Journal of Clinical Epidemiology 58 (2005) 190–197 An item bank was created to improve the measurement of cancer-related fatigue Jin-shei Lai a,b, * , David Cella a,b , Kelly Dineen d , Rita Bode b,c , Jamie Von Roenn b , Richard C. Gershon a,b , Daniel Shevrin a a Evanston Northwestern Healthcare, 1001 University Place, #100, Evanston, IL 60201, USA b Northwestern University, Chicago, IL, USA c Rehabilitation Institute of Chicago, Chicago, IL, USA d Private practice Accepted 3 July 2003 Abstract Objective: Cancer-related fatigue (CRF) is one of the most common unrelieved symptoms experienced by patients. CRF is underrecognized and undertreated due to a lack of clinically sensitive instruments that integrate easily into clinics. Modern computerized adaptive testing (CAT) can overcome these obstacles by enabling precise assessment of fatigue without requiring the administration of a large number of questions. A working item bank is essential for development of a CAT platform. The present report describes the building of an operational item bank for use in clinical settings with the ultimate goal of improving CRF identification and treatment. Study Design and Setting: The sample included 301 cancer patients. Psychometric properties of items were examined by using Rasch analysis, an Item Response Theory (IRT) model. Results and Conclusion: The final bank includes 72 items. These 72 unidimensional items explained 57.5% of the variance, based on factor analysis results. Excellent internal consistency (α = 0.99) and acceptable item–total correlation were found (range: 0.51–0.85). The 72 items covered a reasonable range of the fatigue continuum. No significant ceiling effects, floor effects, or gaps were found. A sample short form was created for demonstration purposes. The resulting bank is amenable to the development of a CAT platform.  2005 Elsevier Inc. All rights reserved. Keywords: Cancer-related fatigue (CRF); Item bank; Item response theory (IRT); Computerized adaptive testing (CAT); Rasch analysis; Short form 1. Introduction Cancer-related fatigue (CRF) is defined as an overwhelm- ing and sustained sense of exhaustion that decreases one’s capacity for physical and mental work [1]. Although it is one of the most common unrelieved symptoms experienced by patients with cancer [2–6], it is underrecognized and under- treated [7]. Fatigue can result from the disease process itself, disease progression, treatment effects (e.g., chemotherapy, radiation), and/or from medications (e.g., opiods for pain management). The reported prevalence of CRF ranges widely, from 18% to 96% [8,9]. Patients typically find CRF very distressing, because it has profound effects across many areas of life. Fatigue diminishes the ability to work, or work effectively, and to function at one’s usual level in family roles. Many patients find themselves unable to participate * Corresponding author. Tel.: 224-364-7312; fax: 847-570-8033. E-mail address: js-Lai@northwestern.edu (J-S. Lai). 0895-4356/05/$ – see front matter  2005 Elsevier Inc. All rights reserved. doi: 10.1016/j.jclinepi.2003.07.016 in social and physical activities. Untreated fatigue also con- tributes to emotional distress. Complaints of fatigue are not unique to patients with cancer. Fatigue is a common symptom in many chronic diseases, such as rheumatoid arthritis [10] and multiple scle- rosis [11]. Many people in the general population who are without chronic disease also complain of fatigue. Hjermstad et al. [12] estimated that approximately 20% of men and 30% of women in the general population complain of frequent tiredness. Glaus [13] found that 55% of healthy individuals reported a physical sensation of fatigue or tiredness, 21% identified an affective sensation of fatigue, and 24% identi- fied cognitive fatigue. Therefore, one challenge that re- searchers and clinicians face is to distinguish ordinary time-limited fatigue experienced by many from the pervasive and debilitating fatigue experienced by cancer patients. Many instruments have been developed to measure self- reported fatigue, such as the Functional Assessment of Chronic Illness Therapy—Fatigue (FACIT-F) [14,15], the