the European Organisation for Research and Treatment of Cancer Quality -of-Life Question naire-Core 30 , Functional Assessment of Cancer Therapy-Fatigue , Hospital Anxiety and Depression Scale , R AND -36 , Tampa Scale for Kinesiophobia , Distress Barometer , and Tecumseh Step Test . MAIN RESEARCH VARIABLES Quality of life , fatigue , kinesiophobia , distress , anxiety , depression , and physical condition . FINDINGS Significant improvement was observed in quality of life ( p < 0.001 ) , physical condition ( p = 0.007 ) , fatigue ( p = 0.01 ) , and depression ( p = 0.012 ) . In contrast , kinesiophobia ( p = 0.229 ) , distress ( p = 0.344 ) , and anxiety ( p = 0.101 ) did not change significantly . CONCLUSIONS A general and significant improvement in all aspects affecting quality of life and rehabilitation was observed , but less so for aspects that might be influenced by prognostic concerns . The relative contribution of the program versus spontaneous recovery and long-term impact need to be determined further in a prospect i ve r and omized study . IMPLICATION S FOR NURSING Multidisciplinary rehabilitation should become part of the total care plan for patients with cancer To determine the prevalence , severity , and correlates of fatigue among patients with cancers of the prostate or breast receiving high dose radiotherapy with curative intent , a prospect i ve , question naire-based study evaluated a convenience sample of 62 patients who were about to start a course of radiotherapy .  Patients were assessed immediately prior to treatment , and again within a week of finishing . Fatigue was assessed using the Fatigue Severity Scale ( FSS ) and the Bidimensional Fatigue Scale ( BFS ) . Quality of life was assessed using the European Organisation for Research and Treatment of Cancer 30-item Quality of Life Question naire ( EORTC QLQc30 ) . Psychological distress was assessed using the Hospital Anxiety and Depression Scale ( HADS ) . Personality Traits were assessed using the Eysenck Personality Inventory ( EPI ) . Fatigue severity increased significantly on 3 out of the 5 assessment instruments used . Radiotherapy was associated with a decline in global quality of life , role , cognitive and social functioning , and an increase in nausea/vomiting , pain , insomnia , diarrhea , and financial difficulty . At baseline , 39 % of the variation in fatigue scores among the patients could be explained by a combination of measures of their global quality of life and physical functioning . A combination of fatigue and anxiety scores at baseline was able to predict 54 % of the variation in fatigue scores at the completion of radiotherapy . These data indicate that fatigue is a significant problem for patients receiving radical radiotherapy , although its severity is relatively modest Fatigue is one of the most frequent side effects of cancer treatments . According to a number of studies , the incidence of fatigue as a side effect of radiation therapy ( RT ) ranges from 65 % to 100 % depending on which instruments were used ( Greenberg et al. , 1992 ; Jacobsen-Thors , 2003 ) . For many cancer patients , cancer-related fatigue is severe and imposes limitations on normal daily activities ( JereczekFossa et al. , 2002 ) . Patients often report that cancerrelated fatigue differs from fatigue experienced before initiation of cancer . They describe it as severe , chronic and frustrating , effects that fail to be relieved by rest . In many studies in the past , patients have felt that fatigue has adversely affected their quality of life more than pain and sexual dysfunction or other treatment-related side effects ( Stone et al. , 1998 ) . Fatigue has negative impact on various aspects of quality of life , so it is imperative to find non-invasive and nonpharmacological solutions for managing it . There is little however known as to which techniques can help alleviate fatigue .  Physical exercise has been shown to be effective , convenient and a low-cost self-care method for reducing anxiety and sleep difficulties , and increasing adaptation during radiotherapy . Aerobic exercises ( e.g. walking ) have been suggested for the rehabilitation of cancer patients affected by energy loss but this is not a fully accepted approach as yet . Nevertheless , exercise has been shown Fatigue is very common in patients with cancer . Current guidelines suggest that psychostimulants are " reasonable to consider for severe fatigue . " This r and omized , double-blind , placebo-controlled trial investigated the hypothesis that  dexamphetamine  in fatigued patients with advanced cancer would produce a clinical ly significant improvement with minimal side effects . Fifty patients with advanced cancer , who were receiving palliative care , were r and omized to dexamphetamine 10 mg twice daily or placebo for eight days . Effectiveness was assessed using the Brief Fatigue Inventory and the McGill Quality -of-Life Question naire . The side effects were recorded . The results were analyzed on an intention-to-treat basis . The baseline demographics , fatigue levels , and quality -of-life scores were similar between the two arms . Patients were elderly , had impaired performance status ( Eastern Cooperative Oncology Group score=3 ) , and were taking a range of neurologically active medications . Thirty-nine patients completed the trial . There was a transient improvement in the fatigue levels on day 2 , but no significant difference in fatigue ( P=0.267 ) or quality of life ( P=0.579 ) by the end of the study . Statistical modeling did not reveal any significant predictors of response to dexamphetamine . These results suggest that dexamphetamine 20 mg daily , although well tolerated , does not significantly improve fatigue or quality of life in patients with advanced cancer , as measured by the selected instruments
These two scales show similar attributes with reasonably good internal consistency and responsiveness .
Either the Fatigue Scale or PedsQL Multidimensional Fatigue Scale can be incorporated into clinical research .
CONTEXT Despite the recognized distressing symptom of fatigue in children with cancer , little information is available to assist in the selection of an instrument to be used to measure fatigue .
OBJECTIVES The objectives of this study were to 1 ) describe the instruments that have been used to measure cancer-related fatigue in children and adolescents and 2 ) summarize the psychometric properties of the most commonly used instruments used to measure fatigue in children and adolescents with cancer .