A New Approach to Understanding Cancer-Related Fatigue: Leveraging the 3P Model to Facilitate Risk Prediction and Clinical Care

Sleight, Alix G.; Crowder, Sylvia L.; Skarbinski, Jacek; Coen, Paul M.; Parker, Nathan H.; Hoogland, Aasha I.; Gonzalez, Brian D.; Playdon, Mary C.; Cole, Steven W.; Ose, Jennifer; Murayama, Yuichi; Siegel, Erin M.; Figueiredo, Jane C.; Jim, Heather

doi:10.3390/cancers14081982

Cited by 24 publications

(17 citation statements)

References 167 publications

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“…Drugs such as methylphenidate [43, 44] and interventions such as cognitive behavioural therapy [45, 46] have been shown to improve fatigue in cancer patients and survivors and help them achieve the best possible quality of life after CRC diagnosis. Early implementation of evidence‐based fatigue management strategies and care options will benefit patients during and after cancer therapy [47–50]. Our findings, along with the existing evidence [8, 37, 51], are in accordance with guidelines from the National Comprehensive Cancer Network that call for initiating early screening for fatigue and continual monitoring of fatigue until treatment completion.…”

Section: Discussionsupporting

confidence: 82%

Trajectories and risk factors of fatigue following colorectal cancer diagnosis

Li,

Hoogland,

Small

et al. 2023

Colorectal Disease

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AimThis study sought to identify groups of colorectal cancer patients based upon trajectories of fatigue and examine how demographic, clinical and behavioural risk factors differentiate these groups.MethodPatients were from six cancer centres in the United States and Germany. Fatigue was measured using the fatigue subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‐C30) at five time points (baseline/enrolment and 3, 6, 12 and 24 months after diagnosis). Piecewise growth mixture models identified latent trajectories of fatigue. Logistic regression models examined differences in demographic, clinical and behavioural characteristics between fatigue trajectory groups.ResultsAmong 1615 participants (57% men, 86% non‐Hispanic White, mean age 61 ± 13 years at diagnosis), three distinct groups were identified. In the high fatigue group (36%), fatigue significantly increased in the first 6 months after diagnosis and then showed statistically and clinically significant improvement from 6 to 24 months (P values < 0.01). Throughout the study period, average fatigue met or exceeded cutoffs for clinical significance. In the moderate (34%) and low (30%) fatigue groups, fatigue levels remained below or near population norms across the study period. Patients who were diagnosed with Stage II−IV disease and/or current smokers were more likely to be in the high fatigue than in the moderate fatigue group (P values < 0.05).ConclusionA large proportion of colorectal cancer patients experienced sustained fatigue after initiation of cancer treatment. Patients with high fatigue at the time of diagnosis may benefit from early supportive care.

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Section: Discussionsupporting

confidence: 82%

Trajectories and risk factors of fatigue following colorectal cancer diagnosis

Li,

Hoogland,

Small

et al. 2023

Colorectal Disease

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“…In this model, we follow a recently proposed principle of segregating factors associated with complex symptoms into that which pre-disposes one to experience fatigue, factors that are essential for experience of fatigue (precipitating factors), and those that perpetuate fatigue. 84 While outside the scope of this paper, there are several known pre-disposing factors associated with PSF 19,85 which are included in the model, and discussed in the SRRR paper. The essential conditions for development of PSF start with high levels of inflammation setting into motion changes in innate immune response and changes in metabolic pathways.…”

Section: A Unifying Model Of Fatiguementioning

confidence: 99%

Mechanisms of Post-Stroke Fatigue: A Follow-Up From the Third Stroke Recovery and Rehabilitation Roundtable

Kuppuswamy,

Billinger,

Coupland

et al. 2023

Neurorehabil Neural Repair

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Background Post-stroke fatigue (PSF) is a significant and highly prevalent symptom, whose mechanisms are poorly understood. The third Stroke Recovery and Rehabilitation Roundtable paper on PSF focussed primarily on defining and measuring PSF while mechanisms were briefly discussed. This companion paper to the main paper is aimed at elaborating possible mechanisms of PSF. Methods This paper reviews the available evidence that potentially explains the pathophysiology of PSF and draws parallels from fatigue literature in other conditions. We start by proposing a case for phenotyping PSF based on structural, functional, and behavioral characteristics of PSF. This is followed by discussion of a potentially significant role of early inflammation in the development of fatigue, specifically the impact of low-grade inflammation and its long-term systemic effects resulting in PSF. Of the many neurotransmitter systems in the brain, the dopaminergic systems have the most evidence for a role in PSF, along with a role in sensorimotor processing. Sensorimotor neural network dynamics are compromised as highlighted by evidence from both neurostimulation and neuromodulation studies. The double-edged sword effect of exercise on PSF provides further insight into how PSF might emerge and the importance of carefully titrating interventional paradigms. Conclusion The paper concludes by synthesizing the presented evidence into a unifying model of fatigue which distinguishes between factors that pre-dispose, precipitate, and perpetuate PSF. This framework will help guide new research into the biological mechanisms of PSF which is a necessary prerequisite for developing treatments to mitigate the debilitating effects of post-stroke fatigue.

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“…The review should compare fatigue definitions, assessment methods, key mechanisms, common themes on treatment, and future directions. The 3 P's model, factors that predispose, precipitate, and perpetuate fatigue, was agreed to provide a useful overarching framework (Sleight et al, 2022). Second, results of the scoping review could be used to construct a core outcome set of items to be used in fatigue phenotyping.…”

Section: Topic 4: Phenotypingmentioning

confidence: 99%

Fatigue as an Understudied Barrier to Participation in Life Roles

Poole

Murphy

Foster

et al. 2023

OTJR: Occupational Therapy Journal of Research

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Fatigue is one of the most burdensome and disabling symptoms in numerous acute and chronic conditions and is associated with reduced participation in all aspects of daily life, for example, parenting, employment, and socialization. Historically, occupational practitioners played key roles in fatigue management by creating and implementing interventions. The American Occupational Therapy Foundation convened a Planning Grant Collective workshop with the goal to develop collaborative research ideas and proposals to advance the understanding and management of fatigue. Participants from occupational therapy and other disciplines, with expertise with fatigue or who were conducting research on fatigue, participated in a 3-day virtual workshop. Four main topics emerged: implementation science, treatment taxonomy, trial design and comparative effectiveness, and phenotyping. This white paper describes the proceedings, summarizes the discussions, and outlines recommendations from the PGC workshop on fatigue.

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A New Approach to Understanding Cancer-Related Fatigue: Leveraging the 3P Model to Facilitate Risk Prediction and Clinical Care

Cited by 24 publications

References 167 publications

Trajectories and risk factors of fatigue following colorectal cancer diagnosis

Trajectories and risk factors of fatigue following colorectal cancer diagnosis

Mechanisms of Post-Stroke Fatigue: A Follow-Up From the Third Stroke Recovery and Rehabilitation Roundtable

Fatigue as an Understudied Barrier to Participation in Life Roles

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