Psychology RootsFunctional Assessment of Cancer Therapy
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About Functional Assessment of Cancer Therapy
Scale Name
Functional Assessment of Cancer Therapy
Author Details
David Cella
Translation Availability
English
Background/Description
The Functional Assessment of Cancer Therapy (FACT), developed by David Cella in 1993, is a patient-assessed system featuring a core component, the FACT-G, which evaluates general quality of life (QoL), supplemented by optional condition-specific subscales. Published in Quality of Life Research (1993), it was initially designed for cancer therapy outcomes in clinical trials but has expanded via the FACIT organization (www.facit.org) to assess chronic conditions like HIV and multiple sclerosis. The FACT-G includes 27 items (Version 4) grouped into four subscales: Physical Well-Being (PWB, 7 items, 0–28), Social/Family Well-Being (SWB, 7 items, 0–28), Emotional Well-Being (EWB, 6 items, 0–24), and Functional Well-Being (FWB, 7 items, 0–28), using a 0–4 Likert scale (0 = “not at all” to 4 = “very much”). A total score is calculated, with missing items replaced by subscale means if at least 50% are completed.
Items were derived from patient and oncologist interviews, taking ~5 minutes to complete (longer, ~13.5 minutes, for low-education groups). Earlier versions (e.g., Version 3 with 34 items) included a Relationship With Doctor (RWD) subscale and summary ratings (discarded in Version 4). Validated with cancer patients (mean age ≈ 40–70 years, mixed gender, multi-country), it correlates with QoL measures and is used in oncology and chronic illness research. Access requires coordination with FACIT.
Administration, Scoring and Interpretation
- Obtain the FACT from Cella (1993) or www.facit.org, ensuring ethical permissions.
- Explain to participants (cancer or chronic illness patients 18+) that the questionnaire assesses QoL, emphasizing confidentiality and voluntary participation.
- Administer the 27-item FACT-G self-report scale (or with subscales) in clinical or trial settings, with patients responding on a 0–4 Likert scale over the past week.
- Estimated completion time is ~5 minutes (longer for low-education groups).
- Ensure a supportive environment; provide care resources (e.g., support services) and adapt for accessibility (e.g., large print, telephone administration) if needed.
Reliability and Validity
The FACT demonstrates robust psychometric properties (Cella, 1993). Internal consistency is high (Cronbach’s alpha 0.82–0.92 across subscales, N not specified, per Table 10.2). Test-retest reliability is strong (r = 0.92 total, 0.82–0.88 subscales over 3–7 days; Japanese version 0.72 total, 0.63–0.81 over 2 weeks). Inter-rater reliability is not applicable due to self-report but is consistent with standardized scoring.
Convergent validity is supported by correlations with the Beck Depression Inventory (r ≈ 0.70–0.75), Karnofsky Scale (r ≈ 0.60–0.70), and McGill Pain Questionnaire (r ≈ 0.50–0.60). Discriminant validity is evidenced by subscale differentiation (e.g., PWB vs EWB), with total scores reflecting overall QoL. Factor analysis confirms the four-factor structure, supporting construct validity. The FACT reliably assesses QoL. Pairing with the FLIC or Karnofsky Index enhances comprehensive assessment.
Available Versions
27-Items
Reference
Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., … & Brannon, J. (1993). The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. Journal of clinical oncology, 11(3), 570-579.
Important Link
Scale File:
Frequently Asked Questions
What does the FACT measure?
It measures general QoL (FACT-G) with optional condition-specific subscales.
Who is the target population?
Cancer or chronic illness patients (18+) in clinical trials or care settings.
How long does it take to administer?
Approximately 5 minutes (up to 13.5 minutes for low-education groups).
Can it inform interventions?
Yes, it assesses QoL to guide therapy adjustments in clinical trials.
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