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Routinely monitor fatigue in Ca patients. (Updated Guidelines).

HOLLYWOOD, FLA. - Fatigue should be evaluated as a vital sign at every encounter with cancer patients, according to updated treatment guidelines issued at the annual conference of the National Comprehensive Cancer Network.

Many studies have shown that fatigue is the most prevalent and distressing complaint among cancer patients. The problem is exacerbated by the growing use of multimodal, high-intensity regimens. Fatigue often extends for months or years following treatment, said Victoria Mock, D.N.Sc., director of the center for nursing research, Johns Hopkins University Baltimore.

The guidelines, developed by a 27-member panel of experts from leading cancer centers and first published in 2000, were designed to help clinicians improve quality of life in cancer patients by managing treatment-related fatigue, said Dr. Mock, who also is director of nursing research at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. The update will appear this summer in the Journal of the National Comprehensive Cancer Network.

The guidelines address the needs of patients in three treatment categories: those in active treatment, those in long-term follow-up, and those at the end of life.

Only two recommendations are based on high-level (category 1) evidence: one on activity enhancement during active treatment or long-term follow-up, and one on psychosocial intervention in all three treatment categories. All other recommendations are category 2A, indicating consensus among panel members based on lower-level evidence, Dr. Carmen P. Escalante said.

For patients in all three treatment categories, the guidelines call for fatigue screening at every visit.

Patients with mild fatigue (a score of 1-3 on a severity scale of 0-10, with 10 being the worst fatigue imaginable) should be educated about management strategies; evaluation should be ongoing. Those with moderate fatigue (score of 4-6) or severe fatigue (score of 7-10) should undergo primary evaluation, including a focused history, review of systems, and in-depth assessment of fatigue patterns and treatable contributing factors, said Dr. Escalante, interim chair of general internal medicine, ambulatory treatment and emergency center, University of Texas M.D. Anderson Cancer Center, Houston.

Patients in all three treatment categories with moderate or severe fatigue require education and counseling. Those on active treatment need reassurance that fatigue does not necessarily indicate disease progression; they should self-monitor fatigue on a daily basis. Those on long-term follow-up should regularly self-monitor fatigue to assess the effectiveness of interventions. Those at the end of life should be informed that fatigue is expected.

Energy conservation (such as regulating pace, delegating responsibilities, and taking naps that don't interrupt sleep at night) and distraction (such as listening to music, reading, and socializing) are commonly recommended for all cancer patients.
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Author:Worcester, Sharon
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jun 1, 2003
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