Article

Implementing the Fatigue Guidelines at one NCCN member institution: process and outcomes.

Department of Nursing Research & Education, Division of Population Sciences, Beckman Research Institute, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
Journal of the National Comprehensive Cancer Network: JNCCN (Impact Factor: 4.24). 11/2007; 5(10):1092-101.
Source: PubMed

ABSTRACT Fatigue, despite being the most common and distressing symptom in cancer, is often unrelieved because of numerous patient, provider, and system barriers. The overall purpose of this 5-year prospective clinical trial is to translate the NCCN Cancer-Related Fatigue Clinical Practice Guidelines in Oncology and NCCN Adult Cancer Pain Clinical Practice Guidelines in Oncology into practice and develop a translational interventional model that can be replicated across settings. This article focuses on one NCCN member institution's experience related to the first phase of the NCCN Cancer-Related Fatigue Guidelines implementation, describing usual care compared with evidence-based guidelines. Phase 1 of this 3-phased clinical trial compared the usual care of fatigue with that administered according to the NCCN guidelines. Eligibility criteria included age 18 years or older; English-speaking; diagnosed with breast, lung, colon, or prostate cancer; and fatigue and/or pain ratings of 4 or more on a 0 to 10 screening scale. Research nurses screened all available subjects in a cancer center medical oncology clinic to identify those meeting these criteria. Instruments included the Piper Fatigue Scale, a Fatigue Barriers Scale, a Fatigue Knowledge Scale, and a Fatigue Chart Audit Tool. Descriptive and inferential statistics were used in data analysis. At baseline, 45 patients had fatigue only (> or = 4) and 24 had both fatigue and pain (> or = 4). This combined sample (N = 69) was predominantly Caucasian (65%), female (63%), an average of 60 years old, diagnosed with stage 3 or 4 breast cancer, and undergoing treatment (82%). The most common barriers noted were patients' belief that physicians would introduce the subject of fatigue if it was important (patient barrier); lack of fatigue documentation (professional barrier); and lack of supportive care referrals (system barrier). Findings showed several patient, professional, and system barriers that distinguish usual care from that recommended by the NCCN Cancer-Related Fatigue Guidelines. Phase 2, the intervention model, is designed to decrease these barriers and improve patient outcomes over time, and is in progress.

Download full-text

Full-text

Available from: Tami Borneman, Aug 08, 2015
0 Followers
 · 
110 Views
  • Source
    • "Reducing cancer-associated fatigue and fatigue associated with cancer therapy are now considered important therapeutic goals. Psychological, physical, pharmaceutical and nutraceutical methods have been undertaken to reduce fatigue and improve the quality of life of cancer patients (Borneman et al., 2007; Escalante et al., 2011; Nicolson, 2010). These treatments are based on suppressing fatigue but also on controlling co-morbid or related symptoms, such as pain, anemia, cachexia, sleep disorders, depression and other symptoms (Escalante et al., 2011; Mustian et al., 2007; Nicolson, 2010; Ryan et al., 2007; Watson & Mock, 2004; Zee & Acoli-Isreal, 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Nutritional supplements have been used in a variety of diseases to provide patients with a natural, safe alternative to pharmacological drugs. In patients with cancer nutritional supplements are often used for specific purposes or to improve quality of life. For example, cancer-associated fatigue is one of the most common symptoms in all forms and stages of cancer, but few patients receive assistance for their fatigue. Cancer-associated fatigue is associated with cellular oxidative stress, and during cancer therapy excess drug-induced oxidative stress can cause a number of adverse effects, including: fatigue, nausea, vomiting and more serious effects. Cancer-associated fatigue and the adverse effects of cancer therapy can be reduced with Lipid Replacement Therapy, a natural lipid supplement formulation that replaces damaged membrane lipids along with providing antioxidants and enzymatic cofactors. Administering dietary Lipid Replacement Therapy can reduce oxidative membrane damage and restore mitochondrial and other cellular functions. Recent clinical trials using cancer and non-cancer patients with chronic fatigue have shown the benefits of specific Lipid Replacement Therapy nutritional lipid supplements in reducing fatigue and restoring mitochondrial function
    Topics in Cancer Survivorship Vol.2, 01/2012: chapter 10: pages 1-18; , ISBN: ISBN 978-953-307-894-6
    • "f patients are depressed / anxious and tired even when their disease is inactive , we could understand that it is difficult for them to cope with their changing medical conditions ( Lix et al . , 2008 ) . Future studies should involve an occasional and a longitudinal study as done on fatigue in cancer patients ( Bardwell & Ancoli - Israel , 2008 ; Borneman et al . , 2007 ; National Institute of Health State - of - the - Science Panel , 2004 ) . As Detweiler - Bedell et al . ( 2008 ) suggest future research must verify the different possible configurations between depression , anxiety , sleep quality , disease , and fatigue . Such settings should consider depression and disease as comorbidity and with ov"
    [Show abstract] [Hide abstract]
    ABSTRACT: Fatigue in Crohn's disease (CD) is considered as a consequence of the disease and its treatment. If research showed the impact of the activity of the disease on vitality, patients can express fatigue even if the disease is inactive. Sleep disturbances are now considered in inflammatory bowel disease (IBD) and they could be involved in fatigue. It is well-known that depression and anxiety occur in IBD: They involve sleep disturbances and asthenia. But neither factors have been assessed simultaneously from a longitudinal perspective. Fifty-two patients participated in this study. Fatigue (MFI), depression (HAD-D), anxiety (HAD-A), sleep disturbances (ISI, IQPS), subjective quality of life (Mos-SF36) and activity of the disease (CDAI) were assessed twice with a one-year interval. Results showed constancy in fatigue and the mental health state. Moreover, if depression, anxiety, quality of life, and fatigue followed the same course of activity of the disease only during one visit, CDAI did not correlate with these dimensions between visits. CDAI only prognosticated insomnia. These results suggest that fatigue and poor quality of life may be primarily linked to depression in a secondary context of CD.
    Psychology Health and Medicine 08/2010; 15(4):394-405. DOI:10.1080/13548501003759155 · 1.53 Impact Factor
  • Source
Show more