title: Deriving clinically meaningful cut-scores for fatigue in a cohort of breast cancer survivors: a Health, Eating, Activity, and Lifestyle (HEAL) Study.
abstract: OBJECTIVE
  To empirically determine clinically meaningful cut-scores on the 0-10 response scale of the revised Piper Fatigue Scale (PFS-R) and its shorter version (PFS-12). Breast cancer survivors were classified (i.e., none, mild, moderate, or severe fatigue) based on the cut-scores, and relationships between these cut-scores and decrements in health-related quality of life (HRQOL) were examined.
  
  
  METHODS
  A total of 857 breast cancer survivors, stages in situ-IIIa, from the Health, Eating, Activity, and Lifestyle (HEAL) Study were eligible. Survivors completed the PFS-R, SF-36, and a sexual health scale approximately 3 years after diagnosis. Multivariate analysis of covariance was used to examine five fatigue severity cut-score models, controlling for demographics, clinical characteristics, comorbidity, and antidepressant use. Multivariate regression was used to examine HRQOL decrements by cut-score category.
  
  
  RESULTS
  Analyses supported two similar fatigue severity cut-score models for the PFS-R and PFS-12: Model A.) none (0), mild (1-3), moderate (4-6), and severe (7-10); and Model D.) none (0), mild (1-2), moderate (3-5), and severe (6-10). For every threshold increase in fatigue severity, clinically meaningful decrements in physical, mental, and sexual health scores were observed, supporting construct validity of the fatigue cut-scores.
  
  
  CONCLUSIONS
  Standardized fatigue cut-scores may enhance interpretability and comparability across studies and populations and guide treating planning.
authors: Department of Health Behavior, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
authors: Angela M
authors: AM
authors: Stover
authors: Bryce B
authors: BB
authors: Reeve
authors: Barbara F
authors: BF
authors: Piper
authors: Catherine M
authors: CM
authors: Alfano
authors: Ashley Wilder
authors: AW
authors: Smith
authors: Sandra A
authors: SA
authors: Mitchell
authors: Leslie
authors: L
authors: Bernstein
authors: Kathy B
authors: KB
authors: Baumgartner
authors: Anne
authors: A
authors: McTiernan
authors: Rachel
authors: R
authors: Ballard-Barbash
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000503:physiopathology*; D015331:Cohort Studies; D005221:Fatigue / Q000145:classification* / Q000175:diagnosis; D005260:Female; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012016:Reference Values; D017741:Survivors