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