Cancer-Related Fatigue Screening
In this episode of Kessler Foundation's podcast, Linda K. Schmidt, nurse clinician, John Theurer Cancer Center, Hackensack University Medical Center, discusses cancer related fatigue screening. Cancer-related fatigue is the most common side effect of cancer treatment. Being able to accurately screen will improve access to multi-disciplinary interventions.
This is part 2 of a five part series. Listen to the series as it's posted.
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Below is an excerpt from Dr. Schmidt’s lecture.
Linda Schmidt: Cancer screening, you have to recognize the importance of screening for compliance, quality, and value-based care, recognize the role of multi-disciplinary team and screening for cancer-related fatigue, and identify the tools for the use of screening in fatigue and introduce clinical practice guidelines for screening. Fatigue is a subjective experience that should be systematically assessed using self-reporting in other sources of data. How do we measure and make evidence-based interventions if this is a subjective experience? We need objective data. Cancer-related fatigue is the most common side effect of cancer treatment. Being able to accurately screen will improve access to multi-disciplinary interventions.
Chronic Symptoms
These are the most common symptoms of chronic cancer-related fatigue. We have stress, attention deficit, mental fatigue, nausea, short-term memory loss, physical pain, lack of concentration, and physical fatigue. Screening for the treatment of cancer-related fatigue during therapy and during the period of cancer survivorship has become a major focus for supportive care in oncology and is the subject of guidelines from several expert groups, including ASCO, The American Society of Clinical Oncologists, and the NCCN. We also have formal diagnostic criteria outlined as the ICD code 10 are not wide-spread used. But I use the ICD code R53.83, that's fatigue, quite often in my practice to help us get the referrals that we need to make you guys happen. Patients do not necessarily need to have a minimum number of criteria to receive a clinical diagnosis of cancer-related fatigue and their use is not recommended in guidelines for screening and assessment for cancer-related fatigue from expert groups, including the NCCN Network. So how do we screen? Patients should be screened for the presence of the severity of fatigue at their initial clinical visit at regular intervals during and following cancer treatment. And as clinically indicated, this should be happening every time you see the patient. That patient could be just walking down the hallway and your eyes have to be on.
Screening of Patient’s Assessment and Management
We look at what is the patient doing, how are they managing their medicines, when are they taking their medications, when is their fatigue happening. Is it in the morning, is it in the afternoon? Are they sleeping? Are they not sleeping? Can they exercise? Are they exercising? When are they exercising? And sleeping is another issue because many of our patients don't know when to sleep, how to sleep or is it their sleep restful, have they earn their sleep is really important for their quality of life. And that's what we are working on right now because since cancer is a chronic disease, people are living longer. In 1984, I lost a lot of young men to testicular cancer and now it's curable. And I still get-- I just got a Christmas card, last Christmas, to a gentleman I took care of in 1984 who's now a grandfather. So here we are, somebody who's living with cancer for decades now. Okay. So we now have the focus history. We have a disease status and treatment. Now, understand you have the patients that are being diagnosed, initial diagnosis, you also have them during their treatment, during their induction therapy, during their consolidated therapy, during their relapse therapy, and their chronic therapy.
It's not unusual for patients to have not just one line of therapy, to 15 lines of therapy over a course of five years, three years, and 25 years. So we have to keep focused all the time on what is their disease status and their treatment plan. We have to do the review of their systems, in depth fatigue history, the onset, the pattern of duration, change over time, associated alleviating factors, impact on function, their social support and caregivers. Do they have one? Do they have a family member? Do they have a significant other? Do they have the support of a community? Are they a member of a support group? I'm also the medical liaison for the myeloma support group. Do they have somebody that can help them get through the treatment plan or during the course of the disease, whether it's initial diagnosis, in remission, out of remission, end of life? Also their economic status and their resources that they use for support. Money is a big issue. Medication. Lenalidomide is $14,000 a month. So if you have somebody who's on this for 100 cycles, that's $14,000 a month if they don't have insurance. But if they do have insurance, they have copay. So it puts a big burden on their family.
Cancer is a chronic disease
Cancer is a chronic disease. There's a disparity between what patients want to do and what they're able to do. We need to utilize a subjective NCCN fatigue scale, compare with each visit, and document the findings. That's just really important so we know did it make a difference? Because we need to make a difference. Ask questions, assess responses, and develop interventions for every patient. Nobody's going to be the same but we can make things a little bit better. Document the findings. So evaluate findings and make changes, advise patients to journal patient symptoms. That's really important. Again, cancer is a chronic disease with fatigue affecting quality of life for patients and their families because we're living with these disease. We don't die of it, we live with it. And that's just basically it but thank you very much.
