Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 1 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 2 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 3 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 4 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 5 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 6 ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 7 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 8 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 9 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 10 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 11 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 12 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 13