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Fatigue in the general population: German normative values of the EORTC QLQ-FA12

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Abstract

Purpose

Fatigue is a frequent symptom in patients suffering from chronic diseases, especially cancer patients. A new fatigue questionnaire was recently developed to better assess this condition, the EORTC QLQ-FA12. The aims of this study were to test the psychometric properties of this fatigue questionnaire and to provide normative values.

Methods

A total of 2411 individuals (53.5% women), representatively selected from the German general population, responded to the EORTC QLQ-FA12 questionnaire.

Results

Women reported more fatigue than men on all three scales of the EORTC QLQ-FA12 with the following effect sizes: d = 0.29 (physical fatigue), d = 0.22 (emotional fatigue), and d = 0.11 (cognitive fatigue). There were no linear age trends. Confirmatory factorial analysis confirmed the latent structure of the questionnaire. The correlations among the latent scales were between 0.71 and 0.84. The internal consistency coefficients were alpha = 0.92 (physical fatigue), 0.86 (emotional fatigue), 0.79 (cognitive fatigue), and 0.94 (sum score).

Conclusions

The study proved the psychometric quality of the EORTC QLQ-FA12 in the general population. Gender differences should be accounted for when comparing groups of patients. The normative scores can be used to qualify the assessment of the degree of patients’ fatigue.

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References

  1. Saligan, L. N., Olson, K., Filler, K., et al. (2015). The biology of cancer-related fatigue: A review of the literature. Supportive Care in Cancer, 23, 2461–2478.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Weis, J. (2011). Cancer-related fatigue: prevalence, assessment and treatment strategies. Expert Review of Pharmacoeconomics & Outcomes Research, 11, 441–446.

    Article  Google Scholar 

  3. Whitehead, L. C., Unahi, K., Burrell, B., & Crowe, M. T. (2016). The experience of fatigue across long-term conditions: A qualitative meta-synthesis. Journal of Pain and Symptom Management, 52, 131.

    Article  PubMed  Google Scholar 

  4. Giacalone, A., Quitadamo, D., Zanet, E., Berretta, M., Spina, M., & Tirelli, U. (2013). Cancer-related fatigue in the elderly. Supportive Care in Cancer, 21, 2899–2911.

    Article  CAS  PubMed  Google Scholar 

  5. Mehnert, A., Hartung, T. J., Friedrich, M., et al. (2018). One in two cancer patients is significantly distressed: Prevalence and indicators of distress. Psycho-Oncology, 27, 75–82.

    Article  CAS  PubMed  Google Scholar 

  6. Cella, D., Davis, K., Breitbart, W., & Curt, G. (2001). Cancer-related fatigue: Prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. Journal of Clinical Oncology, 19, 3385–3391.

    Article  CAS  PubMed  Google Scholar 

  7. Kuhnt, S., Ernst, J., Singer, S., et al. (2009). Fatigue in cancer survivors—prevalence and predictors. Onkologie, 32, 312–317.

    Article  PubMed  Google Scholar 

  8. Cumming, T. B., Packer, M., Kramer, S. F., & English, C. (2016). The prevalence of fatigue after stroke: A systematic review and meta-analysis. International Journal of Stroke, 11, 968–977.

    Article  PubMed  Google Scholar 

  9. Kentson, M., Tödt, K., Skargren, E., et al. (2016). Factors associated with experience of fatigue, and functional limitations due to fatigue in patients with stable COPD. Therapeutic Advances in Respiratory Disease, 10, 410–424.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Katz, P. (2017). Causes and consequences of fatigue in rheumatoid arthritis. Current Opinion in Rheumatology, 29, 269–276.

    Article  PubMed  Google Scholar 

  11. Kratz, A. L., Schilling, S., Goesling, J., & Williams, D. A. (2016). The PROMIS FatigueFM Profile. A self-report measure of fatigue for use in fibromyalgia. Quality of Life Research, 25, 1803–1813.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Herlofson, K., & Kluger, B. M. (2017). Fatigue in Parkinson’s disease. Journal of the Neurological Sciences, 374, 38–41.

    Article  PubMed  Google Scholar 

  13. van den Akker, L. E., Beckerman, H., Collette, E. H., Eijssen, I. C. J. M., Dekker, J., & Groot, V. (2016). Effectiveness of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: A systematic review and meta-analysis. Journal of Psychosomatic Research, 90, 33–42.

    Article  PubMed  Google Scholar 

  14. Han, C. J., & Yang, G. S. (2016). Fatigue in irritable bowel syndrome: A systematic review and meta-analysis of pooled frequency and severity of fatigue. Asian Nursing Research, 10, 1–10.

    Article  CAS  PubMed  Google Scholar 

  15. Agasi-Idenburg, C., Velthuis, M., & Wittink, H. (2010). Quality criteria and user-friendliness in self-reported questionnaires on cancer-related fatigue: A review. Journal of Clinical Epidemiology, 63, 705–711.

    Article  PubMed  Google Scholar 

  16. de Raaf, P. J., de Klerk, C., & van der Rijt, C. C. D. (2013). Elucidating the behavior of physical fatigue and mental fatigue in cancer patients: A review of the literature. Psycho-Oncology, 22, 1919–1929.

    Article  PubMed  Google Scholar 

  17. Seyidova-Khoshknabi, D., Davis, M. P., & Walsh, D. (2011). Review article: A systematic review of cancer-related fatigue measurement questionnaires. American Journal of Hospice and Palliative Medicine, 28, 119–129.

    Article  PubMed  Google Scholar 

  18. Aaronson, N. K., Ahmedzai, S., Bergman, B., et al. (1993). The European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30—a quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365–376.

    Article  CAS  PubMed  Google Scholar 

  19. Weis, J., Tomaszewski, K. A., Hammerlid, E., et al. (2017). International psychometric validation of an EORTC quality of life module measuring cancer related fatigue (EORTC QLQ-FA12). Journal of the National Cancer Institute, 109, djw273.

    Article  Google Scholar 

  20. Scott, J. A., Lasch, K. E., Barsevick, A. M., & Piault-Louis, E. (2011). Patients’ experiences with cancer-related fatigue. A review and synthesis of qualitative research. Oncology Nursing Forum, 38, E191–E203.

    Article  Google Scholar 

  21. Weis, J., Arraras, J. I., Conroy, T., et al. (2012). Development of an EORTC quality of life phase III module measuring cancer-related fatigue (EORTC QLQ-FA13). Psycho-Oncology, 22, 1002–1007.

    Article  PubMed  Google Scholar 

  22. Rief, H., Akbar, M., Keller, M., et al. (2014). Quality of life and fatigue of patients with spinal bone metastases under combined treatment with resistance training and radiation therapy—a randomized pilot trial. Radiation Oncology, 9, 151.

    Article  PubMed  Google Scholar 

  23. Rief, H., Heinhold, M., Bruckner, T., et al. (2014). Quality of life, fatigue and local response of patients with unstable spinal bone metastases under radiation therapy—a prospective trial. Radiation Oncology, 9, 133.

    Article  PubMed  Google Scholar 

  24. Fuhrmann, K., Mehnert, A., Geue, K., & Hinz, A. (2015). Fatigue in breast cancer patients: Psychometric evaluation of the fatigue questionnaire EORTC QLQ-FA13. Breast Cancer, 22, 608–614.

    Article  PubMed  Google Scholar 

  25. Nashan, D., Reuter, K., Mohr, P., & Agarwala, S. S. (2012). Understanding and managing interferon-alpha-related fatigue in patients with melanoma. Melanoma Research, 22, 415–423.

    Article  CAS  PubMed  Google Scholar 

  26. Kecke, S., Ernst, J., Einenkel, J., Singer, S., & Hinz, A. (2017). Psychometric properties of the fatigue questionnaire EORTC QLQ-FA12 in a sample of female cancer patients. Journal of Pain and Symptom Management, 54, 922–928.

    Article  PubMed  Google Scholar 

  27. Löwe, B., Wahl, I., Rose, M., et al. (2010). A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. Journal of Affective Disorders, 122, 86–95.

    Article  PubMed  Google Scholar 

  28. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.

    Article  Google Scholar 

  29. Cella, D., Lai, J.-S., & Stone, A. (2011). Self-reported fatigue: One dimension or more? Lessons from the functional assessment of chronic illness therapy—fatigue (FACIT-F) questionnaire. Supportive Care in Cancer, 19, 1441–1450.

    Article  PubMed  Google Scholar 

  30. Yost, K. J., Waller, N. G., Lee, M. K., & Vincent, A. (2017). The PROMIS fatigue item bank has good measurement properties in patients with fibromyalgia and severe fatigue. Quality of Life Research, 26, 1417–1426.

    Article  PubMed  Google Scholar 

  31. Smets, E. M. A., Garssen, B., Bonke, B., & Dehaes, J. C. J. M. (1995). The multidimensional fatigue inventory (MFI): Psychometric qualities of an instrument to assess fatigue. Journal of Psychosomatic Research, 39, 315–325.

    Article  CAS  PubMed  Google Scholar 

  32. de Vries, J., Michielsen, H., van Heck, G. L., & Drent, M. (2004). Measuring fatigue in sarcoidosis: The Fatigue Assessment Scale (FAS). British Journal of Health Psychology, 9, 279–291.

    Article  PubMed  Google Scholar 

  33. Lai, J.-S., Cella, D., Yanez, B., & Stone, A. (2014). Linking fatigue measures on a common reporting metric. Journal of Pain and Symptom Management, 48, 639–648.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Beutel, M. E., Hinz, A., Albani, C., & Brähler, E. (2006). Fatigue Assessment Questionnaire: Standardization of a cancer-specific instrument based on the general population. Oncology, 70, 351–357.

    Article  CAS  PubMed  Google Scholar 

  35. Schwarz, R., Krauss, O., & Hinz, A. (2003). Fatigue in the general population. Onkologie, 26, 140–144.

    CAS  PubMed  Google Scholar 

  36. Nordin, Å, Taft, C., Lundgren-Nilsson, Å, & Dencker, A. (2016). Minimal important differences for fatigue patient reported outcome measures-a systematic review. BMC Medical Research Methodology, 16, 62.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hinz, A., Singer, S., & Brähler, E. (2014). European reference values for the quality of life questionnaire EORTC QLQ-C30: Results of a German investigation and a summarizing analysis of six European general population normative studies. Acta Oncologica, 53, 958–965.

    Article  PubMed  Google Scholar 

  38. Fischer, F., Gibbons, C., Coste, J., Valderas, J. M., Rose, M., & Leplège, A. (2018). Measurement invariance and general population reference values of the PROMIS Profile 29 in the UK, France, and Germany. Quality of Life Research, 27, 999–1014.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany

    Andreas Hinz, Elmar Brähler & Anja Mehnert

  2. Tumor Biology Centre, University Clinic Centre, Freiburg, Germany

    Joachim Weis

  3. Clinic for Psychosomatic Medicine and Psychotherapy, University of Mainz, Mainz, Germany

    Elmar Brähler

Authors
  1. Andreas Hinz
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  2. Joachim Weis
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  3. Elmar Brähler
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  4. Anja Mehnert
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Corresponding author

Correspondence to Andreas Hinz.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of the University of Leipzig. All procedures were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants.

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Hinz, A., Weis, J., Brähler, E. et al. Fatigue in the general population: German normative values of the EORTC QLQ-FA12. Qual Life Res 27, 2681–2689 (2018). https://doi.org/10.1007/s11136-018-1918-0

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  • DOI: https://doi.org/10.1007/s11136-018-1918-0

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