cancer fatigue dimensions?
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Cancer Fatigue Cancer Fatigue Dimensions?Dimensions?
David Cella, Ph.D.David Cella, Ph.D.
Some “Fatigue” Scale ItemsSome “Fatigue” Scale Items
Think ClearlyThink ClearlyRemember thingsRemember thingsTense – RelaxedTense – RelaxedDiscouragedDiscouragedEmbarassedEmbarassedImpatientImpatientFed upFed upMotivatedMotivatedCheerful – Happy – SadCheerful – Happy – SadEyes hurtEyes hurtLots of plansLots of plansConcentrationConcentrationWandering thoughtsWandering thoughts
AchinessAchinessUncertaintyUncertaintyExhilarationExhilarationTender neckTender neckStiff shouldersStiff shouldersLivelyLivelyAngry Angry FeverishFeverishMuddledMuddledYell at othersYell at othersPhysically fitPhysically fitDread doing thingsDread doing things
Without fatigue attribution, what’s being measured here?
Category Category NamedNamed
## %%
SynonymsSynonyms 170170 42%42%
InterferenceInterference 6767 16%16%
SeveritySeverity 4444 11%11%
Lethargy/EffortLethargy/Effort 3333 8%8%
RestRest 2929 7%7%
Physical Physical ImpactImpact
2121 5%5%
SleepSleep 1717 4%4%
ApathyApathy 1616 4%4%
Mental ImpactMental Impact 1111 3%3%
Spontaneous Endorsements of Fatigue
Categories by 296 Cancer Patients:
Descriptors mentioned more than once
Descriptor Count (% of total)
Tired 151 (58%)
Lack of energy 47 (18%)
Exhausted 20 (8%)
Drained 5 (2%)
Worn out 4 (2%)
No pep 2 (<1%)
Worn down 2 (<1%)
Stressed 2 (<1%)
Wiped out 2 (<1%)
Cancer Patient-Generated Synonyms for Fatigue (n=296 interviews)
Scree Plot of Fatigue Scree Plot of Fatigue Responses to Responses to
Multidimensional Content Multidimensional Content (same result as QM; PROMIS HepC analysis; (same result as QM; PROMIS HepC analysis;
PROMIS wave one)PROMIS wave one)
0
5
10
15
20
25
30
35
40
45
1 2 3 4 5 6 7 8 9Factor
Eig
enva
lues
All 72 items
Reduced 66 items
Reference: Lai, J-S, Crane, P.K., Cella, D. (2006). Factor Analysis Techniques for Assessing Sufficient Unidimensionality of Cancer Related Fatigue. Quality of Life Research, 15, 1179-1190
CFA-based Bi-Factor CFA-based Bi-Factor AnalysisAnalysis
Fatigue
GeneralPhysical- negative
Mental
GP1 F72…. AN14 F41…. AN7 F67…. AN16 F60…. F04 F70….
Physical – positive
Social/Family
NOTE: All items had higher loadings on the general factor than on the local factors
Reference: Lai, J-S, Crane, P.K., Cella, D. (2006). Factor Analysis Techniques for Assessing Sufficient Unidimensionality of Cancer Related Fatigue. Quality of Life Research, 15, 1179-1190
PROMIS experience (n>14,000)PROMIS experience (n>14,000)“Fatigue Impact” versus “Fatigue Experience”“Fatigue Impact” versus “Fatigue Experience”
Form Correlation
D 0.95 H 0.91 I 0.90 J 0.88 K 0.88 L 0.88 M 0.96 N 0.91 O 0.92 P 0.90 Q 0.79 R 0.84 S 0.85 T 0.86 U 0.87 V 0.85 W 0.85
Form D is the “full bank” and others are all “blocks”
Fatigue
Impact Experience
FATIMP-1 FATIMP-59 FATEXP-1FATEXP-
53
Sufficient Unidimensionality –Sufficient Unidimensionality –Impact (n=59) versus Experience (n=51)Impact (n=59) versus Experience (n=51)
NOTE: All items had higher loadings on the general factor than on the local factors
Fatigue
Fatigue Vitality
FAT-1 FAT-98 VIT-1 VIT-12
Sufficient Unidimensionality –Sufficient Unidimensionality –““Fatigue” (n=98) versus “Vitality” (n=12)Fatigue” (n=98) versus “Vitality” (n=12)
NOTE: All items had higher loadings on the general factor than on the local factors
SamplSampleses Sample 1
(CBT N=300) Sample 2
(CAT N=255) Pooled Samples
(N=555)
Male 34.9% 37.7% 36.2% Gender Female 65.1% 62.4% 63.8%
White 82.4% 94.1% 87.8% Black 9.6% 2.8% 6.4%
Race
Hispanic origin 3.7% 1.6% 2.7%
Breast 34.13% 32.6% 33.4%
Colorectal 12.6% 11.0% 11.9% Non-Hodgkin’s 7.9% 10.6% 9.1% Ovarian 7.2% 7.5% 7.3% Lung 6.8% 7.5% 7.1%
Cancer Type
Prostate 5.1% 5.1% 5.1%
Local 17.2% 10.4% 14.1%
Regional 4.0% 17.1% 10.3% Distant metastases 52.0% 49.5% 50.9%
Extent of Disease
N/A or missing 26.7% 22.7% 24.8%
Normal 29.8% 35.3% 32.4% Some symptom 46.4% 42.8% 44.7% Confined to bed (<50%) 18.0% 18.8% 18.4% Confined to bed (>50%) 5.8% 3.1% 4.6%
ECOG PSR
Unable to get of bed 0% 0% 0%
Mean hemoglobin (SD) in g/dL Not collected 11.8 (SD=1.5; range 7.5-16.2)
N/A
Mean age (SD) 58.6 (SD=13.4)
60.9 (SD=13.2)
59.7 (SD=13.4)
Sample used for testing Sample used for testing
dimensionality (Full-bank data)dimensionality (Full-bank data)Sample used for parameter estimation Sample used for parameter estimation
(Full-bank + Block data)(Full-bank + Block data)
NN 803803 14,93114,931
AgeAge 51.0 (SD=18.2)51.0 (SD=18.2) 54.07 (SD=16.4)54.07 (SD=16.4)
GenderGender 45.9% male; 54.1% female45.9% male; 54.1% female 47.8% male (52.2% female)47.8% male (52.2% female)
RaceRace 80.8% white, 9.2% African 80.8% white, 9.2% African
American, 8.8% multiple racesAmerican, 8.8% multiple races83.0% white, 8.2% African American, 7.9% 83.0% white, 8.2% African American, 7.9%
multiple racesmultiple races
EducationEducation 19.1% high school or below; 19.1% high school or below;
44.3% some college; 19.4% 44.3% some college; 19.4%
college; 17.2% advanced degreecollege; 17.2% advanced degree
17.9% high school or below; 37.9% some 17.9% high school or below; 37.9% some
college; 24.4% college; 19.9% advanced college; 24.4% college; 19.9% advanced
degreedegree
ComorbidityComorbidity 65.6% OA or degenerative 65.6% OA or degenerative
arthritis; 35.7% hypertension; arthritis; 35.7% hypertension;
22.5% arthritis or rheumatism; 22.5% arthritis or rheumatism;
20.6% depression; 16.1% 20.6% depression; 16.1%
anxiety; 14.5% asthma; 11.0% anxiety; 14.5% asthma; 11.0%
diabetesdiabetes
43.0% hypertension; 28.3% arthritis or 43.0% hypertension; 28.3% arthritis or
rheumatism; 28.2% depression; 20.3% rheumatism; 28.2% depression; 20.3%
cancer; 18.3% migraines; 18.0% anxiety; cancer; 18.3% migraines; 18.0% anxiety;
17.8% OA or degenerative arthritis; 17.1% 17.8% OA or degenerative arthritis; 17.1%
asthma; 15.1% sleep disorder; 14.6% asthma; 15.1% sleep disorder; 14.6%
diabetes; 13.5% COPD, bronchitis, diabetes; 13.5% COPD, bronchitis,
emphysema; 11.5% anginaemphysema; 11.5% angina
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