1. 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

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
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?
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
Cognitive
Components?
MENTAL FATIGUE
Affective
Components?
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007

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
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007

7. ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007

8. - + Symptoms * Severity Impairment Factors Causes
Cancer Type
& Stage
Cancer
Treatments
Medications
Surgery
Radiation
Behavioral Interventions Treatment Coping Resources
Causes
Ameliorating
Factors
Participation Cognition Distress -
Impairment
Severity
Factors
Symptoms * +
Physical
Functioning
Exacerbating
Factors
Exertion
Stress
Comorbidities
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007

9. ‘Drained’ (Emotional)
Intense
Sudden
Time of Day
Not due to exertion
Persistent
‘Unusual’
Symptoms
No energy
Tired
‘Drained’ (Emotional)
Fog (Cognitive)
Achy
Weak
No stamina ?
Unpredictable
Rest/sleep doesn’t help
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007

10. (Reading/Conversation) Performing Daily Activities
Remembering
Thinking Clearly
Cognition
Making Decisions
Comprehension
(Reading/Conversation)
Planning
Worried
Stamina
Angry
Isolated
Strength
Distress
Physical
Function
Sad
Lonely
Impairment
Frustrated
Helpless
Performing Daily Activities
Hopeless
Participation
Working
Spending Time w/Friends & Family
Community Involvement
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007

11. 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?
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.
ASCPRO Fatigue Workshop, Washington, DC October 14-16, 2007