BETHESDA, Maryland—Labeling the treatment of pain, depression, and fatigue in many cancer patients inadequate, a National Institutes of Health (NIH) state-of-the-science panel has called for optimal symptom control for all cancer patients from diagnosis and throughout their illness. It also called for escalated funding to support research on the definition, occurrence, assessment, and treatment of all three problems.
"Currently, cancer-related pain, depression, and fatigue are undertreated, and this situation is simply unacceptable," said chair Donald L. Patrick, PhD, MSPH, professor and director of the Social and Behavioral Sciences Program, Department of Health Services, University of Washington, Seattle. "There are effective strategies to manage these symptoms, and all patients should have optimal symptom control."
The 13-member panel spent 2 days listening to expert testimony and drafting a statement. It released its final report on the third day of the conference after hearing public comments on the draft. Although sponsored by the National Cancer Institute and NIH’s Office of Medical Applications of Research, and co-sponsored by six other NIH units and the FDA, the panel was an independent body, and its statement does not represent NIH or federal policy.
In its report, the panel addressed five issues—occurrence, the reliability and validity of methods for clinical assessment, the effectiveness of treatments, impediments to effective symptom management, and future directions for research.
With regard to the occurrence of pain, depression, and fatigue, "published studies on all three symptoms are virtually restricted to prevalence data; there are no reliable incidence studies," the report said. Prevalence studies estimate a range of 14% to 100% for pain, 1% to 42% for depression, and 4% to 91% for fatigue. The estimates’ lack of consistency stems from both conceptualization and measurement problems, and weaknesses in research methodology, the panel said.
Assessment
Most clinical assessments of pain, depression, and fatigue rely on self-reporting by patients, who do the best job of assessing the severity of their own symptoms, but the sickest patients often cannot complete symptom questionnaires. Although a number of assessment tools exist, only a few assess all three symptoms simultaneously.
