Upload
karin-fox
View
212
Download
0
Embed Size (px)
Citation preview
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 1
Conceptualizing Conceptualizing FatigueFatigue
Kelly Grotzinger, Marlene Frost, & Jane ScottKelly Grotzinger, Marlene Frost, & Jane Scott
Discussants: Andrea Barsevick, Barbara Piper and Discussants: Andrea Barsevick, Barbara Piper and Jeff WefelJeff Wefel
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 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?
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 3
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 4
Conceptual Models For Fatigue in Cancer Patients
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?
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 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
PHYSICAL FATIGUE
MENTAL FATIGUE
MENTAL FATIGUE
Cognitive Components?
Affective Components?
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 6
Fatigue
Physical Cognitive
• Tiredness• Weakness• Energy• Exhaustion• Listless• Malaise
• Attention• Concentration• Motivation• Memory• Mental
capacity
Function / HRQOL
Behavioral Mental
• Capacity for work
• Sleep quality• Social
activities• Task
completion
• Helplessness• vulnerability• distress• Reactivity• Impatience• Anxiety• Emotional
numbness
Cancer /Treatment
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 7
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 8
AmelioratingFactors
Impairment
ExacerbatingFactors
-
+
Behavioral Interventions Treatment Coping Resources
Exertion Stress
Comorbidities
CancerTreatments
Medications Surgery
Radiation
Causes
Cancer Type & Stage
PhysicalFunctioning
ParticipationCognition
Distress
*Symptoms SeverityFactors
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 9
‘Unusual’Persistent
Sudden
Unpredictable
Intense
Rest/sleepdoesn’t help
Not due toexertion
?
Time of Day
Symptoms
No energy
Tired
‘Drained’(Emotional)
Fog(Cognitive)
Achy
Weak
No stamina
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 10
Impairment
Cognition
Physical Function
Participation
Distress
Thinking Clearly
Comprehension(Reading/Conversation)
Planning
Angry
Frustrated
Isolated
Spending Time w/Friends & Family
Stamina
Performing Daily Activities
Remembering
Hopeless
Helpless
Worried
Strength
Making Decisions
Working
CommunityInvolvement
Sad Lonely
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007 11
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 12
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 13
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.