Journal of Nippon Medical School: Vol.71 No.5 page.314

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ArticleTitle Cross-Cultural Validation of the Japanese Functional Assessment of Cancer Therapy-Anemia (FACT-An)

AuthorList Akinobu Yoshimura^1,2, Kunihiko Kobayashi^1,2,3, Hiyori Fumimoto^1,2, Yuki Fujiki³, Sonya Eremenco⁴ and Shoji Kudoh^1,2

Affiliation ¹East Japan Chesters Group (EJCG)
²Department of 4th Internal Medicine, Nippon Medical School
³Department of Respiratory Medicine, Saitama Medical School
⁴Center on Outcomes, Research and Education (CORE), Evanston Northwestern Healthcare and Northwestern University

Language EN

Volume 71

Issue 5

Year 2004

Page 314-322

Received June 2, 2004

Accepted July 22, 2004

Keywords anemia, quality-of-life, questionnaire, FACT-An, translation

Abstract Background: The Functional Assessment of Cancer Therapy-Anemia (FACT-An) questionnaire, which consists of a core questionnaire named the General Measure of the Functional Assessment of Cancer Therapy (FACT-G) and the Anemia additional concerns subscale, was developed in an English-speaking culture. The validation of the Japanese FACT-G was reported previously (Fumimoto et al., 2001), and, in this report, a cross-cultural validation for the subscale was performed.
Methods: The Japanese version was developed through an iterative forward-backward translation sequence used throughout the Functional Assessment of Chronic Illness Therapy (FACIT) Multilingual Translation Project. In evaluating psychometric performance, its construct validity was investigated by exploratory factor-analyses, and confirmed by Cronbach's alpha coefficient.
Results: The FACT-An was given to 180 patients with lung cancer. Using the 20 items of the Anemia subscale, a factor analysis extracted four factors of fatigue, chest condition, activities and headache. When analyzed as two extracted factors, fatigue, chest condition and headache were combined to be a major factor, although the minor factor of activities still remained. Thirteen of the 20 items construct the Fatigue additional concerns subscale. Cronbach's alpha coefficients for the Fatigue subscale (0.93) and the Anemia subscale (0.88) confirmed that, although these subscales had items that focus on different aspects of anemia or fatigue, each subscale was unidimensional. Clinical validity was indicated by moderate values of Spearman's correlation coefficients between Eastern Cooperative Oncology Group performance status rating (ECOG PSR) and the Anemia subscale (-0.50) or the Fatigue subscale (-0.48).
Conclusion: Both the Fatigue subscale and the Anemia subscale are valid in Japan, indicating that FACT-An is an instrument that is applicable across cultures and particularly with a Japanese cancer population.

Correspondence to Kunihiko Kobayashi MD, Ph D, Department of Respiratory Medicine, Saitama Medical School, 38 Morohongo Moroyama, Iruma-gun, Saitama 350-0495, Japan
kobakuni@saitama-med.ac.jp

ArticleTitle	Cross-Cultural Validation of the Japanese Functional Assessment of Cancer Therapy-Anemia (FACT-An)
AuthorList	Akinobu Yoshimura^1,2, Kunihiko Kobayashi^1,2,3, Hiyori Fumimoto^1,2, Yuki Fujiki³, Sonya Eremenco⁴ and Shoji Kudoh^1,2
Affiliation	¹East Japan Chesters Group (EJCG) ²Department of 4th Internal Medicine, Nippon Medical School ³Department of Respiratory Medicine, Saitama Medical School ⁴Center on Outcomes, Research and Education (CORE), Evanston Northwestern Healthcare and Northwestern University
Language	EN
Volume	71
Issue	5
Year	2004
Page	314-322
Received	June 2, 2004
Accepted	July 22, 2004
Keywords	anemia, quality-of-life, questionnaire, FACT-An, translation
Abstract	Background: The Functional Assessment of Cancer Therapy-Anemia (FACT-An) questionnaire, which consists of a core questionnaire named the General Measure of the Functional Assessment of Cancer Therapy (FACT-G) and the Anemia additional concerns subscale, was developed in an English-speaking culture. The validation of the Japanese FACT-G was reported previously (Fumimoto et al., 2001), and, in this report, a cross-cultural validation for the subscale was performed. Methods: The Japanese version was developed through an iterative forward-backward translation sequence used throughout the Functional Assessment of Chronic Illness Therapy (FACIT) Multilingual Translation Project. In evaluating psychometric performance, its construct validity was investigated by exploratory factor-analyses, and confirmed by Cronbach's alpha coefficient. Results: The FACT-An was given to 180 patients with lung cancer. Using the 20 items of the Anemia subscale, a factor analysis extracted four factors of fatigue, chest condition, activities and headache. When analyzed as two extracted factors, fatigue, chest condition and headache were combined to be a major factor, although the minor factor of activities still remained. Thirteen of the 20 items construct the Fatigue additional concerns subscale. Cronbach's alpha coefficients for the Fatigue subscale (0.93) and the Anemia subscale (0.88) confirmed that, although these subscales had items that focus on different aspects of anemia or fatigue, each subscale was unidimensional. Clinical validity was indicated by moderate values of Spearman's correlation coefficients between Eastern Cooperative Oncology Group performance status rating (ECOG PSR) and the Anemia subscale (-0.50) or the Fatigue subscale (-0.48). Conclusion: Both the Fatigue subscale and the Anemia subscale are valid in Japan, indicating that FACT-An is an instrument that is applicable across cultures and particularly with a Japanese cancer population.
Correspondence to	Kunihiko Kobayashi MD, Ph D, Department of Respiratory Medicine, Saitama Medical School, 38 Morohongo Moroyama, Iruma-gun, Saitama 350-0495, Japan kobakuni@saitama-med.ac.jp