Chalder Fatigue Scale (CF Scale)
Also known as: CFS, Chalder Fatigue Scale, Fatigue Scale
The Chalder Fatigue Scale is an 11-item brief self-report instrument measuring physical and mental fatigue, developed by Trudie Chalder and colleagues at St. Bartholomew's Hospital, London, in 1993. Originally designed for chronic fatigue syndrome (myalgic encephalomyelitis/ME) research, the CFS has been extensively validated across cancer populations, chronic illness, and general populations. The scale offers two scoring options: continuous 0–33 scale for severity measurement or bimodal 0–11 scoring for caseness determination, making it versatile for both research and clinical screening.
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When to use it
Chalder Fatigue Scale is appropriate for fatigue assessment in cancer populations, chronic fatigue syndrome, and general chronic illness research. Use in clinical trials examining tolerability and fatigue side effects of chemotherapy, radiation, targeted therapies, or supportive interventions. Employ in observational research characterizing fatigue prevalence, burden, and risk factors across cancer types. In routine clinical oncology, CFS can serve as a brief screening tool (using bimodal cutoff) or severity measure (continuous 0–33 scoring) integrated into symptom-assessment protocols. Particularly valuable in long-term follow-up and survivorship studies tracking persistent fatigue post-treatment.
Strengths & limitations
- Ultra-brief (11 items, ~2–3 min) yet multidimensional (physical and mental subscales); balances comprehensiveness with feasibility for repeated clinical assessment.
- Two scoring options (continuous 0–33 for research severity measurement; bimodal for rapid clinical caseness determination) enable flexibility across clinical and research contexts.
- Well-validated across cancer populations, chronic fatigue syndrome, and general chronic illness. Robust internal consistency (Cronbach α ≥0.75) and test–retest reliability (ICC ≥0.70).
- Extensively used in international fatigue research (20+ language translations); substantial published literature enabling comparison across studies and populations.
- Freely available for research and clinical use; integrated into some cancer center symptom-screening systems and fatigue research protocols.
- Subscales are brief (7 physical, 4 mental items); individual item fluctuations can shift subscale means noticeably. Longitudinal studies may exhibit notable score variability despite true stability.
- Some ambiguity in item interpretation; 'worse than usual' for a patient with progressive cancer may reflect disease progression rather than intervention failure. Clinical context essential.
- No universal cutoff thresholds for continuous 0–33 scoring; 0–10, 11–20, 21–33 bands are empirically derived but context-dependent. Bimodal cutoff (≥4) is more evidence-based but less granular for severity measurement.
- Mental Fatigue subscale is brief (4 items); may not capture detailed cognitive impairment. Concurrent cognitive screening may be warranted if detailed cognitive assessment is needed.
Frequently asked
Should I use continuous 0–33 or bimodal scoring?
Continuous 0–33 scoring is standard for research measuring fatigue severity and tracking change over time; enables precision and effect-size calculation. Bimodal scoring (≥4=case) is useful for rapid clinical screening or determining whether fatigue warrants intervention. Choose continuous for research trials; bimodal for routine clinical screening. Always specify scoring method in reports.
What are typical Chalder Fatigue Scale scores in cancer populations?
Published means vary by cancer type and treatment phase: actively treated cancer patients: mean CFS ~18–22 (moderate-to-severe fatigue); post-treatment survivors (6–12 months): mean ~12–16 (mild-to-moderate); long-term survivors (5+ years): mean ~8–12 (minimal-to-mild). Use cancer-type and treatment-phase specific reference data for contextualization.
How does Chalder Fatigue Scale differ from other cancer fatigue scales?
CFS (11 items, physical + mental subscales) is brief and practical for routine screening. Piper Fatigue Scale (22 items, four subscales including behavioral/affective/sensory/cognitive) is more comprehensive. Brief Fatigue Inventory (9 items, severity + interference) focuses on functional impact. Chalder is rapid; Piper is mechanistic; BFI is pragmatic. Choose based on clinical context and detail needed.
Can CFS Mental Fatigue subscale replace formal depression/anxiety screening?
No. CFS Mental Fatigue measures concentration and memory difficulty related to fatigue, not mood. High mental fatigue does not diagnose depression or anxiety. If mental fatigue is elevated, use concurrent screening (PHQ-9 for depression, GAD-7 for anxiety) or formal psychiatric evaluation to assess comorbid mood disorders.
Sources
- Chalder, T., Berelowitz, G., Pawlikowska, T., et al. (1993). Development of a fatigue scale. J Psychosom Res, 37(2), 147–153. DOI: 10.1016/0022-3999(93)90081-P ↗
- Chalder, T., Power, M. J., & Wessely, S. (1996). Chronic fatigue in the community: 'The prevalence and use of health care. J Psychosom Res, 41(2), 197–103. link ↗
How to cite this page
ScholarGate. (2026, June 3). Chalder Fatigue Scale (CF Scale). ScholarGate. https://scholargate.app/en/oncology-nursing/chalder-fatigue-scale
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
- Brief Fatigue InventoryOncology Nursing↔ compare
- Cancer Fatigue ScaleOncology Nursing↔ compare
- FACT-GOncology Nursing↔ compare
- MFIOncology Nursing↔ compare
- Piper Fatigue ScaleOncology Nursing↔ compare