title: Usefulness of the PERFORM questionnaire to measure fatigue in cancer patients with anemia: a prospective, observational study.
abstract: BACKGROUND
  The PERFORM Questionnaire is a 12-item scale developed for assessing fatigue in cancer patients in the clinical practice. It has advantages over other tools in that it is short and includes beliefs and attitudes of patients about fatigue. It was psychometrically validated in cancer patients with and without anemia.
  
  
  OBJECTIVE
  We evaluated the usefulness of the PERFORM scale to measure fatigue in a large study focusing exclusively on anemic patients.
  
  
  METHODS
  This was an observational, multicenter, prospective, 3-month study in cancer patients with hemoglobin (Hb)≤11 g/dl. Fatigue was assessed using the PERFORM questionnaire. The overall score ranges from 12 (no fatigue) to 60 (maximum fatigue).
  
  
  RESULTS
  We included 667 patients: 54.1 % women, mean age 60 (standard deviation, 12) years. A highly significant, but mild correlation was observed between low baseline Hb and high patient perception of fatigue (r with PERFORM score=-0.215, p < 0.0001). Of the patients, 65.8 % improved Hb level during follow-up (increase of ≥1 g/dL and/or achieving >11 g/dL), which translated into a significant improvement in the PERFORM score [mean (95 % confidence interval (CI)] change, -1.2 (-0.04 to -2.4), whereas more fatigue was observed in patients without improvement in Hb [change (95 % CI) in PERFORM, +3.3 (1.5 to 5)]. In a multivariate linear regression analysis, the independent factors associated to fatigue at 3 months were a low Hb level, a low Karnofsky index, active chemotherapy, cancer treatment with palliative intention, and transfusion need in the last 3 months.
  
  
  CONCLUSIONS
  Minimal increases or decreases in Hb of ≥1 g/dL were associated with meaningful changes in patient-perceived fatigue as measured with the PERFORM questionnaire. In addition to anemia severity, other factors such as active chemotherapy and advanced disease contribute to perception of fatigue by cancer patients.
authors.affiliation: Hospital Clínic de Barcelona, Villarroel 170, ES-08036, Barcelona, Spain, GASCON@clinic.ub.es.
authors.forename: Pere
authors.initials: P
authors.lastname: Gascón
authors.forename: César A
authors.initials: CA
authors.lastname: Rodríguez
authors.forename: Vicente
authors.initials: V
authors.lastname: Valentín
authors.forename: Jesús García
authors.initials: JG
authors.lastname: Mata
authors.forename: Joan
authors.initials: J
authors.lastname: Carulla
authors.forename: Javier
authors.initials: J
authors.lastname: Cassinello
authors.forename: Ramón
authors.initials: R
authors.lastname: Colomer
authors.forename: Eva
authors.initials: E
authors.lastname: Baró
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001803:Blood Transfusion; D004921:Erythropoietin / Q000008:administration & dosage; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D005260:Female; D006397:Hematinics / Q000008:administration & dosage; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods* / Q000592:standards; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin