Brief fatigue inventory as a fatigue identification scale in lung cancer patients under immunotherapy – A real-life study

Abstract

Introduction: Lung cancer (LC) is one of the most frequent oncological diseases in the world, and the use of immunotherapy is a substantial progress regarding new therapeutic options. Fatigue is the most frequently reported adverse effect in patients starting immunotherapy treatment, but it remains underdiagnosed. The purpose of this study was to identify whether the assessment of fatigue, recorded by the clinical team in the pulmonology consultation, agrees with that reported by patients with Non-Small Cell Lung Cancer (NSCLC), when answering the Brief Fatigue Inventory (BFI) questionnaire during treatment with immunotherapy alone or in combination with chemotherapy.
Methods: A prospective observational study was conducted over 8 months. The research took place through the collection of medical records from the clinical files of the patients and the application of the BFI questionnaire, before each of 4 treatment cycles.
Results: The sample consisted of 31 patients with 26 males and 5 females, with a mean age of 68.5 years. The mean value of the BFI score before the 1st treatment, as well as in the following 3 evaluations, was higher for the participants who presented symptoms of asthenia/tiredness/fatigue recorded in the clinical files at the consultation and lower for those who did not. However, the differences were not statistically significant (pre 1st treatment- p=0.299, pre 2nd treatment- p=0.125, pre 3rd treatment- p=0.103 and pre 4th treatment- p=0.954). By comparing the BFI questionnaire score with the medical records, we found that fatigue remained underreported in the consultation at the different evaluation moments (75.9% of the sample participants were not identified with fatigue at the 1st moment of evaluation; 75% at the pre-2nd treatment consultation; 81.2% at the pre-3rd treatment consultation and 88.9% at the pre-4th treatment consultation).
Conclusions: The benefit of applying the BFI questionnaire was relevant. This tool allowed the identification and stratification of fatigue, demonstrating greater sensitivity when compared only with the medical records of the consultation. The fact that the study sample was small was a limitation and made it difficult to obtain more robust results. Therefore, it is desirable to carry out more prospective, long-term studies in this area, to consolidate the results foundin the present investigation.