Measuring health-related quality of life and neutropenia-specific concerns among older adults undergoing chemotherapy: Validation of the Functional Assessment of Cancer Therapy-Neutropenia (FACT-N)

Lynne I. Wagner, Jennifer L. Beaumont, Beiying Ding, Jennifer Malin, Amy Peterman, Elizabeth Calhoun, David Cella

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: The present study established the psychometric properties of the Functional Assessment of Cancer Therapy-Neutropenia (FACT-N), a self-report instrument to assess neutropenia-specific concerns and health-related quality of life (HRQL), in a sample of adults 65 years of age and older. Materials and methods: Participants were undergoing chemotherapy for lung, breast, or ovarian cancer or non-Hodgkin's lymphoma (n=852) and were randomly assigned to receive pegfilgrastim beginning with cycle 1 (primary prophylaxis) or pegfilgrastim subsequent to cycle 1 at their clinicians' discretion (usual care). Participants completed a self-report assessment on day 1 of each cycle (up to six cycles) and at the expected nadir of the white blood cell count of each cycle. Using factor analysis, three subscales were identified in the 19-item FACT-N subscale: Malaise, Worry, and Flu-like symptoms. Results and discussions: The FACT-N and each of the subscales were sensitive to the presence of neutropenia although did not correlate with the absolute neutrophil count (ANC). While ANC is a marker of the impact of chemotherapy on the myeloid precursors of the bone marrow and is correlated with risk of febrile neutropenia, however the constellation of symptoms and patient experience vary throughout the period of neutropenia as the ANC first declines and then recovers. The 19-item neutropenia subscale can be used alone; however, evidence supporting reliability and validity was most robust for aggregate scores from the FACT-N and the Trial Outcome Index-Neutropenia (TOI-N). Conclusion: Understanding the impact of neutropenia on HRQL through the availability of a validated self-report measure will, ideally, lead to interventions to reduce the burden associated with cancer and its treatments.

Original languageEnglish (US)
Pages (from-to)47-56
Number of pages10
JournalSupportive Care in Cancer
Volume16
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

Fingerprint

Neutropenia
Quality of Life
Drug Therapy
Neoplasms
Self Report
Therapeutics
Neutrophils
Febrile Neutropenia
Leukocyte Count
Psychometrics
Reproducibility of Results
Ovarian Neoplasms
Non-Hodgkin's Lymphoma
Statistical Factor Analysis
Lung Neoplasms
Bone Marrow
Breast Neoplasms

Keywords

  • Health-related quality of life
  • Neutropenia
  • Older adults
  • Patient-reported outcomes
  • Supportive care

ASJC Scopus subject areas

  • Oncology
  • Nursing(all)

Cite this

Measuring health-related quality of life and neutropenia-specific concerns among older adults undergoing chemotherapy : Validation of the Functional Assessment of Cancer Therapy-Neutropenia (FACT-N). / Wagner, Lynne I.; Beaumont, Jennifer L.; Ding, Beiying; Malin, Jennifer; Peterman, Amy; Calhoun, Elizabeth; Cella, David.

In: Supportive Care in Cancer, Vol. 16, No. 1, 01.2008, p. 47-56.

Research output: Contribution to journalArticle

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abstract = "Objective: The present study established the psychometric properties of the Functional Assessment of Cancer Therapy-Neutropenia (FACT-N), a self-report instrument to assess neutropenia-specific concerns and health-related quality of life (HRQL), in a sample of adults 65 years of age and older. Materials and methods: Participants were undergoing chemotherapy for lung, breast, or ovarian cancer or non-Hodgkin's lymphoma (n=852) and were randomly assigned to receive pegfilgrastim beginning with cycle 1 (primary prophylaxis) or pegfilgrastim subsequent to cycle 1 at their clinicians' discretion (usual care). Participants completed a self-report assessment on day 1 of each cycle (up to six cycles) and at the expected nadir of the white blood cell count of each cycle. Using factor analysis, three subscales were identified in the 19-item FACT-N subscale: Malaise, Worry, and Flu-like symptoms. Results and discussions: The FACT-N and each of the subscales were sensitive to the presence of neutropenia although did not correlate with the absolute neutrophil count (ANC). While ANC is a marker of the impact of chemotherapy on the myeloid precursors of the bone marrow and is correlated with risk of febrile neutropenia, however the constellation of symptoms and patient experience vary throughout the period of neutropenia as the ANC first declines and then recovers. The 19-item neutropenia subscale can be used alone; however, evidence supporting reliability and validity was most robust for aggregate scores from the FACT-N and the Trial Outcome Index-Neutropenia (TOI-N). Conclusion: Understanding the impact of neutropenia on HRQL through the availability of a validated self-report measure will, ideally, lead to interventions to reduce the burden associated with cancer and its treatments.",
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