Brazilian Version of Cancer Fatigue Scale: Validation of the Brazilian Version of Cancer Fatigue Scale in Patients With Breast Cancer

ContextScales to assess the fatigue in patients with cancer may help the clinical decision-making process.ObjectivesThe objective of this study was to cross-culturally adapt and determine the validity of the Brazilian version of Cancer Fatigue Scale.MethodsTranslation and cross-cultural adaptation followed the recommendations of international guidelines. One hundred fifty-one women with breast cancer participated in the validity phase and they filled out the Brazilian version of another instruments (Piper Fatigue Scale Revised, Beck Depression Inventory, Verbal Numerical Rating Scale, and Karnofsky Performance Scale). The measurement properties of reliability, internal consistency, and validity were measured.ResultsThe few discrepancies identified in the back-translation were solved by consensus, and the Cancer Fatigue Scale was successfully translated and cross-culturally adapted. The Brazilian version of Cancer Fatigue Scale showed good stability (test-retest reliability intraclass correlation coefficient = 0.95, 95% CI = 0.94–0.97 and interexaminer reliability intraclass correlation coefficient = 0.98, 95% CI = 0.97–0.99) and good internal consistency (Cronbach's alpha >0.70 for the three subscales/domains). The high correlation was found with Piper Fatigue Scale (r = 0.643) and Beck Depression Inventory (r = 0.509) in terms of validity. However, a reasonable correlation was found with Verbal Numerical Rating Scale (r = 0.302) and Karnofsky Performance Scale (r = −0.324).ConclusionHere, we validated the Cancer Fatigue Scale in breast cancer Brazilian women meaning its use for the identification and evaluation of cancer-related fatigue in patients with breast cancer.     

Validity and reliability of a new instrument to measure cancer-related fatigue in adolescents

Adolescents undergoing treatment for cancer rate fatigue as their most prevalent and intense cancer- and treatment-related effect. Parents and staff rate it similarly. Despite its reported prevalence, intensity, and distressing effects, cancer-related fatigue in adolescents is not routinely assessed during or after cancer treatment. We contend that the insufficient clinical attention is primarily due to the lack of a reliable and valid self-report instrument with which adolescent cancer-related fatigue can be measured. Our aim was to determine the reliability and construct validity of a new instrument and its ability to measure change in fatigue over time. Initial testing involved 64 adolescents undergoing curative treatment of cancer who completed the Fatigue Scale-Adolescent (FS-A) at two to four key points in treatment in one of four studies. Internal consistency estimates ranged from 0.67 to 0.95. Validity estimates involving the FS-A with the parent version ranged from 0.13 to 0.76; estimates involving the staff version and the Reynolds Depression Scale were 0.27 and 0.87, respectively. Additional validity findings included significant fatigue differences between anemic and nonanemic patients (P = 0.042) and the emergence of four factors in an exploratory factor analysis. Findings further indicate that the FS-A can be used to measure change over time (t = 2.55, P < 0.01). In summary, the FS-A has moderate to strong reliability and impressive validity coefficients for a new research instrument.     

French validation of the revised Piper Fatigue Scale

The need for a valid and reliable multi-dimensional instrument in French to enable nurses and clinicians to assess intensity and changes in cancer-related fatigue (CRF) and evaluate efficacy of intervention stratégies on patient outcome, prompted us to translate the Piper Fatigue Scale (PFS) and assess its psychometric properties in a French speaking population. The revised PFS is a 22 item self-report instrument with four sub-scales: behavioural/severity, affective, sensory and cognitive/mood. The PFS was translated using a procédure of translation and back translation and tested on 20 bilingual subjects. Correlation coefficients were measured between the item scores of the English and French version of the PFS. The French version of the PFS was adjusted and then completed by 229 adult cancer patients with solid tumours under-going treatment by chemo-, radio-, hormono- or immunotherapy. A factorial analysis and a multi-traits analysis were used to assess the reliability and the dimensional structure of the translated version of the PFS. Cronbach's alpha correlations ranged between 0.85 and 0.92 for the various sub-scales, thus indicating good sub-scale reliability. Item internal consistency was good with 100% of item-scale correlations greater than or equal to 0.4. Item discriminant validity checking showed 3 items to be insufficiently discriminating. Item-scale correlations greater than the correlation of the item with other sub-scales were 98%. The Cognitive/Mood dimension appeared to group 2 separate dimensions. Convergent validity, tested by correlating the PFS with a Visual Analogue Scale measuring fatigue and with the OMS Physical Performance Status Scale, revealed significant relationships. A five sub-scale model of the PFS is proposed containing 22 items to increase performance of the French version of the PFS comparatively to the 4 sub-scale model of the original PFS. Translation of 2 items has been slightly modified to reduce ambiguity. The overall results of this preliminary study are satisfactory. We expect results to be further improved by the modifications proposed and testing is now underway in homogenous populations to evaluate the sensitivity of the instrument to changes over time. This will enable us to ascertain the definitive French version of the Piper Fatigue Scale.     

Construct and criterion validity of the DUFS and DEFS⁴ in Lithuanian patients with coronary artery disease

Background Fatigue has become an important symptom in clinical diagnosis and clinical trials among subjects with cardiovascular diseases and disease‐specific fatigue scales were developed in a Dutch and English version. Objective Various questionnaires for measuring fatigue have been developed, but currently no validated questionnaire targeted at subjects with cardiovascular disease and heart failure exists in the Lithuanian language. Methods Despite the rigor of the exploratory factor analysis and analyses of the psychometric properties of the disease‐specific Dutch Fatigue Scale and the Dutch Exertion Fatigue Scale (DUFS–DEFS) we adopted a confirmatory approach considered as the gold standard method for the evaluation of construct validity in psychometric inventories. To test the criterion validity of the DUFS and DEFS structural equation modelling was employed with the widely used and validated Multidimensional Fatigue Inventory (MFI). Results The a priori specification of a hypothesized five‐factor model of the MFI‐20 and a two‐factor model of the DUFS and DEFS appeared to have a good fit to the data in Lithuanian patients. The hypothesized model of the criterion validity of the DUFS and DEFS had a good fit and classes of disease severity showed statistically significant and clinically relevant differences on fatigue scores. Conclusion The construct validity and criterion validity of the DUFS and DEFS were confirmed in a Lithuanian sample of cardiac patients. The construct validity of the MFI was also supported and this fatigue measure can be used in Lithuanian settings of clinical practice and research.     

Development of the inventory of functional status-cancer

The purpose of this article is to report the development and psychometric testing of the Inventory of Functional Status-Cancer (IFS-CA). The IFS-CA was developed to measure functional status in women with cancer. The questionnaire includes four subscales measuring the extent to which the woman continues her usual household and family, social and community, personal care, and occupational activities. Content validity was established at 98.5%. Internal consistency reliability testing used a sample of 100 women receiving treatment for cancer. Internal consistency reliability using average correlations for the subscale item to subscale total scores ranged from 0.56 to 0.82. Subscale to total IFS-CA score correlations ranged from 0.73 to 0.92. Test-retest reliability used a sample of 17 women who had completed treatment for cancer. The coefficients ranged from 0.43 to 0.96 for the four subscales. Initial construct validity testing was accomplished by examination of subscale correlations and by comparing the functional status of women in active treatment for cancer with those who had completed treatment. The study's findings reveal content validity, internal consistency, test-retest reliability, and beginning construct validity; thus, they demonstrate strong evidence for further development and testing of the IFS-CA's construct validity.     

Development and psychometric testing of a Chinese version of the Fatigue Scale-Children in Taiwan

Aims. The aim of this study was to develop and evaluate the psychometric properties of a Chinese version of the Fatigue Scale-Children (FS-C-C). Background. Cancer-related fatigue is one of the most distressing and prevalent symptoms reported by paediatric oncology patients during and after their cancer treatment. A reliable and valid instrument to measure fatigue is essential to the successful clinical care of paediatric oncology patients in Taiwan who experience this troubling symptom. Design and methods. A total of 108 paediatric oncology Taiwanese patients who were aged 7–12 years participated in this cross-sectional, instrumentation study. The FS-C was translated into Chinese by using an established translation/back-translation method. The psychometric testing of the FS-C-C included internal consistency, content validity, construct validity, convergent validity, criterion-related validity and known-group validity. Results. The FS-C-C achieved an acceptable internal consistency coefficient. Content validity was moderately high (content validity indices ranged from 83–100%). Confirmatory factor analysis supported the three-factor model as an acceptable model fit (the goodness-of-fit index and adjusted goodness-of-fit index both were greater than 0·9; normed fit index, 0·89; root-mean-square residual, 0·15). Although the results did not support the known-group hypothesis, the convergent validity, concurrent validity and predictive validity of the FS-C-C were supported by significant associations with the PedsQL Multidimensional Fatigue Scale, the Anxious/Depressed subscale of the Child Behaviour Checklist and the generic and disease-specific scores on the Quality of Life for Children with Cancer instrument, respectively. Conclusion. Our newly developed FS-C-C is a reliable and valid instrument for the measurement of cancer-related fatigue intensity in Taiwanese children. Relevance to clinical practice. The FS-C-C could provide useful information to guide clinical practice in assessing and managing cancer-related fatigue in childhood cancer patients in Taiwan.     

Validation study of the Chinese version of the Brief Fatigue Inventory (BFI-C)

A cross-sectional study was conducted among 249 Chinese cancer patients with multiple diagnoses to validate a Chinese version of the Brief Fatigue Inventory (BFI-C). Cronbach's coefficient alpha was 0.92 for fatigue severity items and 0.90 for fatigue interference items. Construct validity was explored by principal factor analysis and suggested a two-factor solution: fatigue severity and fatigue interference. Internal consistency reliability was excellent. Convergent validity was examined by correlating the BFI-C with 2 subscales and 2 component scores of the MOS 36-Item Short-Form Health Survey (coefficients ranged between -0.44 and -0.71, P<0.001). Known-group validity was examined by comparing fatigue severity in patients having different scores on the Eastern Cooperative Oncology Group Performance Status Scale. Approximately 60% of patients experienced moderate to severe fatigue (4 or greater on the 0-10 scale of the BFI-C "fatigue worst" item). The BFI-C is a valid, reliable instrument to measure the severity and impact of cancer-related fatigue among Chinese patients.     

Determining the minimal clinically important difference criteria for the Multidimensional Fatigue Inventory in a radiotherapy population

Purpose  

The Multidimensional Fatigue Inventory (MFI) is a commonly used cancer-related fatigue assessment tool. Unlike other fatigue assessments, there are no published minimal clinically important difference (MCID) criteria for the MFI in cancer populations. MCID criteria determine the smallest change in scores that can be regarded as important, allowing clinicians and researchers to interpret the meaning of changes in patient’s fatigue scores. This research aims to improve the clinical utility of the MFI by establishing MCID criteria for the MFI sub-scales in a radiotherapy population.     

Meaning in life for patients with cancer: validation of the Life Attitude Profile-Revised Scale

Title.  Meaning in life for patients with cancer: validation of the Life AttitudeProfile-Revised Scale.
Aim.  This paper is a report of a study to adapt the Life Attitude Profile-Revised Scale for Turkish patients with cancer and to evaluate its psychometric properties.
Background.  Cancer is a life-threatening illness that can challenge the experience of meaning in life. Meaning in life is a multidimensional concept involving meaning and purpose in life, as well as the motivation to find meaning and purpose in life. As meaning in life may be influenced by culture, a culture-sensitive tool is needed for its measurement.
Methods.  A convenience sample of 199 patients with cancer at a Turkish university hospital completed a structured questionnaire including demographic characteristics and the Life Attitude Profile-Revised Scale for Patients with Cancer in 2006. Item analysis, principal components analysis, internal consistency reliability and Cronbach's alpha were used to measure the psychometric properties of the items of the scale.
Findings.  In the assessment of construct validity, identified four factors with eigenvalues greater than 1 explained 46·91% of the total variance. Internal reliability coefficients of these four factor-based scales were 0·73 and 0·82 respectively.
Conclusions.  The present study provides evidence of the Life Attitude Profile-Revised Scale's validity, reliability and acceptability. This scale should be further evaluated with a larger sample, in different regions in Turkey and diverse populations of world. The scale has potential applications for use both in research and as a screening tool in clinical settings.     

Factor analysis of the Revised Piper Fatigue Scale in a caregiver sample

The Revised Piper Fatigue Scale (R-PFS) is an instrument designed to measure subjective fatigue that was developed in samples with physical illness. Its psychometric properties in nonclinical samples are unknown. The purpose of this study was to examine the psychometric properties of the R-PFS in a sample of caregivers of stroke survivors. The convenience sample of 132 caregivers was primarily women (74%), White (71%), college-educated (73%), and employed (52%), with a mean age of 56.7 years (SD = 13.71). Internal consistency reliabilities for the four R-PFS subscales and the total scale were excellent, ranging from .90 to .97. Principal axis factor analysis with oblique rotation was conducted to examine construct validity of the R-PFS. A three-factor solution explained 75.9% of the common variance. Two factors totally replicated the behavioral/severity and affective meaning subscales of the R-PFS. The third factor incorporated a combination of Piper's sensory and cognitive/mood subscales and appeared to summarize how fatigue makes the caregiver feel. The R-PFS demonstrated strong internal consistency reliability and construct validity in this sample. However, data suggest that caregivers may perceive certain feelings associated with fatigue as conceptually similar when these feelings are conceptually distinct in Piper's breast cancer sample. The study supports the need for psychometric evaluation of instruments developed in clinical populations prior to their use in nonclinical populations.     

Quality of life instruments for caregivers of patients with cancer: a review of their psychometric properties

The quality of life of caregivers of patients with cancer is an important construct given the substantial impact of caring on the physical, psychological, social, and financial well-being of caregivers. Moreover, caring for patients with cancer also affects family functioning and places burdens on caregivers. The reliability and validity of instruments used to assess the quality of life of caregivers of patients with cancer were reviewed to aid in the selection of the most appropriate measures for research and practice. (1980-2000) and (1982-2000) searches located relevant quality of life instruments using the keywords "cancer and quality of life" and "caregiver or spouse or partner." The search identified the following instruments: the Caregiver Quality of Life Index-Cancer Scale, the Caregiver Quality of Life Index, the Quality of Life Tool, and the Quality of Life Index-Cancer Version. Quality of life instruments developed specifically to measure the quality of life of caregivers of patients with cancer had the best psychometric properties. The Caregiver Quality of Life Index-Cancer Scale, in particular, met or exceeded minimum psychometric criteria for reliability and validity. The development of reliable and valid caregiver quality of life measures is an important factor in developing interventions to enhance quality of life of caregivers of patients with cancer.     

Validation of the Taiwanese version of the Brief Fatigue Inventory

We validated the Taiwanese version of the Brief Fatigue Inventory (BFI-T) in a sample of 439 Taiwanese patients with multiple cancer diagnoses. Internal consistency was indicated by Cronbach alphas of 0.96 for fatigue-related severity and 0.95 for interference. Test-retest reliability was 0.89 for fatigue severity and 0.91 for interference. Factor analysis revealed a one-factor structure. Convergent validity was examined by correlating the BFI-T worst fatigue and fatigue severity composite scores with POMS vigor and fatigue subscales scores. Known-group validity was established by comparing BFI-T worst fatigue and severity composite scores between patients with low functional status and high functional status and between inpatients and outpatients. The BFI-T's sensitivity was examined by comparing BFI-T severity and interference composite scores before, during, and after chemotherapy treatment in a subsample of 20 breast cancer patients. The BFI-T is reliable, valid, and sensitive for measuring cancer-related fatigue severity and interference among Taiwanese cancer patients.     

The Measurement of Fatigue in Chronic Illness: A Systematic Review of Unidimensional and Multidimensional Fatigue Measures

Fatigue is a common symptom associated with a wide range of chronic diseases. A large number of instruments have been developed to measure fatigue. An assessment regarding the reliability, validity, and utility of fatigue measures is time-consuming for the clinician and researcher, and few reviews exist on which to draw such information. The aim of this article is to present a critical review of fatigue measures, the populations in which the scales have been used, and the extent to which the psychometric properties of each instrument have been evaluated to provide clinicians and researchers with information on which to base decisions. Seven databases were searched for all articles that measured fatigue and offered an insight into the psychometric properties of the scales used over the period 1980–2007. Criteria for judging the “ideal” measure were developed to encompass scale usability, clinical/research utility, and the robustness of psychometric properties. Twenty-two fatigue measures met the inclusion criteria and were evaluated. A further 17 measures met some of the criteria, but have not been tested beyond initial development, and are reviewed briefly at the end of the article. The review did not identify any instrument that met all the criteria of an ideal instrument. However, a small number of short instruments demonstrated good psychometric properties (Fatigue Severity Scale [FSS], Fatigue Impact Scale [FIS], and Brief Fatigue Inventory [BFI]), and three comprehensive instruments demonstrated the same (Fatigue Symptom Inventory [FSI], Multidimensional Assessment of Fatigue [MAF], and Multidimensional Fatigue Symptom Inventory [MFSI]). Only four measures (BFI, FSS, FSI, and MAF) demonstrated the ability to detect change over time. The clinician and researcher also should consider the populations in which the scale has been used previously to assess its validity with their own patient group, and assess the content of a scale to ensure that the key qualitative aspects of fatigue of the population of interest are covered.     

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.     

Validation study of the korean version of the brief fatigue inventory

The goal of this study was to evaluate the reliability and validity of the Korean version of the Brief Fatigue Inventory (BFI-K). One hundred seventy-eight cancer patients and the same number of age- and sex-matched control subjects completed the BFI-K, the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30), the Beck Depression Inventory (BDI), and a Brief Pain Inventory (BPI). The Cronbach's alpha coefficient for the BFI-K was 0.956 in the cancer patient group and 0.955 in the control group. The global score and nine of the single item scores for the BFI-K were significantly correlated with the fatigue and global health status/QoL subscale of the EORTC QLQ-C30, BDI, and BPI (coefficient range 0.38-0.66). Discriminant validity showed that BFI-K could distinguish significant differences of performance status between subgroups of patients, and between the cancer patient group and the control group, as expected. Our study has shown that the BFI-K is a reliable, valid self-rating instrument in terms of its psychometric properties.     

Measuring the symptom experience of Chinese cancer patients: a validation of the Chinese version of the memorial symptom assessment scale

The purpose of this study was to translate the Memorial Symptom Assessment Scale (MSAS) into Chinese and evaluate the psychometric properties of this version. The original MSAS is a 32-item, patient-rated measure that was developed to assess common cancer-related physical and psychological symptoms with respect to frequency, intensity, and distress. In this study, a two-phase design was used. Phase I involved iterative forward-backward translation, testing of content validity (CVI) and a pretest. Phase II established the psychometric properties of the Chinese version MSAS (MSAS-Ch). Results showed that the MSAS-Ch achieved content relevancy CVI of 0.94 and semantic equivalence CVI of 0.94. Pretesting was performed in 10 cancer patients, and the results revealed adequate content coverage and comprehensibility of the MSAS-Ch. A convenience sample of 370 patients undergoing cancer therapy or at the early post-treatment stage was recruited for psychometric evaluation. Confirmatory factor analysis confirmed the construct validity of the MSAS-Ch, with a good fit between the factor structure of the original version and our present sample data (goodness-of-fit indices all above 0.95). The internal consistency reliability of subscales and total MSAS-Ch was moderately high, with Cronbach alpha coefficients ranging from 0.79 to 0.87. The test-retest intraclass correlation results for the subscale and total MSAS-Ch ranged from 0.68 to 0.79. The subscale scores of MSAS-Ch were moderately correlated with the scores on various validation measurements that assessed psychological distress, pain, and health-related quality of life (r = 0.46-0.65, P < 0.01), confirming that they were measurements of similar constructs. The validity of the construct validity was also supported by comparing the MSAS-Ch scores for subpopulations that varied clinically. Inpatients and patients with poorer performance status scored higher on the MSAS-Ch subscale and total scores than outpatients and patients with higher performance status (P < 0.05). Our study shows that the MSAS-Ch has adequate psychometric properties of validity and reliability, and can be used to assess symptoms during cancer therapy and at the early post-treatment stage in Chinese-speaking patients.     

Psychometric assessment of four fatigue scales with a sample of rural cancer patients

There are differences between rural and urban persons experiencing cancer that may make the experience of fatigue more difficult for rural cancer patients. There were no scale to measure fatigue that had been validated with rural cancer patients. The purpose of the present research was to study the psychometric properties of four fatigue scales for use with rural cancer patients. The four scales were the Multidimensional Assessment of Fatigue Scale, the Fatigue Severity Scale, the Visual Analogue Scale for Fatigue, and the Rhoten Fatigue Scale. The four scales were mailed to 270 rural cancer patients, with 131 usable scales returned (48% return rate). Interitem correlations, Cronbach's alpha reliability, and factor analyses were performed on the four scales. Based on these analyses, the Multidimensional Assessment of Fatigue Scale, the Fatigue Severity Scale, and the Visual Analogue Scale for Fatigue were judged to be adequate for use with rural cancer patients.     

Validity and reliability of the Norwegian version of the Ferrans and Powers Quality of Life Index

The purpose of this study was to examine the validity and reliability of the Norwegian version of the Ferrans and Powers Quality of Life Index in a sample of 131 men and women with newly diagnosed cancer. The Quality of Life Index was translated into Norwegian using a standardized international approach, including back-translation. The findings showed high internal consistency reliability for the global score (alpha = 0.93 (test)) as well as for the following domains: health and functioning (alpha = 0.88), socio-economic (alpha = 0.82), psychological/spiritual (alpha = 0.82) and family (alpha = 0.79). The test-retest reliability after 3-4 weeks was 0.78 for the global score. A factor analysis partially confirmed the different subscales. In conclusion, the Quality of Life Index was found to be reliable and had sufficient validity to be used for measuring quality of life in Norwegian cancer patients.     

Reliability and validity of the continence self-efficacy scale in Turkish women with urinary incontinence

This study investigated the psychometric properties of the Continence Self-Efficacy Scale. Data was collected from 128 women who had urinary incontinence using the following instruments: the Continence Self-Efficacy Scale, the Broome Pelvic Muscle Exercise Self-Efficacy Scale, the International Consultation on Incontinence Questionnaire Short Form, and the Beck Depression Inventory. The validity of the Continence Self-Efficacy Scale was investigated using confirmatory factor analysis and convergent and divergent validity analyses. The reliability of the Continence Self-Efficacy Scale was examined in terms of internal consistency and test-retest correlations. Confirmatory factor analysis indicated a three -factor model that had acceptable goodness-of-fit indices. The convergent validity of the Continence Self-Efficacy Scale was supported by a positive correlation between the Continence Self-Efficacy Scale and the Broome Pelvic Muscle Exercise Self-Efficacy Scale. The divergent validity of the Continence Self-Efficacy Scale was supported by negative relationships between the Continence Self-Efficacy Scale and the Beck Depression Inventory. The Cronbach's alpha values regarding internal consistency were 0.94 for the overall scale and 0.92-0.93 for the subscales. Test-retest correlations were 0.75 for the overall scale and 0.52-0.74 for the subscales. The Continence Self-Efficacy Scale is a valid and reliable instrument for use in Turkish women with urinary incontinence.     

Women experience higher levels of fatigue than men at the end of life: a longitudinal home palliative care study

Few studies have evaluated sex differences in the prevalence, severity, and correlates of fatigue at the end of life. The Brief Fatigue Inventory, McGill Quality of Life (MQOL) Questionnaire, and Karnofsky Performance Scale were administered at two-week intervals to 102 patients in a home palliative program. Outcomes in the sample and a regional palliative database (n=3,096) were analyzed. Cancer was the diagnosis in 96% of patients enrolled. Prevalence (P=0.0091) and severity of fatigue (P<0.001) were higher in women at entry and in a repeated measures analysis over time (severity, P=0.0048). Performance status did not explain this difference. MQOL scores were inversely correlated to fatigue (Spearman coefficient=-0.48, P<0.0001), but did not differ by sex. There was no difference in fatigue interference with MQOL in women and men. Although depression was higher in women (P=0.042) and related to fatigue at entry, it did not explain the sex difference in fatigue scores. Of the sociodemographic variables examined, neither education nor living situation contributed to the fatigue difference. This study shows a sex effect in the fatigue experienced by patients with advanced illnesses, which is not explained by baseline differences in performance, depression, MQOL, education, or living situation. That fatigue interference with MQOL is the same for men and women suggests that higher fatigue scores in women reflect not only a difference in the dimension of fatigue severity, but are also relevant in relation to impact on QOL. Assessment of fatigue should include the dimension of QOL important for both women and men.