Takashi Hosaka

Development and validation of the cancer fatigue scale: a brief, three-dimensional, self-rating scale for assessment of fatigue in cancer patients.

We herein describe the development and validation of the Cancer Fatigue Scale (CFS) for assessment of fatigue in cancer patients. We designed this scale specifically to reflect the nature of fatigue experienced by cancer patients, by using factor analysis; the CFS is a 15-item scale composed of 3 subscales (physical, affective, and cognitive subscales). Three hundred seven cancer patients participated in the validation phase. Construct validity, confirmed by repeating factor analysis, was good. Convergent validity, confirmed by a correlation between CFS and a visual analogue scale for fatigue, was also shown to be good (r = 0.67, P < 0.001). The CFS had good stability (average test-retest reliability r = 0.69, P < 0.001) and good internal consistency (Cronbachs alpha coefficient for all 15 items = 0.88). The present study indicates that the CFS is a brief, valid, and feasible measure of fatigue for use with cancer patients.

Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale

Abstract Fatigue is one of the most frequent symptoms in cancer patients. However, the precise causes of this fatigue are still unknown, and this situation makes it difficult to combat the problem. The present study was conducted to investigate factors correlated with fatigue in disease-free breast cancer patients. A group of 134 randomly selected ambulatory breast cancer patients who had undergone successful surgical treatment participated. They completed the Cancer Fatigue Scale, the Hospital Anxiety and Depression Scale, the Mental Adjustment to Cancer Scale, and an ad hoc questionnaire detailing physical symptoms, social support, and demographic variables at home and returned them by mail the following day. Multiple regression analysis revealed that fatigue was significantly correlated with dyspnea, insufficient sleep, and depression, and that these three variables accounted for a total of 46% of variance in fatigue. Factors concerned with the cancer and treatment, such as disease stage, lymph node metastasis, number of days since operation, past intravenous chemotherapy, radiotherapy, current use of fluoropyrimidine compounds, and current use of tamoxifen citrate were not correlated with fatigue. The results suggest that fatigue in this population is determined by current physical and psychological distress rather than by the cancer itself and prior cancer treatments, and that the management of dyspnea, insomnia, and depression might be important in reducing fatigue in this population.

Fatigue in Ambulatory Patients with Advanced Lung Cancer: Prevalence, Correlated Factors, and Screening

Although it has been indicated that patients with lung cancer experience higher level of fatigue than patients with other cancers, few published studies have focused on the characteristics of this fatigue and how it interferes with daily activities. The purpose of this study was to clarify fatigue prevalence and the factors correlated with fatigue, and to develop a screening method for fatigue in patients with advanced lung cancer. One hundred fifty-seven patients completed two fatigue scales (Cancer Fatigue Scale [CFS], and Fatigue Numerical Scale [FNS]) plus other measures, along with a self-administered questionnaire asking whether fatigue had interfered with any of 7 areas of daily activities. Fifty-nine percent of patients had experienced clinical fatigue, which was defined as fatigue that interfered with any daily activities. Logistic regression analysis demonstrated that symptoms of dyspnea on walking, appetite loss, and depression were significant correlated factors. Both CFS and FNS were found to have sufficient sensitivity and specificity for use as a screening tool. The results indicated that fatigue is a frequent and important symptom, which is associated with both physical and psychological distress in this population. The CFS and FNS were confirmed to have sufficient screening ability.

Validation Study of the Japanese Version of the Brief Fatigue Inventory

Fatigue has been recognized as one of the most distressing symptoms in cancer patients. Concise assessment is essential to managing this symptom. To that end, the Brief Fatigue Inventory (BFI), a 9-item questionnaire, was designed to assess fatigue in cancer patients. The purpose of this study was to examine the validity and reliability of the Japanese version of this scale (BFI-J), when compared with previously validated fatigue instruments. We randomly selected 252 cancer patients and presented them with the BFI-J, along with the Cancer Fatigue Scale; Profile of Mood States fatigue, vigor, and depression subscales; and European Organization for Research and Treatment of Cancer QLQ-C30. Specifically, the reliability and construct, criterion, convergent, and discriminant validity of each instrument were evaluated. Additionally, fatigue severity classification was explored using the BFI-J. The results indicated that the BFI-J is a brief, valid, and feasible measure of fatigue for use with Japanese cancer patients.

Increased natural Killer-Cell activity is associated with infertile women

PROBLEM: An increase in natural killer (NK)‐cell activity has been observed in women with unexplained recurrent miscarriages. Because of the many similarities between infertility and early pregnancy loss patients, we investigated whether infertile women had raised NK‐cell activity.
 METHOD OF STUDY: We tested 94 infertile women who, in spite of treatment, were unable to conceive for 6 or more months. NK‐cell activity was measured by using a chromium‐51 release cytotoxicity assay, with K562 human myeloid leukemia cells as targets.
 RESULTS: NK‐cell activity of the infertile group (mean±SD; 40.2%±14.7) was significantly higher than the control group (31.5%±11.9, P<0.0001). The increased NK‐cell activity was not associated with age, infertile duration, depression scores, treated hyperprolactinemia, or treated endometriosis.
 CONCLUSIONS: In certain patients, elevated NK‐cell activity may be considered an independent risk factor for infertility.

Occurrence of fatigue and associated factors in disease-free breast cancer patients without depression

Goals of workStudies on fatigue in disease-free breast cancer patients have consistently found a significant association between fatigue and depression; and some characteristics of this fatigue may be confused with and/or concealed by those of depression. To clarify the characteristics of fatigue in disease-free breast cancer patients, we examined the frequency of fatigue and associated factors in disease-free breast cancer patients without major depression.Patients and methodsSeventy-nine ambulatory breast cancer patients without major depression who had been disease-free for more than 3 years since their surgery completed the Cancer Fatigue Scale (CFS), a multidimensional scale assessing cancer-related fatigue. Participants also completed the Short-form Eysenck Personality Questionnaire–Revised (EPQR) for assessing their personalities. Sociodemographic, physical, and treatment-related factors were also obtained by interview.Main resultsWe found that 36.7% of the patients exhibited fatigue and that fatigue was significantly associated with neuroticism.ConclusionsThese results suggest that a considerable number of disease-free breast cancer patients without major depression experience fatigue and that careful attention to those exhibiting high neuroticism may be of benefit in ameliorating their fatigue.

Validity and reliability of the Japanese version of the Stress and Coping Inventory

Abstract We examined the validity and reliability of the Japanese version of the Stress and Coping Inventory (SCI) among 170 Japanese college students and 234 healthy subjects. The validity and reliability of this version of the SCI in the college student group were supported by significant test‐retest correlations, relatively high internal consistency coefficients, and adequate correlations with the Coping Inventory for Stressful Situations (CISS). AS for the healthy subject group, the reliability was supported by relatively high internal consistency coefficients, although further analyses, such as test‐retest, are required. The Japanese version of the SCI appears to be suitable for use among college students.

Structured intervention in family caregivers of the demented elderly and changes in their immune function

Abstract The aim of the present study was to investigate the effects of a group structured intervention on the mental and physical discomfort and immune function of 20 family caregivers. A structured intervention for caregivers consists of five sessions, each of which lasts 90 min. This was a modified version of the program that had been originally developed for cancer patients. All the family caregivers were female and ranged in age from 47 to 66 years (mean: 54.7 ± 4.4). The period of care at home ranged from 1 to 12 years (mean: 5.8 ± 2.7). Concerning the original diseases of the care‐receivers, 10 had vascular dementia and eight had Alzheimers disease. Nine out of 20 caregivers had no care support, and seven utilized no public resources such as day‐care centers. Only five caregivers felt that they were healthy. Two psychometries, that is, Profile of Mood States (POMS) and General Health Questionnaire‐30 (GHQ‐30) were administered and blood samples were drawn before and after intervention. Comparison of results showed that there was significant improvement (P < 0.05) in the scores of depression, anger–hostility, fatigue and confusion in the POMS, and physical symptoms, anxiety–mood disorder, suicidality–depression in the GHQ‐30. Also, there was significant (P = 0.0325) augmentation of natural‐killer cell activity. The present study suggests that this kind of intervention was effective for relieving emotional and physical discomfort, and also for improving immune function.

Depression among cancer patients

Abstract This study was done to investigate the frequency of co‐morbidity and to demonstrate the best method for assessing depression among cancer patients. The subjects were 50 (25 male and 25 female) cancer patients and 50 (25 male and 25 female) medically ill patients. All subjects were interviewed by psychiatrists and were administered psychological tests such as SAS (self‐rating anxiety scale), SDS (self‐rating depression scale), POMS (Profile of Mood States), HADS (Hospital Anxiety and Depression Scale) and DRP (Depression‐related personality traits). The psychiatric interview revealed that 44% of cancer patients and 38% of the medical patients had mental disorders according to DSM‐IV. The most frequently observed disorder was depression, which was seen in 28% of the cancer patients and 30% of the medical patients. The cancer patients with depression scored significantly higher on the DRP and the Anger mood state of POMS than did the medically ill patients with depression. In addition, most psychological tests employed had no discrimination between depressed and normal subjects among the cancer and the medical patients. However, it was found that the Depression scale in HADS (HADS‐D) split depressed patients from normal subjects since the HADS‐D was composed of items that were not concerned with physically ill conditions.

Avoidance Coping Behaviors and Low Social Support Are Related to Depressive Symptoms in HTV-Positive Patients in Japan

The authors examined the influences of several psychosocial factors (i.e., coping behavior responses, social support, etc.) on mood states in 47 human immunodeficiency virus (HIV)-positive patients without the acquired immunodeficiency syndrome (AIDS). No patients fulfilled the DSM-III-R diagnostic criteria for mood disorders, including major depression. However, the HIV group indicate significantly stronger depressive symptoms and lower social support than the healthy control group. The strength of depressive symptoms and poor social support were significantly correlated with one another. Although the HIV group indicated significantly stronger active coping behaviors than the healthy control group, depressive symptoms were significantly and positively correlated with avoidance coping behaviors. When existence of social support was controlled for, this significant correlation was not noted, indicating that avoidance coping behaviors are independently and significantly related to depressive symptoms. The results suggest that, although depressive symptoms are not strong enough to warrant a psychiatric diagnosis of mood disorders, including major depression, avoidance coping behaviors and poor existence of social support may be a high-risk combination for the manifestation of depressive symptoms in HIV-positive patients without AIDS in Japan.