Skip to main content
SpringerLink
Log in

Conducting routine fatigue assessments for use in clinical oncology practice: patient and provider perspectives

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goals of work

Fatigue is the most common symptom associated with cancer and its treatment. The present study measured patient and provider perceptions of the feasibility and acceptability of conducting computerized fatigue assessments during routine follow-up outpatient clinic visits.

Materials and methods

A subset of 64 patients from a larger study, testing items for inclusion in a fatigue item bank, completed two computerized fatigue assessments at 2- to 3-month intervals. After the second assessment, patients completed a questionnaire about the usefulness of the assessments and the understandability of graphic reports depicting the fatigue scores. They were also asked about the optimal frequency for conducting fatigue assessments. Providers were asked similar feasibility questions.

Main results

Providers thought displays of fatigue scores would be more useful than patients did. Patients and providers also differed on the frequency with which fatigue assessments should be conducted. Interestingly, of the 37% of patients who reported that assessments should be conducted at a different frequency than the choices that were offered, 50% reported that the assessments should be conducted according to their treatment schedule. The majority of providers thought fatigue assessments should be administered at each MD visit.

Conclusion

Patients and providers differed about the perceived usefulness of displaying fatigue scores and the frequency with which routine assessments should be conducted. However, both patients and providers appeared to endorse the notion that routine assessments would be beneficial. Integration of routine assessments of commonly experienced symptoms such as fatigue may have important implications for improving symptom management in the future, ultimately resulting in better overall patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cella D (1997) The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 34(3 Suppl 2):13–19

    PubMed  CAS  Google Scholar 

  2. Cella D, Davis K, Breitbart W, Curt G (2001) Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol 19(14):3385–3391

    PubMed  CAS  Google Scholar 

  3. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579

    PubMed  CAS  Google Scholar 

  4. Curt G, Johnston PG (2003) Cancer fatigue: the way forward. Oncologist 8(Suppl 1):27–30

    Article  PubMed  Google Scholar 

  5. Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH, Miaskowski C, Scherr SL, Portenoy RK, Vogelzang NJ (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 5(5):353–360

    Article  PubMed  CAS  Google Scholar 

  6. Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum. Ann Oncol 11(8):971–975

    Article  PubMed  CAS  Google Scholar 

  7. Vogelzang NJ, Breitbart W, Cella D, Curt GA, Groopman JE, Horning SJ, Itri LM, Johnson DH, Scherr SL, Portenoy RK (1997) Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 34(3 Suppl 2):4–12

    PubMed  CAS  Google Scholar 

  8. National Comprehensive Cancer Network (2007) NCCN Clinical Practice Guidelines in Oncology: cancer-related fatigue. Version 2.2007. http://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf. Cited June 5, 2007

  9. Ferrell BR, Grant M, Dean GE, Funk B, Ly J (1996) “Bone Tired”: the experience of fatigue and its impact on quality of life. Oncol Nurs Forum 23(10):1539–1547

    Google Scholar 

  10. Irvine D, Vincent L, Graydon JE, Bubela N, Thompson L (1994) The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals. Cancer Nurs 17(5):367–378

    Article  PubMed  CAS  Google Scholar 

  11. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 13(2):63–74

    Article  PubMed  CAS  Google Scholar 

  12. Mock V, Atkinson A, Barsevick A, Cella D, Cimprich B, Cleeland C, Donnelly J, Eisenberger MA, Escalante C, Hinds P, Jacobsen PB, Kaldor P, Knight SJ, Peterman A, Piper BF, Rugo H, Sabbatini P, Stahl C (2000) NCCN practice guidelines for cancer-related fatigue. Oncology (Williston Park) 14(11A):151–161

    CAS  Google Scholar 

  13. Cella D, Lai JS, Chang CH, Peterman A, Slavin M (2002) Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 94(2):528–538

    Article  PubMed  Google Scholar 

  14. Lai JS, Cella D, Dineen K, Bode R, Von Roenn J, Gershon RC, Shevrin D (2005) An item bank was created to improve the measurement of cancer-related fatigue. J Clin Epidemiol 58(2):190–197

    Article  PubMed  Google Scholar 

  15. Wu HS, McSweeney M (2004) Assessing fatigue in persons with cancer: an instrument development and testing study. Cancer 101(7):1685–1695

    Article  PubMed  Google Scholar 

  16. Sarna L (1998) Effectiveness of structured nursing assessment of symptom distress in advanced lung cancer. Oncol Nurs Forum 25(6):1041–1048

    PubMed  CAS  Google Scholar 

  17. Naughton M, Homsi J (2002) Symptom assessment in cancer patients. Curr Oncol Rep 4(3):256–263

    Article  PubMed  Google Scholar 

  18. Velikova G, Booth L, Smith AB, Brown PM, Lynch P, Brown JM, Selby PJ (2004) Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. J Clin Oncol 22(4):714–724

    Article  PubMed  Google Scholar 

  19. Batel-Copel LM, Kornblith AB, Batel PC, Holland JC (1997) Do oncologists have an increasing interest in the quality of life of their patients? A literature review of the last 15 years. Eur J Cancer 33(1):29–32

    Article  PubMed  CAS  Google Scholar 

  20. Detmar SB, Aaronson NK (1998) Quality of life assessment in daily clinical oncology practice: a feasibility study. Eur J Cancer 34(8):1181–1186

    Article  PubMed  CAS  Google Scholar 

  21. Feld R (1995) Endpoints in cancer clinical trials: is there a need for measuring quality of life. Support Care Cancer 3(1):23–27

    Article  PubMed  CAS  Google Scholar 

  22. Taylor KM, Macdonald KG, Bezjak A, Ng P, Depetrillo AD (1996) Physicians’ perspective on quality of life: an exploratory study of oncologists. Qual Life Res 5(1):5–14

    Article  PubMed  CAS  Google Scholar 

  23. Davis K, Cella D (2002) Assessing quality of life in oncology clinical practice: a review of barriers and critical success factors. J Clin Outcomes Manage 9(6):327–332

    Google Scholar 

  24. Morris J, Perez D, McNoe B (1998) The use of quality of life data in clinical practice. Qual Life Res 7(1):85–91

    Article  PubMed  CAS  Google Scholar 

  25. Buxton J, White M, Osoba D (1998) Patients’ experiences using a computerized program with a touch-sensitive video monitor for the assessment of health-related quality of life. Qual Life Res 7(6):513–519

    Article  PubMed  CAS  Google Scholar 

  26. Fortner B, Okon T, Schwartzberg L, Tauer K, Houts AC (2003) The Cancer Care Monitor: psychometric content evaluation and pilot testing of a computer administered system for symptom screening and quality of life in adult cancer patients. J Pain Symptom Manage 26(6):1077–1092

    Article  PubMed  Google Scholar 

  27. Hahn EA, Cella D, Dobrez D, Shiomoto G, Marcus E, Taylor SG, Vohra M, Chang CH, Wright BD, Linacre JM, Weiss BD, Valenzuela V, Chiang HL, Webster K (2004) The talking touchscreen: a new approach to outcomes assessment in low literacy. Psychooncology 13(2):86–95

    Article  PubMed  Google Scholar 

  28. Mullen KH, Berry DL, Zierler BK (2004) Computerized symptom and quality-of-life assessment for patients with cancer part II: acceptability and usability. Oncol Nurs Forum 31(5):E84–E89

    Article  PubMed  Google Scholar 

  29. Taenzer P, Bultz BD, Carlson LE, Speca M, DeGagne T, Olson K, Doll R, Rosberger Z (2000) Impact of computerized quality of life screening on physician behaviour and patient satisfaction in lung cancer outpatients. Psychooncology 9(3):203–213

    Article  PubMed  CAS  Google Scholar 

  30. Velikova G, Brown JM, Smith AB, Selby PJ (2002) Computer-based quality of life questionnaires may contribute to doctor-patient interactions in oncology. Br J Cancer 86(1):51–59

    Article  PubMed  CAS  Google Scholar 

  31. Wright EP, Selby PJ, Crawford M, Gillibrand A, Johnston C, Perren TJ, Rush R, Smith A, Velikova G, Watson K, Gould A, Cull A (2003) Feasibility and compliance of automated measurement of quality of life in oncology practice. J Clin Oncol 21(2):374–382

    Article  PubMed  CAS  Google Scholar 

  32. Goldsmith G, Brodwick M (1989) Assessing the functional status of older patients with chronic illness. Fam Med 21(1):38–41

    PubMed  CAS  Google Scholar 

  33. Kazis LE, Callahan LF, Meenan RF, Pincus T (1990) Health status reports in the care of patients with rheumatoid arthritis. J Clin Epidemiol 43(11):1243–1253

    Article  PubMed  CAS  Google Scholar 

  34. Rubenstein LV, Calkins DR, Young RT, Cleary PD, Fink A, Kosecoff J, Jette AM, Davies AR, Delbanco TL, Brook RH (1989) Improving patient function: a randomized trial of functional disability screening. Ann Intern Med 111(10):836–842

    PubMed  CAS  Google Scholar 

  35. Davis KM, Yount S, Del Ciello K, Whalen M, Khan S, Bass M, Du H, Eton D, Masters G, Hensing T, Cella D (2007) An innovative symptom monitoring tool for people with advanced lung cancer: a pilot demonstration. J Support Oncol (in press)

  36. Detmar SB, Muller MJ, Schornagel JH, Wever LD, Aaronson NK (2002) Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. JAMA 288(23):3027–3034

    Article  PubMed  Google Scholar 

  37. Donovan KA, Jacobsen PB, Andrykowski MA, Winters EM, Balducci L, Malik U, Kenady D, McGrath P (2004) Course of fatigue in women receiving chemotherapy and/or radiotherapy for early stage breast cancer. J Pain Symptom Manage 28(4):373–380

    Article  PubMed  Google Scholar 

  38. Geinitz H, Zimmermann FB, Stoll P, Thamm R, Kaffenberger W, Ansorg K, Keller M, Busch R, van Beuningen D, Molls M (2001) Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer. Int J Radiat Oncol Biol Phys 51(3):691–698

    PubMed  CAS  Google Scholar 

  39. Greene D, Nail LM, Fieler VK, Dudgeon D, Jones LS (1994) A comparison of patient-reported side effects among three chemotherapy regimens for breast cancer. Cancer Pract 2(1):57–62

    PubMed  CAS  Google Scholar 

  40. Irvine DM, Vincent L, Graydon JE, Bubela N (1998) Fatigue in women with breast cancer receiving radiation therapy. Cancer Nurs 21(2):127–135

    Article  PubMed  CAS  Google Scholar 

  41. Jacobsen PB, Hann DM, Azzarello LM, Horton J, Balducci L, Lyman GH (1999) Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. J Pain Symptom Manage 18(4):233–242

    Article  PubMed  CAS  Google Scholar 

  42. Passik SD, Kirsh KL, Donaghy K, Holtsclaw E, Theobald D, Cella D, Breitbart W (2002) Patient-related barriers to fatigue communication: initial validation of the fatigue management barriers questionnaire. J Pain Symptom Manage 24(5):481–493

    Article  PubMed  Google Scholar 

  43. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2004) Living beyond cancer: finding a new balance. President’s Cancer Panel 2003–2004 Annual Report. http://deainfo.nci.nih.gov/ADVISORY/pcp/pcp.htm

Download references

Acknowledgments

We would like to thank all participants (patients and clinicians) at each of the sites for their willingness to participate in the work regarding fatigue. We hope that it will result in important improvements in the management of fatigue and other symptoms associated with cancer and its treatment.

Author information

Authors and Affiliations

  1. Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA

    Kimberly M. Davis

  2. Department of Pediatrics and Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jin-Shei Lai

  3. Department of Preventive Medicine and Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Elizabeth A. Hahn

  4. Department of Psychiatry, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    David Cella

  5. Center on Outcomes, Research and Education, 1001 University Place, Suite 100, Evanston, IL, 60201, USA

    Jin-Shei Lai, Elizabeth A. Hahn & David Cella

Authors
  1. Kimberly M. Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin-Shei Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth A. Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Cella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly M. Davis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Davis, K.M., Lai, JS., Hahn, E.A. et al. Conducting routine fatigue assessments for use in clinical oncology practice: patient and provider perspectives. Support Care Cancer 16, 379–386 (2008). https://doi.org/10.1007/s00520-007-0317-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-007-0317-9

Keywords

Search

Navigation