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.