Fatigue and physical performance in children and adolescents receiving chemotherapy. Psychometric testing of fatigue instruments for use with cancer patients. Pilot Study of Massage to Improve Sleep and Fatigue in Hospitalized Adolescents With Cancer. Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. The Development and Testing of an Instrument for Perceived Self-efficacy for Fatigue Self-management Promising insights into the health related quality of life for children with severe obesity Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide.
PURPOSE / OBJECTIVES To examine the relationship between physical performance and fatigue in child and adolescent cohorts during the first three cycles of chemotherapy . DESIGN Prospect i ve , observational design . SETTING Two pediatric cancer centers in the upper Midwest region of the United States . SAMPLE 16 children and 14 adolescents newly diagnosed with cancer . METHODS St and ardized instruments were administered during the first and third cycles of chemotherapy . Instruments included  physical performance tests ( Timed Up and Down Stairs [ TUDS ] and the 6-Minute Walk Test [ 6MWT ] ) and a self-report fatigue scale .  MAIN RESEARCH VARIABLES Fatigue and physical performance . FINDINGS In the child cohort , physical performance appeared to improve and fatigue diminished from cycle 1 to 3 of chemotherapy . When time on TUDS decreased , fatigue tended to decrease ; when 6MWT distance increased , fatigue decreased . In the adolescent cohort , fatigue seemed to decrease but physical performance measures evidence d little change . Correlations between changes in the physical performance variables and fatigue were not significant . CONCLUSIONS Fatigue may decrease early in treatment as disease symptoms resolve . Fatigue in the child cohort was related to physical performance , which is consistent with previous studies that defined fatigue in children as primarily a physical sensation . Findings in the adolescent cohort support research that defined adolescent fatigue as more complex with mental , emotional , and physical components . IMPLICATION S FOR NURSING Knowing how fatigue relates to physical performance in children and adolescents informs the nurse in educating patients and families about symptom management BACKGROUND Cancer treatment-related fatigue ( CRF ) is a common side effect of cancer treatment . A problem identified in most review s of CRF is lack of sound approaches to measurement that are congruent with the conceptualization of CRF as a self-perceived state . The diversity of instruments available to measure fatigue and the lack of comprehensive testing of several promising instruments with cancer patients undergoing treatment provided the rationale for this study . The purpose of this article is to report the results of psychometric testing of several fatigue instruments in patients undergoing cancer treatment . OBJECTIVES The aims of this study were to determine the reliability , validity , and responsiveness of each instrument and to determine the ability of each instrument to capture CRF . METHODS Existing fatigue instruments with published psychometric information that indicated suitability for further testing were selected and included the Profile of Mood States Short Form fatigue subscale ( F_POMS-sf ) ,  Multidimensional Assessment of Fatigue ( MAF ) ,  Lee Fatigue Scale ( LFS ) , and the  Multidimensional Fatigue Inventory ( MFI ) . Data were collected at a university-based clinical cancer center and a freest and ing comprehensive cancer center . Subjects completed all study instruments , which were presented in r and om order , at a time when CRF was expected to be high and again when it was expected to be low . A subset of subjects completed the instruments within 48 hours of one of the data collection points when CRF was expected to be relatively unchanged to provide stability data . RESULTS Reliability estimates using Cronbach 's alpha indicated that all instruments examined had good internal consistency . Test-retest correlations showed good stability for total scores on all the instruments , but some subscales of the LFS and MFI had marginal stability . Factor analysis of all instruments indicated that only the LFS and the F_POMS-sf fully supported their construct validity . All of the instruments showed responsiveness to changes in CRF related to treatment . CONCLUSIONS The results of the study provide research ers and clinicians with detailed comparisons of the performance of established fatigue measures in cancer patients undergoing treatment to use when selecting measures of CRF BACKGROUND Adolescents with cancer experience many troubling symptoms , including sleep disruptions that can affect mood and quality of life .  Massage is a safe and popular intervention that has demonstrated efficacy in pediatric and adult patients with cancer . This study aim ed to assess the feasibility of conducting a massage intervention to help with sleep in hospitalized adolescent oncology patients . PROCEDURE Adolescents ages 12 - 21 with cancer who were expected to be hospitalized for at least four consecutive nights were recruited from the inpatient unit at Children 's National Health System and r and omized to either massage intervention or a waitlist control . Patients in the intervention group received one massage per night , for two or three nights . Sleep was measured with actigraphy and patient and proxy reported instruments were used to measure fatigue , mood , and anxiety . RESULTS The majority ( 78 % ) of patients approached for the study consented , and almost all patients in the intervention group ( 94 % ) received at least one massage , 69 % received two , and rates of completion of instruments among adolescents were high demonstrating feasibility . There were trends toward increased night time and overall sleep in the intervention group compared with st and ard of care , but no differences between groups in the patient reported outcome measures . Participant and parent feedback on the intervention was positive and was the impetus for starting a clinical massage service at the hospital . CONCLUSIONS Massage for hospitalized adolescents with cancer is feasible , well received , and can potentially improve patients ' sleep . A r and omized multicenter efficacy study is warranted In this paper the psychometric properties of the multidimensional fatigue inventory ( MFI-20 ) are established further in cancer patients . The MFI is a 20-item self-report instrument design ed to measure fatigue . It covers the following dimensions : general fatigue , physical fatigue , reduced activity , reduced motivation and mental fatigue . The instrument was used in a Dutch and Scottish sample of cancer patients receiving radiotherapy .  The dimensional structure was assessed using confirmatory factor analyses ( Lisrel 's unweighted least-squares method ) . The hypothesised five-factor model appeared to fit the data in both sample s ( adjusted goodness of fit ; AGFI : 0.97 and 0.98 ) . Internal consistency of the separate scales was good in both the Dutch and Scottish sample s with Cronbach 's alpha coefficients ranging from 0.79 to 0.93 . Construct validity was assessed by correlating the MFI-20 to activities of daily living , anxiety and depression . Significant relations were assumed . Convergent validity was investigated by correlating the MFI scales with a visual analogue scale measuring fatigue and with a fatigue-scale derived from the Rotterdam Symptom Checklist . Results support the validity of the MFI-20 . The highly similar results in the Dutch and Scottish sample suggest that the portrayal of fatigue using the MFI-20 is quite robust Background : Persons with chronic illness commonly report fatigue . Measurement of perceived self-efficacy for fatigue self-management ( PSEFSM )  is essential if fatigue is to be monitored and enhanced to improve physical functional status . Objective : The objective of the study was to describe the development and testing of the PSEFSM instrument . Methods : The PSEFSM instrument was incorporated into 2 r and omized controlled trials for secondary analysis ( N = 298 ) : 63 persons with lung cancer and 235 persons with other cancer diagnoses undergoing a course of chemotherapy .  Results : Evidence for construct validity and generalizability was supported through hypotheses testing of the mediation pathway from fatigue to physical functional status through PSEFSM , with results indicating support for partial mediation . Structural modeling indicated a good model fit that further supported the construct validity of the PSEFSM instrument . Conclusions : The instrument provides a reliable and valid measure of PSEFSM that could be used in research to facilitate the development of interventions to increase perceived self-efficacy to achieve optimal symptom self-management . Implication s for Practice : The PSEFSM instrument is brief and easy to complete , which results in a low response burden for persons who are already fatigued , providing for regular use in transdisciplinary research and practice setting s. This is important because the use of this instrument can impact how we partner with our patients to better underst and how to manage this troublesome symptom , fatigue Background Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents . The Patient Reported Outcomes Measurement Information System ( PROMIS ) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents . The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity . Methods The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index ( BMI ) greater than the 85th percentile in a design to establish known-group validity . The children completed the  depressive symptoms , anxiety , anger , peer relationships , pain interference , fatigue , upper extremity , and mobility PROMIS domains utilizing a computer interface . PROMIS domains and individual items were administered in r and om order and included a total of 95 items . Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile . Results 136 participants were recruited and had all necessary clinical data for analysis . Of the 136 participants , 5 % ended the survey early result ing in missing domain scores at the end of survey administration . In multivariate analysis , patients with BMI ≥ 99th percentile had worse scores for depressive symptoms , anger , fatigue , and mobility ( p < 0.05 ) . Parent-reported exercise was associated with better scores for depressive symptoms , anxiety , and fatigue ( p < 0.05 ) . Conclusions Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting . In the 5 % with missing domain scores , the missing scores were consistently found in the domains administered last , suggesting the length of the assessment is important . The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity . We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life PURPOSE / OBJECTIVES To examine the influence of the proposed symptom cluster of fatigue , nausea and vomiting , and sleep disturbances on clinical outcomes defined as behavior changes , depression , and performance status in children and adolescents before and after receiving cisplatin , doxorubicin , or ifosfamide chemotherapy .  DESIGN A prospect i ve , descriptive , within-group , before- and -after-chemotherapy design was used . SETTING Two major childhood cancer treatment hospitals in the United States . SAMPLE 67 patients aged 7 - 18 years who were receiving chemotherapy courses of cisplatin , doxorubicin , or ifosfamide .  METHODS Fatigue , depression , behavior , and performance assessment s were completed on the first day of cisplatin , doxorubicin , or ifosfamide therapy and one week later . Patients wore a  wrist actigraph on the nondominant h and during the course of therapy and for 48 hours after discharge from the hospital . Nausea and vomiting were measured every 24 hours during the course of therapy and for 48 hours after discharge . A linear mixed model was used to evaluate the influence of the symptom cluster . Regression analysis was used to examine the associations between performance status and the symptom cluster . Principal component analysis with varimax rotation was used to produce the correlation of sleep symptoms . MAIN RESEARCH VARIABLES Fatigue , nausea and vomiting , sleep disturbances , behavior , depression , and performance . FINDINGS Adolescents with the cluster of increased fatigue and sleep disturbances  experienced more depressive symptoms and behavior changes . Children with higher levels of fatigue had increased depressive symptoms . The more fatigue parents perceived in their children or adolescents , the more behavior and emotional difficulties were reported . CONCLUSIONS Fatigue , sleep disturbance , and nausea and vomiting , when clustered , impacted depressive symptoms and behavior changes in adolescents after chemotherapy . In children , fatigue alone impacted depressive symptoms and behavior changes . IMPLICATION S FOR NURSING Symptom clusters can have a significant impact on children 's and adolescents ' quality of life during cancer treatment . Early recognition and intervention for these symptoms are an important nursing role
These two scales show similar attributes with reasonably good internal consistency and responsiveness .
Either the Fatigue Scale or PedsQL Multidimensional Fatigue Scale can be incorporated into clinical research .
CONTEXT Despite the recognized distressing symptom of fatigue in children with cancer , little information is available to assist in the selection of an instrument to be used to measure fatigue .
OBJECTIVES The objectives of this study were to 1 ) describe the instruments that have been used to measure cancer-related fatigue in children and adolescents and 2 ) summarize the psychometric properties of the most commonly used instruments used to measure fatigue in children and adolescents with cancer .