title: 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).
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.
  
  
  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.
  
  
  CONCLUSIONS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center on Outcomes, Research and Education, Evanston Northwestern Healthcare and Northwestern University Feinberg Medical School, 1001 University Place, Evanston, IL 60201, USA. lwagner@northwestern.edu
authors.forename: Lynne I
authors.initials: LI
authors.lastname: Wagner
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Beaumont
authors.forename: Beiying
authors.initials: B
authors.lastname: Ding
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malin
authors.forename: Amy
authors.initials: A
authors.lastname: Peterman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Calhoun
authors.forename: David
authors.initials: D
authors.lastname: Cella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control / Q000523:psychology*; D009504:Neutrophils / Q000187:drug effects; D011092:Polyethylene Glycols; D011594:Psychometrics; D011788:Quality of Life; D011994:Recombinant Proteins; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim