Background: The Symbolic Assessment of Fatigue Extent (SAFE) is being developed to assess fatigue in an adult clinical population. The tool assesses both extent (4 items) and impact (8 items) of fatigue. Responses are either symbolic or visual representations on a 5 point likert scale (smileys, shape gradients or body caricatures). Further, items assessing impact (activities at home, work, sleep, etc) have been represented pictorially. The scores range from 0 to 48. The face validity of this tool was established through expert consultation using the Delphi procedure. The objective of the current study is to further establish the reliability of the SAFE in an adult cancer population. 

Methodology: Cancer in-patients (N=53, 31 males and 23 females) and Healthy individuals (N=33, 18 males and 15 females) were administered the SAFE twice with a gap of 24 hours.  Additionally, cancer patients (N=102, 51 males and 51 females) at different stages of treatment were administered the SAFE to understand the variability of responses. 

Results:  The internal consistency Cronbach’s alpha coefficients of the SAFE in Cancer patients and Healthy individuals were 0.906 and 0.834 respectively. The test re-test reliability in Cancer patients and Healthy individuals were 0.847 and 0.943 respectively. The tool was able to differentiate responses between cancer patients (just diagnosed (n=11, M=12.82,) under treatment (n=93, M = 12.73) and follow-up (n=17, M = 11.12) and healthy individuals (n=33, M = 6.36). Cancer patients reported 2.5 times greater fatigue when compared to healthy individuals (β=2.469, p=.01). 

Conclusion: The reliability of the Symbolic Assessment of Fatigue Extent (SAFE) was well established.