Psychometric Properties of the Functional Assessment Instrument for Cancer
Therapies - Cognitive Function (FACT-COG) in the Mexican General Population
Oscar Galindo Vazquez1, Mónica Ramírez Orozco1,2, Astrid Ximena Romero Hernández1,2, and Luis Alberto Mendoza Contreras1,3
1Research and Development Unit of Psycho-oncology, National Cancer Institute (INCan) Mexico
2School of Psychology, National Autonomous University of Mexico (UNAM), Mexico
3School of Psychology, Latin University (UNILA), South Campus, Mexico
Submission: June 17, 2020; Published: September 02, 2020
*Corresponding author: Oscar Galindo Vázquez Research and Development Unit of Psychooncology, National Cancer Institute, Av. San Fernando No.22, Colonia. Section XVI, Mexico, C.P. 14080
How to cite this article: Oscar G V, Mónica R O, Astrid X R H, Luis A M C. Psychometric Properties of the Functional Assessment Instrument for Cancer
Therapies - Cognitive Function (FACT-COG) in the Mexican General Population. Open Access J Neurol Neurosurg 2020; 14(1): 555879.DOI: 10.19080/OAJNN.2020.14.555879.
Introduction: Cognitive deterioration can be a factor that can affect the quality of life of the general population throughout life.
Objective: To determine the psychometric properties of the Functional Assessment Instrument for Cancer Therapies - Cognitive Function (FACT-COG) in the Mexican general population.
Method: 212 people with an average age of 33 years participated. A non-experimental cross-sectional design was used. Instruments: FACT-COG (3rd version-MX).
Statistical analysis: An exploratory and confirmatory factor analysis was performed.
Results: Five factors with a total of 31 items were identified. The overall internal consistency of the scale was α = 0.964 and for each subscale, the alpha indices ranged from 0.803 to 0.937, accounting for 71% of the total variance. The confirmatory factor analysis presents satisfactory model structure adjustment indicators (CFI, RMR, and RMSEA) that denote a balanced and parsimonious model.
Discussion and conclusion: The FACT-COG in the Mexican general population presented adequate exploratory and confirmatory psychometric characteristics, which suggests that it is an adequate instrument to assess perceived cognitive function in the general population.
Keywords:Quality of life; Cognitive function; Mexico; Psychometric properties
Cognitive impairment (CD) is defined as that alteration in cognitive functions that prevent a person from carrying out their daily activities with the usual efficiency . CD is usually measured employing standardized neuropsychological tests; however, the use of self-report questionnaires is increasingly common, which allows knowing the subject’s perception of their cognitive functions from the observation of their daily activities. These questionnaires are usually one of the most common reasons for conducting neuropsychological tests and knowing cognitive functioning in an objective way . So, in recent years, the evaluation of cognitive function on quality of life has become relevant, as well as the impact on daily life. In this context, the
Functionality Assessment Instrument in Cancer Treatment - Cognitive Function (FACT-COG)  is a self-report questionnaire initially used in cancer patients to assess deterioration in cognitive abilities and their impact on the quality of life based on the patient’s perception .
It is an instrument widely used worldwide since it has been validated in different populations, it consists of 37 items, in a self-applicable format, it has constructs functionality and quality of life concerning cognitive function and it is used to assess the self-reported perception of different neuropsychological symptoms and their effect on the quality of life, since it is common for this population to notice negative changes in their cognitive functioning, such as memory problems, concentration failure,
and attentional difficulties. In the cancer population, there are
validations of the FACT-COG in the Asian , which identified
reliability of 0.92, with 4 original factors and variance of 74.2%.
In the validation in the French population  in a heterogeneous
sample of cancer patients, reliability of 0.93 and its 4 original
factors were obtained. Finally, the validation of the FACT-COG in
Korea  showed an internal consistency of 0.94, statistically
significant correlations with symptoms of depression and other
measures of quality of life, preserving the 4 original factors. A
factorial structure of four factors with 36 items was identified in
the Mexican population with cancer  The internal consistencies
of each subscale had a value of between 0.98 to 0.95, of the
global scale 0.98, which explained 77.6% of the variance, with
appropriate indicators of the adjustment of the structure of the
In a healthy population, psychometric properties have been
reported in a sample of the French population to obtain normative
data . To measure the effect of age on cognitive functions,
three age groups were considered: 30-49, 50-69, and 70-89. The
results of the validation in the general population of the FACTCog
showed good internal consistency, with Cronbach’s alpha of
.91 for the Perceived Cognitive Impairment (DCP) subscale, of
.74 for Comments of Others (CO), of .90 for Perceived Cognitive
Abilities (CCP) and .88 for Effects on Quality of Life (CVD). To
assess internal validity, correlations were made between the
four subscales, which correlated significantly with each other.
Spearman correlation from .31 to .63, ps <.0001, except CO and
CVD. An effect of age was found on the DCP and CCP subscales,
where older people presented more subjective complaints
(p<.001). On the other hand in students and the elderly population
 identified a structure of four factors (deficiencies, abilities,
ability to notice and quality of life), with some support to separate
the factors of disability / wide capacity in domains specific
cognitive. The older adult sample was better described using both
disabilities/abilities and specific cognitive domains, while the
student sample suggested two factors of disability/ability, but the
separation of the elements of concentration/acuity and memory
/ verbal disability.
Both studies conclude that FACT-Cog can be used in
populations other than cancer patients, the values obtained from
the healthy population can be used to compare the perceived
cognitive function in cancer patients, as they provide a reliable
reference to evaluate the impact of disease and / or treatments
on perceived cognitive function. However, a validated instrument
that evaluated the perception of cognitive deterioration in the
quality of life has not been identified in the Mexican population,
so the objective of this study was to validate the FACT-COG in a
group of the Mexican general population.
An online survey was conducted, in which 212 men and women
of Mexican nationality participated through a non-probability
convenience sample. A non-experimental, cross-sectional design
Participants inclusion criteria:
a. Minimum age of 18 years,
b. Know how to read and write.
c. With internet access and some electronic device such as
a smartphone or laptop.
d. Acceptance and signing of informed consent Exclusion
e. cognitive impairment that prevents you from completing
the survey. Elimination criteria:
f. That during or after completing the survey they decide
not to continue participating.
g. Non-acceptance of informed consent
Assessment Instrument for cancer therapies - Cognitive Function.
The entire sample voluntarily participated by understanding and
signing the informed consent. The procedures of this research
complied with the provisions of the Declaration of Helsinki
regarding research in human participants.
The Functionality Assessment Instrument in Cancer
Treatment - Cognitive Function (FACT-COG) (19) is an instrument
that evaluates, through self-report, the patient’s perception of
their cognitive abilities and the effects of cognitive changes on
their functionality and quality of life. The original instrument has
shown an internal consistency of α = 0.96.
Statistical analysis: Descriptive statistical analyzes of the
total sample were performed.
Exploratory analysis: The central tendency statistics of each
item were obtained to know their distribution in the response
options; extreme groups (quartile 25 and 75) were determined,
a Student’s t-test was performed for independent samples to
identify the discrimination property of each reagent, those with
a p> 0.05 were eliminated from the analysis. Subsequently, crosstable
analyzes were performed to determine the correlation
between items and the exploratory factor analysis considering
an a priori value of > .50 per item. With the reagents that passed
these analyzes, Cronbach’s alpha was estimated.
Confirmatory analysis: With the exploratory results, the
fit of the 4-factor model was evaluated utilizing confirmatory
factor analysis (AFC) using the maximum likelihood method
that included the steps of identification and specification of the
model, estimation of standardized parameters, (R2 correlations,
covariances, modification indices and critical proportions of
the differences), and finally, evaluation of the fit by observing
acceptable limits of the estimators, as well as non-collinearity in
the measured variables. The following indices were estimated X2,
goodness-of-fit index (GFI) and its complements (AGFI, TLI), as
well as the comparative goodness-of-fit index (CFI) 27, which is
the best indicator for samples equal to or greater than 200 and
finally the mean square root of the approximation error (RMSEA).
As shown in Table 1, the total sample was made up of 212
participants, 83% women, and 17% men, with an average age
of 33.9 years. Just over half are single residents of Mexico City,
mainly with a bachelor’s degree table 1.
The internal consistency analysis identified a general index α
= 0.966, a reagent was removed that did not obtain the minimum
of .50. Five factors were identified: Perceived cognitive memory
impairments α = 0.934, Perceived cognitive deficits in the
generation of ideas: α = 0.937, Comments from Others: α = 0.803,
Perceived Cognitive Abilities: α = 0.909 and Effects on Quality of
Life: α = 0.925.
Exploratory factor structure
The exploratory factor analysis obtained in the Bartlett
sphericity test a value p = 0.001 indicating non-identity of the
correlation matrix, while the Kaiser-Meyer-Olkin index (KMO)
was 942; Varimax rotation was used to extract the model, in which
five factors were identified, which together explain 71.3% of the
variance. See table 2 for the exploratory factor structure table 2.
Confirmatory factor structure
The fit of the model of factors obtained with the exploratory
analysis was evaluated using confirmatory factor analysis (AFC)
using the maximum likelihood method, with the following steps:
a. Identification of the model: For the analyzed model, of a
total of 22 variables, there were 21 endogenous variables. There
were 5 unobserved variables (total parameters to be estimated by
b. Parameter estimation: The STATA 14.2 program was
asked to apply the maximum likelihood method, with standardized
estimators, R2 estimator (multiple squared correlations),
covariances of the estimators, indexes to be modified and critical
proportions for the differences.
c. For the evaluation of the fit (the sample exceeds n = 212),
as a first step, all the results were examined to ensure that the
estimated coefficients did not exceed the acceptable limits (that
there were no negative or insignificant error variances, higher
standardized coefficients to 1, or excessively high standard errors
related to some estimated coefficient).
d. The regarding the absolute measures of the global
adjustment, the chi-square value was 1142 (p = ≤0.000, 424gl).
Comparative measures of global fit, such as the comparative index
(CFI), is near ideal (CFI = 0871), as is the Tucker-Lewis index,
which takes into account the complexity of the model (TLI =
0.858) indicating an acceptable fit to the data.
The parsimony indices (PCFI) are very close to the optimal
value, so the model is adequate as the goodness of fit statistics
acceptably show, plus the root of the mean squared approximation
residual (RMSEA = .089, IC 90 [.083-.096] and the root mean
standardized quadratic residual (SRMR = .061).
The psychometric analyzes carried out for the validation of
the Functional Assessment Instrument for Cancer Therapies -
Cognitive Function (FACT-COG) in the Mexican general population
present a factorial structure similar to the original and to the
validations in other countries, the version of this study identified
5 original factors that are Comments from Others (CO), Perceived
Cognitive Skills (HCP) and Impact on Quality of Life (ICV) while
Perceived Cognitive Impairment (DCP) was made up of two
components ¨ Perceived cognitive deficits attentional memory ¨
and ¨Perceived cognitive deficits in the generation of ideas with
a variance¨ that together explained an adequate percentage of the
The model contains 5 factors with a strong association
between them, as shown by the exploratory analysis, which makes
it possible to recommend this instrument to assess perceived
cognitive function in the general population. The most powerful
indicators of the model structure adjustment (CFI, SRMR, and
RMSEA) suggest that it is a balanced and parsimonious model.
The FACT-COG is a widely worldwide used instrument worldwide
since it has been validated in different populations. When
comparing the present study with those of other countries, it
can be seen that they are very similar both in their reliability,
factor loads, explained variance, and validity. This study supports
the use of FACT-Cog with five identified factors, the factor
perceived cognitive deficiencies in two components may be more
appropriate for the general population expressing a quality of life
without high rates of dysfunction or characteristic symptoms of
a population with some disease chronic-degenerative like cancer.
The suggested that the disability/deficit items partly represent
the mood states of the respondents, while the skill/ability items
capture general self-efficacy. Different emotional and cognitive
processes may be involved in the negative evaluation and positive
experiences . Finally, this version validated in the Mexican
population can help people to evaluate their cognitive functions
from the observation of their daily activities. This will allow more
scope for research and utility of FACT-Cog use in both research
and clinical settings.
The Instrument for the Evaluation of Functionality in Cancer
Treatment - Cognitive Function (FACT-COG) is an instrument that
demonstrated adequate psychometric properties in the Mexican
population, thus providing evidence of the instrument’s validity.
In addition to that, the FACT-COG can be used in the Mexican
population in both clinical and diagnostic studies. It would
also allow patients to be referred to the corresponding clinical
intervention on time to improve the quality of care received by the
multidisciplinary team, for a specialist to be able to carry out an
objective evaluation and determine if appropriate rehabilitation
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