Congress Abstracts 2004

46

USING CLINICAL PRACTICE GUIDELINES TO MANAGE CANCER-RELATED FATIGUE: WHERE ARE WE? Victoria Mock, DNSc, AOCN^®, Johns Hopkins University School of Nursing, Baltimore, MD.

Fatigue affects 70%–100% of patients with cancer and is the most prevalent symptom reported. Patients perceive fatigue to be the most distressing symptom associated with cancer and its treatment and a significant source of decreased in quality of life. Although practice guidelines for managing cancer-related fatigue (CRF) have been published, fatigue remains under-reported, under-diagnosed, and under-treated. Oncology nurses can improve the care of patients with CRF by implementing evidence-based practice guidelines.

The purpose of this presentation is to describe the 2003 National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Cancer-Related Fatigue from screening to intervention and evaluation, including the evidence base upon which the guidelines are based.

The NCCN Clinical Practice Guidelines for CRF were developed by an interdisciplinary panel of experts on fatigue, including oncology nurse researchers and clinicians. The guidelines present a definition of CRF, standards of care for management, and specific clinical approaches to screening, evaluation, and management. Interventions for management are specific to three categories of patient clinical status: Patients on active treatment, disease-free patients on long-term follow-up, and patients at the end of life. Case studies will be used to illustrate management of CRF in the three clinical status categories. Research, including the contribution of nursing research, to support the guidelines will be reviewed.

The presentation will give specific criteria for evaluation of the effectiveness of interventions for CRF and discuss appropriate next steps for oncology nurses when CRF is not resolved. An evaluation of the state of the science that supports the guidelines and the status of evaluation of the guidelines’ effectiveness will be discussed.

Clinical practice guidelines represent the strongest evidence available to guide clinical care of patients. The NCCN Clinical Practice Guidelines for management of CRF are a powerful tool that oncology nurses can use to manage this distressing symptom and improve the quality of life of patients with cancer.