Congress Abstracts 2005

31

COLLABORATING TO IMPROVE CANCER-RELATED FATIGUE: A MULTIDISCIPLINARY THORACIC ONCOLOGY TEAM IMPLEMENTS THE NCCN GUIDELINES FOR SCREENING CANCER-RELATED FATIGUE IN THE AMBULATORY SETTING. Barbara Cashavelly, MSN, RN, AOCN^®, Jennifer Temel, MD, and William Pirl, MD, Massachusetts General Hospital, Boston, MA.

Advanced lung cancer patients experience a very high symptom burden due to the extensive disease at the time of diagnosis. Cancer related-fatigue is the most commonly reported symptom in this patient population. Despite the prevalence of cancer-related fatigue in the lung cancer population, clinicians report that routine screening for fatigue is neglected. As a result, cancer-related fatigue is an under reported, under-diagnosed and under-treated symptom. Routine fatigue screening, documentation, assessment and management of fatigue can ensure that patients with fatigue are identified and treated effectively. Systematic and structured symptom assessment has been shown to decrease symptom distress in nursing interventions.

The purpose of this project is to implement and integrate the NCCN Practice Guidelines for cancer-related fatigue screening and to also determine the fatigue levels in the Thoracic Oncology population. The problem of inadequate screening, assessment, documentation and management of cancer-related fatigue was identified through a cursory review of medical records and at multidisciplinary team meetings. Fatigue screening and assessment were not standardized across the practice setting. This presented an opportunity to implement the NCCN guidelines for screening cancer-related fatigue and to determine the prevalence of fatigue in the Thoracic Oncology ambulatory practice.

Interventions included screening all thoracic oncology patients for fatigue in the ambulatory practice setting during each patient visit. A quantitative 0–10 fatigue rating scale was used to obtain the rating. The screening method needed to be rapid, practical and clinically meaningful. Medical assistants were educated and in-serviced on cancer-related fatigue and were instructed on how to obtain the self-reported fatigue rating from the patient. Fatigue ratings were collected on each patient encounter for 3 months. Each rating was entered into a database and documented in the patient’s electronic medical record.

The data collected from this project will be used to determine the feasibility of routine fatigue screening according to the NCCN Guidelines in the practice setting. The overall fatigue levels in the Thoracic Oncology practice will be determined and evaluated.

Management of cancer-related fatigue begins with the initial screening. Implementing the NCCN Guidelines for cancer-related fatigue screening in the clinical setting can enhance clinician awareness, assessment and management of cancer-related fatigue.