Appropriateness of the treatment of fatigued patients with stage IV cancer
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ORIGINAL ARTICLE
Appropriateness of the treatment of fatigued patients with stage IV cancer Andrea L. Cheville & Tiffany Shen & Megan Chang & Jeffrey R. Basford
Received: 25 January 2012 / Accepted: 23 May 2012 / Published online: 23 August 2012 # Springer-Verlag 2012
Abstract Background Fatigue among patients with cancer is prevalent, disabling, and treatable. While fatigue management guidelines have been in place for a decade, their use remains unclear. Methods We surveyed 160 patients with stage IV lung (40), breast (40), colon (40), and prostate (40) cancer who reported moderate to severe fatigue (i.e., >5 of 10 on an 11-point numerical rating scale). Participants were queried about receipt of treatments in fatigue management domains emphasized in the National Comprehensive Cancer Network guidelines: general management strategies, activity enhancement, psychosocial strategies, and pharmaceuticals. Results The cohort was half male, had a mean age of 67, and reported an average fatigue rating of 6.4. Participants reported treatment or receipt of specific guidance in the fatigue management domains as follows: general management strategies 16.8 %, activity enhancement 11.9 %, psychosocial strategies 9.9 %, and pharmaceuticals 37.3 %. Fatigue >7 of 10 increased the likelihood of instruction in activity enhancement but no other domain. Conclusion The low rates of guideline-congruent treatment reported here are concerning, particularly as better validated behavioral treatments were the least prescribed. A. L. Cheville (*) : J. R. Basford Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA e-mail: [email protected] T. Shen : M. Chang Mayo Clinic Medical School, Rochester, MN, USA
Keywords Cancer . Fatigue . National Comprehensive Cancer Network
Introduction Fatigue, regardless of its cause, limits a person’s quality of life (QoL) and becomes particularly problematic in the frail and elderly. It is, in fact, the most prevalent and problematic side effect of cancer and its treatment where its presence, in addition to its degrading impact on quality of life and functional status, is associated with reduced survival [1–3]. Fatigue has economic and societal costs as well: the presence of moderate to severe fatigue is associated with increased direct and indirect costs of cancer care [4, 5]. Fatigue is, at least in part, amenable to treatment through a variety of approaches including exercise, sleep enhancement, cognitive behavioral therapy, activity modification, and pharmaceuticals [6–10]. Despite mounting empirical support for these interventions, and the endorsement of fatigue management guidelines by the National Comprehensive Cancer Network (NCCN) [11], little is known about the extent to which fatigue is currently being monitored or addressed in people with cancer [12]. It is likely that its treatment may mirror the undertreatment of pain and functional problems that has been consistently documented in cancer populations [13, 14]. In summary, while i
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