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.     

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.     

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.     

Validity and reliability of the multidimensional assessment of fatigue scale in Iranian patients with relapsing-remitting subtype of multiple sclerosis

Purpose: The purpose of this study is to investigate the validity and reliability of the Persian version of the Multidimensional Assessment of Fatigue Scale (MAFS) in an Iranian population with multiple sclerosis.

Method: A self-reported survey on fatigue including the MAFS, Fatigue Impact Scale and demographic measures was completed by 130 patients with multiple sclerosis and 60 healthy persons sampled with a convenience method. Test–retest reliability and validity were evaluated 3 days apart. Construct validity of the MAFS was assessed with the Fatigue Impact Scale.

Results: The MAFS had high internal consistency (Cronbach’s alpha >0.9) and 3-d test–retest reliability (intraclass correlation coefficient?=?0.99). Correlation between the Fatigue Impact Scale and MAFS was high (r?=?0.99). Correlation between MAFS scores and the Expanded Disability Status Scale was also strong (r?=?0.85). Questionnaire items showed acceptable item-scale correlation (0.968–0.993).

Conclusions: The Persian version of the MAFS appears to be a valid and reliable questionnaire. It is an appropriate short multidimensional instrument to assess fatigue in patients with multiple sclerosis in clinical practice and research.

• Implications for Rehabilitation

• The Persian version of Multidimensional Assessment of Fatigue is a valid and reliable instrument for the assessment and monitoring the fatigue in Persian-language patients with multiple sclerosis.

• It is very easy to administer and a time efficient scale in comparison to other instruments evaluating fatigue in patients with multiple sclerosis.

     

Evaluating cancer related fatigue during treatment according to children's,adolescents' and parents' perspectives in a sample of Greek young patients

IntroductionCancer related fatigue in children and adolescents has received limited clinical attention. The aim of the study is to assess the change in fatigue scores during cancer treatment according to children's, adolescents' and parents' perspectives and to describe the possible causes of fatigue from children's, adolescents' and parents' view.Patients and methodsThe sample consisted of 40 children aged 7–12 years old, 29 adolescents aged 13–15 years old with cancer and one of their parents. Three measurements were performed for the evaluation of cancer related fatigue. Three versions of the instrument for the assessment of fatigue in pediatric patients with cancer were used: «The Child Fatigue Scale» (CFS), «The Adolescent Fatigue Scale» (AFS) and «The Parent Fatigue Scale» (PFS). The survey was performed from March 2003 till October 2006.ResultsChildren (F = 6.85, p = 0.00), adolescents (F = 4.15, p = 0.03) and parents (F = 3.98, p = 0.02) reported a statistically significant increase in fatigue scores during their treatment. The hospital environment was assessed as the most contributing factor of fatigue by the three groups.ConclusionsCancer treatment was found significantly to increase children's fatigue levels. Medical procedures and the hospital environment seemed to be major causative factors of the fatigue experienced by young patients with cancer during their treatment.     

Effects of Reflexology and Progressive Muscle Relaxation on Pain,Fatigue, and Quality of Life during Chemotherapy in Gynecologic Cancer Patients

PurposeOur aim was to investigate the effect of reflexology and progressive muscle relaxation (PMR) exercises on pain, fatigue, and quality of life (QoL) of gynecologic cancer patients during chemotherapy.MethodsEighty participants were randomly assigned to one of four groups: reflexology, progressive muscle relaxation (PMR) exercises, both (reflexology + PMR), or a control group. Data were collected with a general data collection form, Brief Pain and Fatigue inventories, and Multidimensional Quality-of-Life Scale—Cancer.ResultsIn reflexology and reflexology + PMR groups, a significant decrease in pain severity and fatigue and an increase in QoL were found (p < .05). In the PMR alone group, pain severity and fatigue decreased significantly (p < .05), but there was no significant change identified in QOL (p > .05).ConclusionsReflexology and PMR exercises given to gynecologic cancer patients during chemotherapy were found to decrease pain and fatigue and increase QoL.     

The PedsQL in type 1 and type 2 diabetes: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales and type 1 Diabetes Module

OBJECTIVE: The Pediatric Quality of Life Inventory (PedsQL) is a modular instrument designed to measure health-related quality of life (HRQOL) in children and adolescents aged 2-18 years. The PedsQL 4.0 Generic Core Scales are child self-report and parent proxy-report scales developed as the generic core measure to be integrated with the PedsQL disease-specific modules. The PedsQL 3.0 Type 1 Diabetes Module was designed to measure diabetes-specific HRQOL. RESEARCH DESIGN AND METHODS: The PedsQL Generic Core Scales and Diabetes Module were administered to 300 pediatric patients with type 1 or type 2 diabetes and 308 parents. RESULTS: Internal consistency reliability for the PedsQL Generic Core Total Scale score (alpha = 0.88 child, 0.89 parent-report) and most Diabetes Module scales (average alpha = 0.71 child, 0.77 parent-report) was acceptable for group comparisons. The PedsQL 4.0 distinguished between healthy children and children with diabetes. The Diabetes Module demonstrated intercorrelations with dimensions of generic and diabetes-specific HRQOL. CONCLUSIONS: The results demonstrate the reliability and validity of the PedsQL in diabetes. The PedsQL may be used as an outcome measure for diabetes clinical trials and research.     

Quality of life and symptom prevalence as reported by children with cancer in Lebanon

PurposeTo date, there are no studies on quality of life (QoL) and symptom prevalence reported by pediatric oncology patients in Lebanon. The purpose of this study was to evaluate the QoL, symptom prevalence and symptom management among a sample of pediatric oncology patients.MethodsThe study design was cross-sectional. The Pediatric Quality of Life Inventory (PedsQL) cancer module and the Memorial Symptom Assessment Scale were administered in Arabic using face-to-face interviews to a convenience sample of 85 pediatric cancer patients (7–18 years) at a tertiary hospital in Lebanon.ResultsThe mean age of the study group was 12.5 years with leukemia being the most common cancer (43.5%). The lowest scores on the PedsQL subscales were in nausea (score = 64.82; SD = 25.76) and worry (score = 68.14; SD = 30.07), thus indicating more problems in these areas. A comparison based on age showed significant differences in pain and hurt, nausea, and worry. In children (7–12 years), lack of appetite, pain, and nausea were mostly prevalent whereas adolescents (13–18 years) experienced lack of energy, irritability, and pain. In both age groups, pain and nausea were the most frequently treated symptoms.ConclusionOverall, the participants had good health-related QoL as indicated by most of the PedsQL subscales. Symptom management was found to be inadequate and in some cases ineffective. More attention should be given to the management of symptoms in general using pharmacological and non-pharmacological techniques. Of particular importance is the importance of providing psychological support to alleviate symptom burden and improve QoL.     

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 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.     

Benefit finding in adult cancer populations: Psychometric properties and performance of existing instruments

PurposeTo analyse the psychometric properties and performance of existing instruments that aim to measure benefit finding in adult cancer populations.MethodsFour electronic databases were searched. The focus was to identify English language, peer-reviewed journal articles where benefit finding is assessed with adult cancer populations. The terms ‘benefit finding’, ‘cancer’, ‘instruments’, ‘scales’, and ‘adult’ were used in various combinations. The instruments were rated against established criteria for instrument construction, reliability, validity, and interpretability.ResultsSeventeen benefit finding instruments were reviewed. The instruments present a multifarious conceptualisation of the construct. Instrument structure is diverse. Several instruments (n = 4) reported on all the psychometric properties, but not interpretability. One instrument, the Stress-Related Growth Scale – Revised, additionally reported correlation statistics with another benefit finding instrument. Based on the information provided, the psychometric rigour of a number of instruments is yet to be established.ConclusionsOne instrument reported validation statistics for all the identified criteria. While existing instruments provide a range of operationalisations of the benefit finding concept and have been more or less used in previous research, a majority are in the early stages of development and require further validation work in adult cancer populations. Given the increasing interest in the role benefit finding in clinical practice, researchers are urged to use these instruments further and to report relevant validation statistics when using them.     

Validation of the Chinese version of Multidimensional Fatigue Inventory-20 in Chinese patients with cancer

Goals of work

The purpose of this research is to study the validation of the Chinese version of Multidimensional Fatigue Inventory-20 in measuring fatigue status of the patients with cancer in China.

Materials and methods

The original English version of the Multidimensional Fatigue Inventory-20 was translated into a Chinese version, which was applied to measure the fatigue status of cancer patients prior to commencing chemotherapy and during the last week of chemotherapy, respectively. The reliability and criterion-related validity of the Chinese version of the Multidimensional Fatigue Inventory-20 were assessed by calculating Cronbach's α and Pearson correlation coefficients. The construct validity was analyzed by employing factor analysis.

Main results

There were three dimensions in the Chinese version of the MFI-20, which measures the physical, mental, and spiritual fatigue of patients with cancer. All of the correlation coefficients between EORTC QLQ-C30V3.0 and MFI-20 were statistically significant (P?α coefficient was more than 0.8 and 0.7 for total MFI-20 and for the three dimensions of the Chinese version of the MFI-20, respectively.

Conclusions

The Chinese version of the MFI-20 is a reliable and valid instrument to assess fatigue in Chinese patients with cancer.     

The LITE study: Rationale and protocol for a randomized controlled trial of light therapy for cancer-related fatigue in cancer survivors

Fatigue is a common and distressing symptom that can last for months or years in up to one-third of cancer survivors. Despite its prevalence, the nature and mechanisms of cancer-related fatigue are poorly understood and the available treatments may not provide sufficient relief. Fatigue has been identified as a significant contributor to decreased quality of life, making it an important target for intervention. One approach that may be a safe and inexpensive treatment is bright light therapy.MethodsThis study is a 4-week blinded randomized controlled trial. Subjects will be men and women who meet criteria for cancer-related fatigue and have completed cancer treatment. Subjects will be randomly assigned to receive a Litebook treatment device that produces either bright white light (treatment) or dim red light (active control). The devices will be used daily for 30 min upon waking for a period of four weeks. The primary outcome, fatigue, will be measured with the Multidimensional Fatigue Symptom Inventory-SF. Secondary outcomes include mood disturbance, sleep quality, quality of life, diurnal cortisol, and inflammatory biomarkers. Fatigue assessments will be completed weekly and secondary outcomes will be assessed at pre- and post-intervention.ConclusionsThe current research will examine the effect of light exposure on cancer-related fatigue and its potential psychological, behavioral, and biological mechanisms. If successful, this research would support the use of light therapy for the management of persistent fatigue in cancer survivors, expanding existing treatment options. It may also improve upon the current understanding of the mechanisms that underlie cancer-related fatigue.     

Pain and fatigue consistency in adults with cerebral palsy

Purpose.?To examine the consistency of pain and fatigue and describe pain interference with daily activities in ambulatory (AMB) and non-ambulatory (non-AMB) adults with cerebral palsy (CP) over a 3-month period.

Method.?A repeated measures design with 26 participants (12 AMB, 14 non-AMB) acting as their own controls. Pain and fatigue data were collected once per month for three consecutive months using the FACES pain scale and PedsQL? Multidimensional Fatigue Scale. Pain interference with daily life was assessed using the Pain Disability Index (PDI).

Results.?No significant differences were found in maximum pain intensity. AMB reported significantly fewer pain sites in the whole body during month 1 than non-AMB. Fatigue was consistent across months; however, AMB reported significantly more General fatigue. Across groups, significant correlations were found between PDI and General, Resting, and Overall fatigue. Non-AMB exhibited significant correlations between total number of pain sites and General and Cognitive fatigue, as well as PDI and Overall fatigue. For the AMB group, PDI and total number of pain sites were significantly correlated.

Conclusions.?Pain and fatigue consistently and significantly affect adults with CP. Both factors impact the ability of adults, who have CP, to participate in daily life.     

Development of Fatigue in Cancer Survivors: A Prospective Follow-Up Study From Diagnosis Into the Year After Treatment

ContextThere is a lack of longitudinal studies investigating fatigue from before cancer treatment to long after successful cancer treatment.ObjectivesThis prospective follow-up study aimed to determine the prevalence and predictors of persistent fatigue in cancer survivors in the first year after completion of cancer treatment.MethodsSixty patients with various malignancies were assessed before (T1), shortly after curative cancer treatment (T2), and one year after T2 (T3). Fatigue was assessed monthly between T2 and T3. Fatigue severity was measured using the subscale of the Checklist Individual Strength. Questionnaires were used to measure impaired sleep and rest, physical activity, social support, fatigue catastrophizing, and somatic-related attributions regarding fatigue. Linear regression analyses were performed to identify predictors of persistent fatigue.ResultsIn total, 22% of survivors had severe persistent fatigue over the last six months in the first year after cancer treatment. Fatigue at T1, T2, and negative interactions predicted the severity of persistent fatigue. Analyses without fatigue showed that more negative interactions, impaired sleep and rest, fatigue catastrophizing, and lower self-reported physical activity at T2 were associated with the severity of persistent fatigue.ConclusionTwenty-two percent of the survivors had severe persistent fatigue in the year after cancer treatment. Fatigue and cognitive behavioral factors predicted persistent fatigue in the year after cancer treatment. Diagnosis or cancer treatment did not predict persistent fatigue. The implication is that cognitive behavioral therapy for postcancer fatigue, aimed at the fatigue-perpetuating factors, could be offered from two months after successful cancer treatment.     

PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations

BACKGROUND: The PedsQL (Pediatric Quality of Life Inventory) (Children's Hospital and Health Center, San Diego, California) is a modular instrument for measuring health-related quality of life (HRQOL) in children and adolescents ages 2 to 18. The PedsQL 4.0 Generic Core Scales are multidimensional child self-report and parent proxy-report scales developed as the generic core measure to be integrated with the PedsQL Disease-Specific Modules. The PedsQL 4.0 Generic Core Scales consist of 23 items applicable for healthy school and community populations, as well as pediatric populations with acute and chronic health conditions. METHODS: The 4 PedsQL 4.0 Generic Core Scales (Physical, Emotional, Social, School) were administered to 963 children and 1,629 parents (1,677 subjects accrued overall) recruited from pediatric health care settings. Item-level and scale-level measurement properties were computed. RESULTS: Internal consistency reliability for the Total Scale Score (alpha = 0.88 child, 0.90 parent report), Physical Health Summary Score (alpha = 0.80 child, 0.88 parent), and Psychosocial Health Summary Score (alpha = 0.83 child, 0.86 parent) were acceptable for group comparisons. Validity was demonstrated using the known-groups method, correlations with indicators of morbidity and illness burden, and factor analysis. The PedsQL distinguished between healthy children and pediatric patients with acute or chronic health conditions, was related to indicators of morbidity and illness burden, and displayed a factor-derived solution largely consistent with the a priori conceptually-derived scales. CONCLUSION: The results demonstrate the reliability and validity of the PedsQL 4.0 Generic Core Scales. The PedsQL 4.0 Generic Core Scales may be applicable in clinical trials, research, clinical practice, school health settings, and community populations.     

Concordance between couples reporting their child's quality of life and their decision making in pediatric oncology palliative care

In children 18 years and younger with cancer and no reasonable chance for cure the authors used a cross-sectional study design to (1) describe concordance between fathers' and mothers' evaluation of quality of life (QoL) and (2) determine parental correlation for how factors such as hope, anticipated QoL, and prolonged survival time influence decisions between supportive care alone versus aggressive chemotherapy. Both parents of 13 children performed PedsQL 4.0 Generic Core Scales, Acute Cancer Module, and Multidimensional Fatigue Scale. Concordance was assessed using intraclass correlation coefficient (ICC). Parents reported preferences of supportive care versus aggressive chemotherapy in a hypothetical scenario and rated factors that influenced decision making. Concordance was variable across QoL domains, better for physical health (ICC = 0.46), nausea (ICC = 0.61), general fatigue (ICC = 0.50), and sleep/rest fatigue (ICC = 0.76). Correlation was variable between parents on the influence of factors on their decision, with particularly poor correlation for importance of hope (r = -0.24). Variable concordance was reported between parental assessment of child QoL and factors influencing their decision making, suggesting parents may have different perspectives in decision making and that understanding both is important in clinical care.     

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.     

Dimensions of fatigue during radiotherapy

The aim of the present study was to describe fatigue in a group of irradiated cancer patients. Fatigue was assessed prospectively in 81 Swedish cancer patients, using the Multidimensional Fatigue Inventory (MFI-20), which was also validated in the study, the Karolinska Sleepiness Scale and a Borg CR10 scale before curative radiotherapy, at the end of therapy and 1 and 3 months after treatment. The mean age of these patients was 56 years; 90% were female; and 65% were being treated for cancer of the breast. The absorbed radiation dose was 50 Gy or lower in 90% of the patients. A clear peak in experienced fatigue according to the three scales was seen at the end of treatment. In the MFI-20 the dimensions of General fatigue, Physical fatigue and Reduced activity, were more pronounced than the aspects of Mental fatigue and Reduced motivation. Comparison with other studies using the same instrument in other irradiated patients revealed a similar pattern. The internal consistency of the Swedish version of the MFI-20 was good. The MFI-20 is shown to be a valid instrument for assessing fatigue in patients undergoing radiotherapy.