HOUSTON—Using subjective complaints reported by patients as a basis for treatment is new, "in a sense revolutionary," said Charles S. Cleeland, PhD, and worth pursuing. Well-established pain measurement scales can be used as a model to assess multiple symptoms, including fatigue, among cancer patients and identify moderate to severe levels of symptoms that might warrant intervention, he explained. Dr. Cleeland is McCullough Professor of Cancer Research at the University of Texas M.D. Anderson Cancer Center in Houston.

"Fatigue nests within a much larger set of cancer-related symptoms," he said. "These symptoms are present not only for weeks but often months," and "many symptoms such as fatigue persist dramatically after therapy."

Dr. Cleeland introduced the concept of "symptom burden," although he did not coin the term. Symptom burden is defined as "the combined impact of all the symptoms (related to disease or therapy) on the ability of persons to function as they did prior to the onset of the disease and/or therapy."

What’s Driving Demand?

"We’re in an era where there is an increasing demand for better symptom control," Dr. Cleeland said. Media coverage has increased awareness of symptom control and "more knowledgeable and demanding consumers are asking for broad symptom control, and specifically for fatigue."

The federal government also promotes the concept. Just last year, the Institute of Medicine called for quality of life and symptom control to be high priority issues. Dr. Cleeland acknowledged the public policy aspects of symptom control. "The cost of treatment for the symptom must be balanced by improved function and comfort and be supported by those who pay for such treatments," he noted (see Table 1).

Pain as a Model