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Understanding Cancer-Related Fatigue: Measurement, Impact, and Intervention Strategies

This session explores the multifaceted nature of cancer-related fatigue and its implications for clinical practice and research. Discussion focuses on effective measurement solutions, trade-offs in multi-site clinical trials, and key determinants of fatigue in cancer patients. Attendees will engage in dialogue about the complexities of fatigue, including physical, mental, and emotional components, as well as the consequences and mitigating factors that must be assessed in trial designs. By proposing a comprehensive conceptual model, we aim to enhance our understanding and management of fatigue in those living with cancer.

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Understanding Cancer-Related Fatigue: Measurement, Impact, and Intervention Strategies

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  1. Conceptualizing Fatigue Kelly Grotzinger, Marlene Frost, & Jane Scott Discussants: Andrea Barsevick, Barbara Piper and Jeff Wefel

  2. 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?

  3. Questions for Discussion • What concept(s) must be assessed to monitor a cancer patient's fatigue? • What concept(s) (determinants, consequences, mitigating factors) should we consider when designing trials to evaluate treatment for fatigue in cancer patients?

  4. Fatigue Concept Models How do we measure fatigue itself? Dimensionality Essential subconcepts Relationships among subconcepts Fatigue Disease Models What causes it? What factors influence severity or change? What are the consequences? Conceptual Models For Fatigue in Cancer Patients

  5. 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? PHYSICAL FATIGUE MENTAL FATIGUE Cognitive Components? Affective Components?

  6. Cancer / Treatment Fatigue Function / HRQOL Physical Cognitive Behavioral Mental • Tiredness • Weakness • Energy • Exhaustion • Listless • Malaise • Attention • Concentration • Motivation • Memory • Mental capacity • Capacity for work • Sleep quality • Social activities • Task completion • Helplessness • vulnerability • distress • Reactivity • Impatience • Anxiety • Emotional numbness

  7. Ameliorating Factors Impairment Exacerbating Factors Cancer Type & Stage Cancer Treatments Medications Surgery Radiation Behavioral Interventions Treatment Coping Resources Causes ParticipationCognitionDistress - Severity Factors Symptoms * + Physical Functioning Exertion Stress Comorbidities

  8. Achy Tired Symptoms Weak No energy No stamina ‘Drained’(Emotional) Fog(Cognitive) Intense Sudden Time of Day Not due toexertion Persistent ‘Unusual’ ? Unpredictable Rest/sleepdoesn’thelp

  9. Remembering Thinking Clearly Cognition Making Decisions Comprehension (Reading/Conversation) Planning Worried Stamina Angry Isolated Strength Distress Physical Function Lonely Sad Impairment Frustrated Helpless Performing Daily Activities Hopeless Participation Working Spending Time w/Friends & Family CommunityInvolvement

  10. Questions for Discussion • What concept(s) must be assessed to monitor a cancer patient's fatigue? • What concept(s) (determinants, consequences, mitigating factors) should we consider when designing trials to evaluate treatment for fatigue in cancer patients?

  11. What is cancer-related fatigue? • The perception of tiredness • that may interfere with lives of people who have experienced cancer

  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.

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