A review of the content and psychometric properties of cancer-related fatigue (CRF) measures used to assess fatigue in intervention studies

Abstract Purpose Cancer-related fatigue (CRF) is a common and debilitating consequence of cancer and its treatment. Numerous supportive care interventions have been developed to alleviate CRF; however, the diversity of outcome measures used to assess CRF limits comparability of findings. We aimed to evaluate the content and psychometric properties of measures used to assess CRF in interventions targeting fatigue, to inform the selection of suitable measures in future research. Methods Included measures were identified from a systematic review of interventions targeting CRF. General characteristics of each measure were extracted, and item content was assessed against domains specified by the National Comprehensive Cancer Network (NCCN) definition of CRF. Psychometric properties were evaluated against COnsensus-based Standards for the selection of heath Measurement INstruments (COSMIN) criteria. Results Of 54 measures identified, 25 met inclusion criteria. Seventeen were fatigue-specific and eight a fatigue subscale or single item within a broader measure. Only 14 (56%) were specifically developed for cancer populations. Content coverage according to the NCCN CRF definition ranged from 0 to 75%. Evidence for fulfilment of COSMIN criteria in cancer populations ranged from 0 to 93%, with only five measures meeting &gt; 70% of the COSMIN criteria. Conclusion The Piper Fatigue Scale-Revised had good content coverage, but did not comprehensively address COSMIN criteria. The EORTC-FA12 and FACIT/FACT-F had excellent psychometric properties, with each capturing different aspects of fatigue. Ultimately, the choice of CRF measure should be guided by the research question and the CRF domains most relevant to the particular research context. </jats:sec

Sex-specific outcomes of LBBAP versus biventricular pacing : results from I-CLAS

Background: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) has been associated with greater clinical improvement in women than men. Recently, left bundle branch area pacing (LBBAP) has been shown to be an alternative form of CRT. Objectives: The purpose of this study was to investigate sex-specific outcomes for death and heart failure events in a large, international, multicenter, cohort of patients undergoing CRT with BVP or LBBAP. Methods: In this international study of 1,778 patients (575 female and 1203 male), sex-specific survival analysis was performed to compare the effect of LBBAP-CRT relative to BVP-CRT on the combined endpoint of death or heart failure hospitalization (HFH), and secondary endpoints of HFH only, and death alone. Results: Female patients were more likely to have nonischemic cardiomyopathy and left bundle branch block (LBBB) and less likely to have hypertension, diabetes, or coronary artery disease than were male patients. Overall, female patients had a better result with LBBAP compared with BVP than did male patients, with a significant 36% reduction in death or HFH (HR: 0.64; 95% CI: 0.43 to 0.97; P = 0.03) and a significant 60% reduction in HFH alone (HR: 0.4; 95% CI: 0.24 to 0.69, P &lt; 0.01). Women had a greater reduction in death or HFH among those with nonischemic cardiomyopathy (HR: 0.45 95% CI: 0.26 to 0.79; P &lt; 0.01) and LBBB (HR: 0.49; 95% CI: 0.27 to 0.87; P &lt; 0.01). Sex-specific echocardiographic outcomes were better in women than in men. Conclusions: Women obtained significantly greater reductions in the combined endpoint of death or HFH (primarily driven by reduction in HFH) with LBBAP compared with BVP among patients requiring CRT than did men

Rescue left bundle branch area pacing in coronary venous lead failure or nonresponse to biventricular pacing : results from International LBBAP Collaborative Study Group

BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, left bundle branch block (LBBB) and reduced left ventricular function. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT. OBJECTIVE: The aim of this study was to assess the feasibility and outcomes of LBBAP in patients who failed conventional BVP due to coronary venous lead complications or were non-responders to BVP. METHODS: At 16 international centers, LBBAP was attempted in patients with conventional CRT indication who failed BVP due to either, coronary venous (CV) lead complications, or lack of therapeutic response to BVP. We are reporting heart failure hospitalizations (HFH) and death, echocardiographic outcomes, procedural data, pacing parameters, and lead complications including CV lead failure. RESULTS: LBBAP was successfully performed in 200 patients (CV lead failures-156; non-responders-44): age 68±11years, female-35%, LBBB-55%, RVP-23%, ischemic cardiomyopathy-28%, nonischemic cardiomyopathy-63%, LVEF ≤35% in 80%. Procedure and fluoroscopy duration were 119.5±59.6 and 25.7±18.5 min. LBBAP threshold and R-wave amplitudes were 0.68±[email protected] and 10.4±5mV at implant and remained stable during mean follow-up of 12±10.1 months. LBBAP resulted in significant QRS narrowing from 170±28ms to 139±25ms (p<0.001) with V6 R-wave peak times of 85±17ms. LVEF improved from 29±10% at baseline to 40±12% (p<0.001) during follow-up. The risk for death or HFH was lower in CV lead failure compared to non-responders (HR-0.357;95%CI 0.168-0.756,p=0.007) CONCLUSION: LBBAP is a viable alternative for CRT in patients who failed conventional BVP due to CV lead failure or were non-responders