Sofie Jakobsson

Exploring a Link Between Fatigue and Intestinal Injury During Pelvic Radiotherapy

BACKGROUND The association between cancer-related fatigue and pathological processes in the body is largely unknown. This study was designed to investigate a possible linkage between fatigue and intestinal injury during pelvic radiotherapy. METHODS Twenty-nine women undergoing pelvic radiotherapy for anal or uterine cancer were prospectively followed. Fatigue and diarrhea were assessed using patient self-reported questionnaires. Plasma citrulline concentration, as a sign of intestinal injury, and C-reactive protein, orosomucoid, albumin, α(1)-antitrypsin, and haptoglobin, as signs of systemic inflammation, were analyzed. RESULTS Fatigue increased significantly (p < .001) and citrulline decreased significantly (p < .001) during treatment. A significant negative correlation (r = -0.40; p < .05) was found between fatigue and epithelial atrophy in the intestine (as assessed by plasma citrulline) after 3 weeks of treatment and a significant positive correlation (r = 0.75; p < .001) was found between fatigue and diarrhea. Signs of systemic inflammation were evident, with significant increases in serum orosomucoid, serum haptoglobin (p < .05) and serum α(1)-antitrypsin (p < .001) and a significant decrease in serum albumin (p < .001). CONCLUSION The present study indicates a link between fatigue and intestinal injury during pelvic radiotherapy. This observation should be considered as a preliminary finding because of the small sample size but may serve as a rationale for therapeutic interventions aimed at alleviating both fatigue and gastrointestinal symptoms during pelvic radiotherapy.

Fatigue: a distressing symptom for patients with irritable bowel syndrome.

Fatigue is a frequent symptom in patients with irritable bowel syndrome (IBS), and is associated with poor quality of life. However, few studies have evaluated its impact on daily life or the perceived distress it can cause. Using a multi‐methods approach, this study describes the impact and manifestations of fatigue in patients with IBS and investigates the relationship between fatigue severity and illness‐related and health‐promoting factors.

Performance of the Swedish version of the Revised Piper Fatigue Scale

PURPOSE The Revised Piper Fatigue scale is one of the most widely used instruments internationally to assess cancer-related fatigue. The aim of the present study was to evaluate selected psychometric properties of a Swedish version of the RPFS (SPFS). METHODS An earlier translation of the SPFS was further evaluated and developed. The new version was mailed to 300 patients undergoing curative radiotherapy. The internal validity was assessed using Principal Axis Factor Analysis with oblimin rotation and multitrait analysis. External validity was examined in relation to the Multidimensional Fatigue Inventory-20 (MFI-20) and in known-groups analyses. RESULTS Totally 196 patients (response rate = 65%) returned evaluable questionnaires. Principal axis factoring analysis yielded three factors (74% of the variance) rather than four as in the original RPFS. Multitrait analyses confirmed the adequacy of scaling assumptions. Known-groups analyses failed to support the discriminative validity. Concurrent validity was satisfactory. CONCLUSION The new Swedish version of the RPFS showed good acceptability, reliability and convergent and- discriminant item-scale validity. Our results converge with other international versions of the RPFS in failing to support the four-dimension conceptual model of the instrument. Hence, RPFS suitability for use in international comparisons may be limited which also may have implications for cross-cultural validity of the newly released 12-item version of the RPFS. Further research on the Swedish version should address reasons for high missing rates for certain items in the subscale of affective meaning, further evaluation of the discriminative validity and assessment of its sensitivity in detecting changes over time.

Construct Validity of the Swedish Version of the Revised Piper Fatigue Scale in an Oncology Sample—A Rasch Analysis

OBJECTIVES Fatigue is a common and distressing symptom in cancer patients due to both the disease and its treatments. The concept of fatigue is multidimensional and includes both physical and mental components. The 22-item Revised Piper Fatigue Scale (RPFS) is a multidimensional instrument developed to assess cancer-related fatigue. This study reports on the construct validity of the Swedish version of the RPFS from the perspective of Rasch measurement. METHODS The Swedish version of the RPFS was answered by 196 cancer patients fatigued after 4 to 5 weeks of curative radiation therapy. Data from the scale were fitted to the Rasch measurement model. This involved testing a series of assumptions, including the stochastic ordering of items, local response dependency, and unidimensionality. A series of fit statistics were computed, differential item functioning (DIF) was tested, and local response dependency was accommodated through testlets. RESULTS The Behavioral, Affective and Sensory domains all satisfied the Rasch model expectations. No DIF was observed, and all domains were found to be unidimensional. The Mood/Cognitive scale failed to fit the model, and substantial multidimensionality was found. Splitting the scale between Mood and Cognitive items resolved fit to the Rasch model, and new domains were unidimensional without DIF. CONCLUSIONS The current Rasch analyses add to the evidence of measurement properties of the scale and show that the RPFS has good psychometric properties and works well to measure fatigue. The original four-factor structure, however, was not supported.

Validation of Fatigue Impact Scale with various item sets – a Rasch analysis

Abstract Purpose: Fatigue is a symptom in patients with chronic gastrointestinal (GI) and liver diseases. Different instruments have been developed to assess the severity of fatigue and the 40-item Fatigue Impact Scale (FIS) is among the most widely used. Shorter versions of FIS include the 21-item Modified Fatigue Impact Scale (MFIS), and an eight-item version for everyday use. The study aimed to assess construct validity, reliability, and sufficiency of the raw score of the original FIS with 40 items, and examine the sufficiency of the 21 items from the Modified scale and the eight items of the Daily Fatigue Impact Scale (D-FIS), all of which are embedded in the 40-item scale. Methods: Patients with chronic GI or liver disease (n = 354) completed the FIS with 40 items. The majority (57%) was under the age of 55 years and approximately half were females (48%). Various item sets of FIS were derived which showed fit to the Rasch model. Results: Local dependency and multidimensionality in FIS and the 21-item Modified scale were resolved with a testlet solution but the D-FIS showed local dependency and multidimensionality and differential item functioning (DIF) still remained. Two new item sets fulfilling unidimensionality and no DIF are suggested, one with 15 items and a six-item scale for daily use. The transformation table shows score-interval scale estimates for all these item sets. Conclusions: Both the FIS and the Modified scale can be used to measure fatigue albeit requiring some adjustment for DIF. The eight-item D-FIS is more problematic, and its summed score is not valid. Alternative 15- and 6-item versions presented in this paper can offer valid summed scores, and the transformation table allows transformation of raw scores and comparisons across all versions. Implications for rehabilitation The Fatigue Impact Scale and the Modified Fatigue Impact Scale can be used to measure fatigue after adjustments for differential item functioning. Alternative 15- and 6-item versions of Fatigue Impact Scale offer valid summed scores. The summed score for the Daily Fatigue Impact Scale is not valid. A transformation table with raw scores and Rasch transformed interval scale metric makes it possible to compare scores derived from the Fatigue Impact Scale, the Modified Fatigue Impact Scale and the proposed 15- and 6-item versions of Fatigue Impact Scale for research and/or clinical use.

Fatigue one to Five Years after Lung Transplantation - A Significant Problem

The Swedish SMATT-study (Self-management after thoracic transplantation). Introduction No comprehensive analysis has been performed regarding fatigue after lung transplantation (LuTx), despite the well-known fact that it influences quality of life and hampers self-management. The aim of this study was to investigate the prevalence of fatigue among lung recipients 1-5 years after transplantation and to explore its relationship to distressing symptoms such as dyspnea, sleep problems, pain, and decreased appetite, as well as psychological and transplant specific well-being. Methods This multicenter, cross-sectional cohort study is a part of the Swedish national study: self-management after thoracic transplantation (SMATT). A total of 117 lung recipients with a mean age of 54 years who were due for their annual follow-up were included at 1 year (n=35), 2 years (n=28), 3 years (n=23), 4 years (n=20), and 5 years (n=11) after lung transplantation. Several instruments were used: the Multidimensional Fatigue Inventory, the Organ Transplant and Symptom Well-being Instrument (OTSWI), the Pain-O-Meter, and the Psychological General Well-Being Index. Results and Discussion Overall 56 % reported high or severe fatigue. All lung recipients had a high level of general fatigue, median score 12 (IQR 8-16), irrespective of the length of time since transplantation. The proportion of recipients with severe fatigue ranged from 22-45 % depending on follow-up time. There were no significant differences between men and women in the MFI-20 subscales except for mental fatigue, where women reported more severe mental fatigue (p<0.05). Lung recipients reporting inability to work were significantly more fatigued in all subscales than those working or studying The psychological general well-being sum score makes the strongest contribution (p<.0001) to explaining general fatigue (Beta -.628) in contrast to the transplant specific wellbeing score (Beta .203, p=.034). Thus, more than half of the lung recipients suffer from high or severe fatigue that possibly hampers the ability of going back to work and negatively affects mental wellbeing. Our study highlights the importance of identifying appropriate interventions targeting fatigue after LuTx. Based on experiences from cancer related fatigue, combined exercise and psychological interventions are most effective and interventions based on pharmaceutical treatment and education are insufficient. Conclusion High or severe fatigue is common 1-5 years after lung transplantation but varies depending on follow-up time. Poor psychological general well-being is a strong contributor to fatigue.

Fear of graft rejection 1-5 years after lung transplantation-A nationwide cohort study

To explore the perceived threat of the risk of graft rejection and its relationship to psychological general well‐being and self‐efficacy 1–5 years after lung transplantation.

Fatigue 1–5 years after lung transplantation: A multicenter cross-sectional cohort study

The aim of this study was to investigate the prevalence of fatigue among lung recipients 1–5 years after transplantation (LuTx) and to explore its relationship to distressing symptoms such as dyspnea, sleep problems, pain, and decreased appetite, as well as psychological and transplant specific wellbeing. A cross-sectional, multicenter cohort study was conducted. A total of 117 lung recipients with a mean age of 54 years (SD 13 years) who were due for their annual follow-up were included at 1 year (n = 35), 2 years (n = 28), 3 years (n = 23), 4 years (n = 20), and 5 years (n = 11) after lung transplantation. Several instruments were used: the Multidimensional Fatigue Inventory, the Organ Transplant and Symptom Well-being Instrument (OTSWI), the Pain-O-Meter, and the Psychological General Well-Being Index. Overall 56% reported high or severe fatigue. The Psychological General Well-Being sum score makes the strongest contribution (p < .0001) to explaining the variance in general fatigue (Beta –.628). The results of the study indicate that efforts both to identify fatigue and to test interventions are needed after LuTx.

3076 POSTER Fatigue Experienced by Patients During Cancer Treatment – the Psychometric Properties of the Swedish Version of the Revised Piper Fatigue Scale

Fatigue experienced by patients during cancer treatment : the psychometric properties of the swedish version of the revised piper fatigue scale