Overview
The Functional Assessment of Anorexia/Cachexia Therapy (FAACT) was designed to measure general aspects of quality of life (QOL) as well as specific anorexia/cachexia-related concerns. It includes the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) and a 12 item subscale that specifically measures the symptoms and concerns of patients with anorexia/cachexia (A/CS). The A/CS subscale can be used in conjunction with the FACT-G or as a standalone instrument. Patients rate each item from 0 to 4 (0 = Not at all; 1 = A little bit; 2 = Somewhat; 3 = Quite a bit; and 4 = Very Much). Chang et al (2003) has shown this “intensity” rating scale to be essentially equivalent to a “frequency” rating scale (i.e., “none of the time” to “all of the time”). The recall period for each question is “during the past 7 days” and this time frame has been found to provide more precise information than a 4-week time frame (Lai et
al 2009). All FACIT scales are scored so that a high score is good. As each of the 12 items of the FAACT anorexia/cachexia-specific subcale ranges from 0-4, the range of possible scores is 0-48, with 0 being the worst possible score and 48 the best. To obtain the 0-48 score each negatively-worded item response is recoded so that 0 is a bad response and 4 is good response. All responses are added with equal weight to obtain the total score. In cases where some answers may be missing, a total score is prorated from the score of the answered items, so long as more than 50% of the items (i.e., at least 7 of 12) were answered.
The FAACT was developed with input from both patients and clinicians. Semistructured interviews conducted with 10 patients and 5 practitioners generated 32 candidate anorexia/cachexia items (Cella et al 1993). The practitioners who helped generate the items were also later asked to review the entire list of items. The items underwent multiple iterative reviews to reduce redundancy and clarify wording, resulting in a final list of 18 anorexia/ cachexia items. These items were then pilot tested in 10 cancer and 6 HIV-infected patients with anorexia/cachexia. Patients were asked to rate each item in terms of importance (0, not at all important to 4, very important). All items were found to be sufficiently important for retention in the next stage. The FAACT was then validated in a randomized trial comparing 200mg vs. 800mg per day of megestrol acetate oral suspension in 213 patients with cancer (n=155) or HIV (n=58) (Ribaudo et al 2001). The majority of the cancer patients had non small cell lung cancer. The FAACT was administered by computer at baseline and at weeks 4 and 12. The Bristol-Myers Anorexia/Cachexia Recovery Instrument (BACRI) was administered at weeks 4 and 12 only. The anorexia/cachexia subscale was reduced from 18 to 12 items. Items were removed because they were conceptually dissimilar to eating concerns (e.g., “I have diarrhea”) or minimally correlated with the total score (e.g., “I enjoy eating breakfast”). The Cronbach’s coefficient alpha did not change significantly with removal of those items (from 0.77 for both cancer and HIV patients to 0.76 for cancer and 0.78 for HIV). The correlation between 18-item and 12-item scores was 0.94. Scores on the 12-item subscale significantly differed between groups defined by ECOG PSR and were sensitive to change in PSR.
MEASURE NAME:
Functional Assessment of Anorexia/Cachexia Treatment (FAACT)
VERSION:
4
NUMBER OF ITEMS:
39
PATIENT POPULATION:
Cancer patients 18 years and older experiencing anorexia/cachexia
RECALL PERIOD:
Past 7 days
RESPONSE SCALE:
5 point Likert-type scale
DATA COLLECTION:
Paper and electronic
ADMINISTRATION:
Self-administration and interview when applicable
SUBSCALE DOMAINS:
Physical Well-Being, Social/Family Well-Being, Emotional Well-Being, Functional Well-Being, Anorexia/Cachexia Subscale
TIME FOR COMPLETION:
10-15 minutes
SCORING:
Manual scoring template, some items are reverse scored. Subscale scores, total scores and TOI scores possible. SAS/SPSS algorithms available.
RELATED MEASURES:
Language Availability
Available translations of the FAACT can be obtained by registering for permission. Users are not permitted to translate the FAACT without permission from FACIT.org. Permission from FACIT.org to translate the FAACT may also be contingent upon timeline expectations and availability of FACIT staff. Translations must undergo a rigorous methodology under the guidance of FACIT.org which includes multiple translators, QA steps and cognitive interviews with patients. For commercial use, FACITtrans is the approved translation vendor to translate the FACIT measurement system.
Please contact us for more information.
Licensing
Licensing fees are assessed on a per trial/per measure basis for commercial use. There is no fee for use of the English version, but a license should be obtained.
Non-commercial use is assessed on a case-by-case basis. Licensing fees are typically not applied to investigator-initiated research, students, or clinical use.
To license an available version of this measure for commercial or non-commercial use, please complete our registration form. All of the information provided in the form will be kept strictly confidential. For questions, please contact us.
Selected References
Blauwhoff-Buskermolen, S., Ruijgrok, C., Ostelo, R., de Vet, H., Verheul, H., de van der Schueren, M., & Langius, J. The assessment of anorexia in patients with cancer: cut-off values for the FAACT–A/CS and the VAS for appetite. Support Care Cancer 2016; 24: 661–666. doi: 10.1007/s00520-015-2826-2.
Change, V., Xia,Q, & Kasimis, B. The Functional Assessment of Anorexia/ Cachexia Therapy (FAACT) Appetite Scale in Veteran Cancer Patients. The Journal of Supportive Oncology 2005; 3(5): 377-382.
Gelhorn, H., Gries, K., Speck, R., Duus, E., Bourne, R., Aggarwal, D., & Cella, D. Comprehensive validation of the functional assessment of anorexia/cachexia therapy (FAACT) anorexia/cachexia subcale (A/CS) in lung cancer patients with involuntary weight loss. Quality of Life Research 2019; 28(6): 1641-1653. doi: 10.1007/s11136-019-02135-7.
Lai, J-S., Cella, D., Peterman, A., Barocas, J., & Goldman, S. Anorexia/Cachexia related QOL for children with cancer: Testing the psychometric properties of the pediatric functional assessment of anorexia and cachexia therapy (peds-FAACT). Cancer 2005; 104(7): 1531-1539.
LeBlanc, T., Samsa, G., Wolf, S., Locke, S., Cella, D., & Abernethy, A. Validation and real-world assessment of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) scale in patients with advanced non-small cell lung cancer and the cancer anorexia-cachexia syndrome (CACS). Support Care Cancer 2015; 23: 2341–2347. doi 10.1007/s00520-015-2606-z.
Ribaudo, J., Cella, D., Hahn, E., Lloyd, S., Tchekmedyian, N., Von Roenn, J., & Leslie, W. Re-validation and shortening of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire. Quality of Life Research 2001; 1137-1146.
Salsman, J., Beaumont, J., Wortman, K., Yan, Y., Friend, J., & Cella, D. Brief versions of the FACIT-fatigue and FAACT subscales for patients with non-small cell lung cancer cachexia. Supportive Care in Cancer 2015; 23 (5): 1355-1364. doi: 10.1007/s00520-014-2484-9.
Yennurajalingam, S., Frisbee-Hume, S., Palmer, J., Delgado-Guay, M., Bull, J., Phan, A., Tannir, N., Litton, J., Reddy, A., Hui, D., Dalal, S., Massie, L., Reddy, S., & Bruera, E. Reduction of Cancer-Related Fatigue With Dexamethasone: A Double-Blind, Randomized, Placebo-Controlled Trial in Patients With Advanced Cancer. Journal of Clinical Oncology 2013; 31(25): 3076-3082doi: 10.1200/JCO.2012.44.4661.
Zhou,T., Yang,K., Thapa, S., Fu, Q, Jiang, Y. , & Yu, S. Validation of the Chinese version of functional assessment of anorexia-cachexia therapy (FAACT) scale for measuring quality of life in cancer patients with cachexia. Support Care Cancer 2017; 25: 1183–1189. doi: 10.1007/s00520-016-3508-4.
Bonomi, A.E., Cella, D.D., Hahn, E.A., Bjordal, K., Sperner, B., Gangeri, L., Bergman, B., Willems, J., Hanquet, P., & Zittoun, R. Multilingual translation of the Functional Assessment of Cancer Therapy (FACT) quality of life measurement system. Quality of Life Research 1996; 5: 309-320.
Eremenco, S., Arnold, B., & Cella, D. A comprehensive method for the translation and cross-cultural validation of health status questionnaires. Evaluation & the Health Professions 2005; 28(2): 212-232.
Webster K., Cella D., & Yost K. The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: Properties applications, and interpretation. Health and Quality of Life Outcomes 2003; 1(1): 79-85.
Yost K.J., Eton D.T. Combining distribution- and anchor-based approaches to determine minimally important differences: The FACIT experience. Evaluation & the Health Professions 2005; 28(2): 172-191.
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