Transcript Conceptualizing Fatigue

Conceptualizing
Fatigue
Kelly Grotzinger, Marlene Frost, & Jane Scott
Discussants: Andrea Barsevick, Barbara Piper and
Jeff Wefel
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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Session 2: Questions
• Discussion questions
– What are the trade-offs (lengthy vs. brief
measures, complexity of intervention) in
efficiently conducting multi-site clinical
trials?
– Can multi-site trials test interventions that
target several components of fatigue; i.e.,
mental, physical?
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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Questions for Discussion
1. What concept(s) must be assessed to monitor a
cancer patient's fatigue?
2. What concept(s) (determinants, consequences,
mitigating factors) should we consider when
designing trials to evaluate treatment for fatigue
in cancer patients?
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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Conceptual Models For
Fatigue in Cancer Patients
Fatigue Concept
Models
Fatigue Disease
Models
How do we measure
fatigue itself?
• Dimensionality
• Essential
subconcepts
• Relationships
among subconcepts
• What causes it?
• What factors
influence severity or
change?
• What are the
consequences?
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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Conceptual Model for Measurement of
Cancer-Related Fatigue (Cleeland et al)
Patient reports tiredness or fatigue
At a level where intervention is desired
Is “unusual” – high rating of severity?
Cognitive
Components?
MENTAL
FATIGUE
PHYSICAL
FATIGUE
Affective
Components?
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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Cancer /
Treatment
Function /
HRQOL
Fatigue
Physical
•
•
•
•
•
•
Tiredness
Weakness
Energy
Exhaustion
Listless
Malaise
Cognitive
•
•
•
•
•
Attention
Concentration
Motivation
Memory
Mental
capacity
Behavioral
• Capacity for
work
• Sleep quality
• Social
activities
• Task
completion
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
Mental
•
•
•
•
•
•
•
Helplessness
vulnerability
distress
Reactivity
Impatience
Anxiety
Emotional
numbness
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ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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Cancer
Treatments
Medications
Surgery
Radiation
Cancer Type
& Stage
Causes
Behavioral Interventions
Treatment
Coping
Ameliorating Resources
Factors
Symptoms
Severity
* Factors
Participation
Cognition
Distress
Impairment
+
Physical
Functioning
Exertion
Exacerbating
Stress
Factors
Comorbidities
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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Intense
Sudden
Time of Day
Not due to
exertion
‘Unusual’
Achy
Persistent
Unpredictable
Tired
Rest/sleep
doesn’t help
Symptoms
Weak
No energy
No stamina
Fog
(Cognitive)
‘Drained’
(Emotional)
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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Thinking Clearly
Comprehension
(Reading/Conversation)
Remembering
Making Decisions
Cognition
Planning
Worried
Angry
Stamina
Isolated
Strength
Lonely
Sad
Frustrated
Physical
Function
Impairment
Distress
Helpless
Performing
Daily Activities
Hopeless
Working
Community
Involvement
Participation
Spending Time
w/Friends &
Family
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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Questions for Discussion
1. What concept(s) must be assessed to
monitor a cancer patient's fatigue?
2. What concept(s) (determinants,
consequences, mitigating factors) should
we consider when designing trials to
evaluate treatment for fatigue in cancer
patients?
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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What is cancer-related
fatigue?
• The perception of tiredness
• that may interfere with lives of people who
have experienced cancer
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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New Definition Proposed
• The perception of tiredness experienced
by people with cancer (or who have had
cancer) that varies in pattern (temporal,
association w/treatment), duration,
severity, and impact on daily life.
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007
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