Psychometric and Clinical Assessment of the 10-Item Reduced Version of the Fatigue Scale—Child Instrument

Accepted 31 July 2009.

Abstract

Fatigue is one of the most debilitating conditions associated with cancer and anticancer therapy. The lack of reliable and valid self-report instruments has prevented accurate assessment of fatigue in pediatric oncology patients. The purpose of this study was to identify the most sensitive and specific score, that is, the “cut score,” on the Fatigue Scale-Child (FS-C) to identify those children with high cancer-related fatigue in need of clinical intervention. We first used Rasch methods to identify the items on the FS-C that distinguished children with high cancer-related fatigue from other children; our findings indicated that the FS-C needed to be reduced from 14 items to 10 items. We then assessed the 10-item FS-C for its psychometric properties and applied the receiver operating characteristics curve analysis to the FS-C responses from 221 children (aged 7–12 years) receiving anticancer treatment. The cut score identified with 75% sensitivity and 73.5% specificity was 12; 73 (33%) patients scored 12 or higher. Findings from this validated instrument provide a needed guide for clinicians to interpret fatigue scores and provide clinical interventions for this debilitating condition to their pediatric patients with cancer.

Key Words: Pediatric, oncology, fatigue, patient-reported outcome, Rasch, ROC

a Department of Nursing Research, Children's National Medical Center, George Washington University, Washington, DC, USA

b Department of Pediatrics, George Washington University, Washington, DC, USA

c Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA

d Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA

e Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA

f The Center for Research and Evidence-Based Practice, Texas Children's Hospital, Houston, Texas, USA

g Hematology/Oncology Program, Hospital for Sick Children, Toronto, Ontario, Canada

h Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA

i LeBonheuer Children's Medical Center, Memphis, Tennessee, USA

j Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg Medical School, Chicago, Illinois, USA

k Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA

Address correspondence to: Pamela S. Hinds, PhD, RN, FAAN, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA.

This study was supported in part by Cancer Center Support CA 21765 from the National Cancer Institute; grant R01NR007610 from the National Institute of Nursing Research; a FIRE grant from the Oncology Nurses Foundation; and the American Lebanese Syrian Associated Charities (ALSAC). Fatigue Initiative Through Research & Education (FIRE).

PII: S0885-3924(10)00099-0

doi:10.1016/j.jpainsymman.2009.07.015

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