Feasibility and Validity of a One-item Fatigue Screen in a Thoracic Oncology Clinic

Introduction: Fatigue is one of the most common symptoms in patients with advanced cancers. Despite its high prevalence, it is often unrecognized and undetected. This study assessed the feasibility and validity of a one-item fatigue scale (OIFS) in an outpatient oncology clinic.

Methods: Over a 3-month trial period, all patients in a thoracic oncology clinic were screened for fatigue with a one-item, 0 to 10 scale. Over a second trial period, an additional sample of 100 clinic patients completed validated measures of fatigue, including the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) and Fatigue Symptom Inventory (FSI), in addition to the OIFS.

Results: During the initial trial period, more than 95% of patients (574 of 600) had a documented OIFS score on their first clinic visit. Data from the second cohort of patients revealed that the OIFS had good test-retest reliability (r = 0.88) and was highly correlated with the FSI severity scale (0.87) and the FACIT-F (-0.75). Receiver operating characteristic analysis showed the OIFS had good discrimination compared with the FACIT-F (area under the curve = 0.87). Sensitivity and specificity of several OIFS cutoff scores were compared, and scores between 3 and 5 were found to be optimal.

Conclusions: The use of a one-item scale to screen for fatigue is feasible in an ambulatory clinic setting. This scale had convergent validity with other measures of fatigue and was able to identify cases of fatigue that met criteria on the FACIT-F. These data support the recommendations in the National Comprehensive Cancer Network guidelines for cancer-related fatigue screening.