Exploring the Use of Two Brief Fatigue Screening Tools in Cancer Outpatient Clinics

Abstract

Purpose: Cancer fatigue guidelines recommend routine fatigue screening, with further assessment for people reporting moderate to severe fatigue. There is neither a gold-standard, nor a broadly accepted screening method, and knowledge about the impact of screening on care processes is limited. This study aimed to explore the feasibility of 2 fatigue screening methods and current clinical practice in cancer outpatient clinics. Methods: Hospital outpatients attending cancer clinics during 1 week completed a five-item survey: a numeric scale for current tiredness, 2 categorical pictorial scales rating tiredness last week and the impact of fatigue (Fatigue Pictogram), screening tool preference and help needed for survey completion. Participant demographics and fatigue documentation by clinical staff for that appointment were extracted from medical records. Analyses used descriptive statistics. Groups were compared using appropriate statistical tests. Results: Over 75% of participants rated their fatigue consistently as mild or significant on both screening tools. Of 1709 eligible outpatients, 533 (31%) completed the survey. Records were audited for 430 (81%) identifiable participants. Over half of the participants reported moderate or severe tiredness either “now” (237, 57%) and/or “last week” (226, 53%). Clinician documentation of fatigue seldom matched self-reports. Fatigue was rated as severe by 103 participants (24%), yet was noted in only 21 (20%) of these individuals’ clinical notes. Both screening tools were equally preferred. Conclusion: The numeric rating scale and Fatigue Pictogram are equally applicable for screening fatigue in cancer outpatient care. There is a high prevalence of clinically significant fatigue in a hospital outpatient setting that is not documented. Adequate care pathways for further management should be established alongside fatigue screening.

Providing the basis for a patient-centred and effective screening for cancer-related fatigue (MERLIN study): design of a longitudinal observational study

“…Another study evaluated the ease of use of a Numerical Rating Scale (NRS) and a Fatigue Pictogram in cancer outpatient care. 15 Although the results of this study showed that both screening programmes are equally applicable in practice, it remains an open question which time points and time intervals are most appropriate for screening of CRF. The European Society for Medical Oncology-guidelines have no definite, strict recommendation but suggest a quantitative scale, such as an NRS ranging from 0 to 10 with a cut-off ≥4.…”

“…Here, it still remains unclear if the results are generalisable to other patients with cancer undergoing different treatments and if these assessment tools are feasible in clinical practice. Another study evaluated the ease of use of a Numerical Rating Scale (NRS) and a Fatigue Pictogram in cancer outpatient care 15. Although the results of this study showed that both screening programmes are equally applicable in practice, it remains an open question which time points and time intervals are most appropriate for screening of CRF.…”

The influence of chemotherapy on nutritional status and oncological fatigue in cancer patients: Cross-sectional study

“…The two questions that make up the Fatigue Pictogram were divided into Pictogram A for the first question and Pictogram B for the second question, being grouped and classified as follows: "not at all tired " for "no fatigue"; "a little bit tired" for "mild fatigue"; "somewhat tired" and "moderately tired" for "moderate fatigue"; "extremely tired" for "extreme fatigue". The second item was grouped as follows: "I can do everything I normally do" for "no fatigue"; "I can do almost everything I normally do" for "mild fatigue"; "I can do some the things I normally do" for "moderate fatigue"; and finally "I do what I have to do" and "I can do very little" for "severe fatigue" 12 .…”