Cancer Symptom Science: On the Mechanisms underlying the Expression of Cancer-related Symptoms
Reporter: Aviva Lev-Ari, PhD, RN
Symptom Research Hosts Panel on Developing Strategies for Reducing Cancer Treatment-Related Toxicities and Symptoms
There is little recognition of the large numbers of patients and survivors who are affected by severe symptoms, and insufficient industry interest in developing and testing agents that can address these problems. In contrast to the rapid progress in curative therapies, little systematic research is being conducted on the mechanisms that cause treatment-related symptoms, developing and exploiting preclinical animal models of these symptoms, phase 1-2 studies of symptom prevention and management, or developing an evidence base for new and existing symptom-focused interventions through the clinical trials groups.
In March 2011, the Department of Symptom Research and the Friends of Cancer Research convened stakeholders in cancer research, industry, regulation, and advocacy to identify the challenges that have prevented progress in reducing treatment-related symptom burden, to develop a list of strategic steps to meet these challenges, and to develop a white paper to identify how to implement these steps.
Cancer Symptom Science: Measurement, Mechanisms, and Management
Edited by Charles S. Cleeland, Michael J. Fisch, and Adrian J. Dunn
Cancer Symptom Science is the first interdisciplinary compilation of research on the mechanisms underlying the expression of cancer-related symptoms. It presents innovations in clinical, animal and in vitro research, research methods in brain imaging, and statistical-descriptive approaches to understanding the mechanistic basis of symptom expression. It also provides perspectives from patients, government and industry. By collecting and synthesizing the developing threads of new approaches to understanding cancer-related symptoms, the book promotes a pioneering framework for merging behavioral and biological disciplines to clarify mechanisms of symptom evolution, incorporating new technologies, testing novel agents for symptom control, and improving patient functioning and quality of life both during and after cancer treatment.
The editorial team includes MD Anderson faculty Charles Cleeland, PhD, chair of the Department of Symptom Research and Michael Fisch, MD, MPH, chair of the Department of General Oncology; and Adrian Dunn, PhD, of The University of Hawaii at Manoa. The book is targeted toward surgical, clinical and medical oncologists, nurses, academic researchers, fellows and nursing students, and pharmaceutical companies developing new agents to control symptom expression.
Cancer Symptom Science is available from Cambridge University Press and at bookstores online.
MD Anderson Publications Focus on Symptom Research
All links will open a PDF document.
- The Final Marker is the Patient (Conquest, Fall 2012)
- Old Drugs, New Possibilities (Conquest, Fall 2008)
- Symptom Research Awarded NIH P01 Grant (Division of Internal Medicine Newsletter, Summer 2008)
- Symptom Research and Psychometrics (Network, Summer 2008)
- Bridging the Divide: A New Dawn For Cancer Research (Conquest, Summer 2008)
- Steps to Validation (Conquest, Spring 2008)
- Surviving Cancer, Living With Pain? A New Dawn for Cancer Research(Network, Spring 2008)
- Survivorship Issues: A Nurse’s Dissertation, a tool for determining hearth health(Network, Winter 2008)
- Measuring the immeasurable: Symptom distress and lung cancer (Network, Fall 2007)
- Symptom Research: Measuring the Immeasurable (Conquest, Fall 2007)
- Assessing Symptom Distress: It’s All About the Patient (Conquest, Summer 2007)
- Survivorship Issues: New Tools for Assessing Symptom Distress (Network, Summer 2007)
- Assessing Symptom Distress (Network, Spring 2007)
- Surviving Survival: The Symptom Burden of Cancer and Cancer Treatment(Network, Summer 2006)
Resources & Links
Clinical Tools
Research Tools
Robert Coghill’s “Brain Mechanisms of Pain”
Texas Cancer Information
View More
Symptom Assessment Tools
Brief Pain Inventory | M. D. Anderson Symptom Inventory | Brief Fatigue Inventory
A symptom is a sensation or perception of change related to health function experienced by an individual. Symptoms, such as fatigue, pain and nausea, may be classified based on their severity and perceived impact on function. Symptoms add to the burden of having a chronic disease, such as cancer, and affect virtually all aspects of life. They interfere with a person’s mood, level of activity and ability to relate to others.
The study of symptoms has consisted primarily of descriptive studies of self-report from patients at specific stages of specific types of cancer. Such patient-reported outcomes (PROs) have been recognized by the US Food and Drug Administration as legitimate primary outcome variables for clinical trials.
The Department of Symptom Research has been working since 1979 to design PRO assessment tools for symptoms experienced by cancer patients to determine their severity, and how they affect quality of life.
The Brief Pain Inventory (BPI)
The Brief Pain Inventory (BPI) was developed in 1989 by Dr. Charles Cleeland for rapid assessment of the severity and impact of pain in cancer patients. The BPI has since been translated into more than three dozen languages, and is widely used in both research and clinical settings.
A BPI User’s Guide addressing FDA requirements for use of patient-reported outcomes in clinical trials is now available.
The M. D. Anderson Symptom Inventory (MDASI)
The M. D. Anderson Symptom Inventory (MDASI) is used to assess multiple symptoms experienced by cancer patients and the interference with daily living caused by these symptoms. The MDASI is available in both paper-and-pencil and interactive voice response (IVR) formats, both of which are equally effective.
A MDASI User’s Guide addressing FDA requirements for use of patient-reported outcomes in clinical trials is now available.
The MDASI-IVR combines the use of touch-tone telephones with computers and the Internet to follow symptoms while the patient is away from the hospital. The MDASI-IVR offers several benefits: (1) missing data are minimized, especially in longitudinal studies; (2) the IVR provides more accurate real-time symptom assessment data at expected time points; and (3) the availability of immediate feedback through the IVR system could allow caregivers to address severe symptoms more effectively.
The Brief Fatigue Inventory (BFI)
The Brief Fatigue Inventory (BFI) is used to rapidly assess the severity and impact of cancer-related fatigue. An increasing focus on cancer-related fatigue emphasized the need for sensitive tools to assess this most frequently reported symptom. The six inventory items correlate with standard quality-of-life measures.
Ease of Use and Readability
Our symptom assessment tools are understandable even by grade-school children, according to the Flesch scoring systems described below.
Flesch Reading Ease score: Rates text on a 100-point scale; the higher the score, the easier it is to understand the document. Most standard documents aim for a score of approximately 60 to 70.
Flesch-Kincaid Grade Level score: Rates text on a U.S. grade-school level. For example, a score of 8.0 means that an eighth grader can understand the document. Most standard documents aim for a score of approximately 7.0 to 8.0.
| Flesch Reading Ease | Flesch-Kincaid Grade Level | |
|---|---|---|
| BPI (short form) | 83.5 | 5.1 |
| BFI | 70.7 | 6.4 |
| MDASI | 82.3 | 3.6 |
The simplicity of the tools facilitates cross-cultural studies of pain and other patient-reported cancer-related symptoms. Validation studies have not been conducted using our assessment tools in the pediatric population, aged 18 years and younger.
Related News
Symptom Research hosts national colloquium on developing strategies for reducing cancer treatment-related toxicities and symptoms. Read more…
Announcing the publication of Cancer Symptom Science, an interdisciplinary, first-of-its-kind compilation of research on the mechanisms underlying the expression of cancer-related symptoms. Read more…
Old Drugs, New Possibilities (Conquest, Fall 2008)
Symptom Research Awarded NIH P01 Grant (Division of Internal Medicine Newsletter, Summer 2008)
Symptom Research and Psychometrics(Network, Summer 2008)
Clinical Tools
Research Tools
Robert Coghill’s “Brain Mechanisms of Pain”
Texas Cancer Information
View More
Michael J. Fisch, MD, MPH, FACP, FAAHPM |
Present Title & Affiliation
Primary Appointment
Bio Statement
Michael J. Fisch, MD, MPH, is Professor and Chair of the Department of General Oncology and Medical Director of the Community Clinical Oncology Program in the Division of Cancer Medicine at the University of Texas MD Anderson Cancer Center in Houston, TX. He earned his MD from the University of Virginia School of Medicine and his master’s in Public Health from Indiana University in Bloomington, IN. He completed a residency in Internal Medicine at University of Virginia and fellowships in Hematology/Oncology and general internal medicine (Health Services Research) at Indiana University. He is board certified in Internal Medicine, Medical Oncology, and Hospice and Palliative Medicine. Dr. Fisch is a fellow of both the American College of Physicians and the American Academy of Hospice and Palliative Medicine.
Dr. Fisch’s research interests include palliative care, symptom management, and health care disparities. He has been published in the Journal of Clinical Oncology, the Journal of the National Cancer Institute, and numerous other peer-reviewed journals. He has also authored or co-authored several book chapters and books and serves as Editor in Chief for the Journal of Supportive Oncology. He has been an invited speaker at many national and international conferences. He is an active blogger for the American Society of Clinical Oncology (ASCO) and for MD Anderson, and he is active on twitter as @fischmd. Dr. Fisch is currently the Chair of the Symptom Management Committee of ECOG-ACRIN and Co-Chair of the Symptom Management and Quality of Life Steering Committee for the National Cancer Institute.
Education & Training
Degree-Granting Education |
|
| 1997 | Indiana University, Bloomington, IN, MPH, Health Education |
| 1990 | University of Virginia, Charlottesville, VA, MD, Clinical Medicine |
Board Certifications
| 1/2008 | ABIM Hospice and Palliative Medicine |
| 1/2003 | American Board of Hospice and Palliative Medicine |
| 1/1997 | Medical Oncology |
| 1/1993 | Internal Medicine |
Selected Publications
Peer-Reviewed Original Research Articles |
|
| 1. | Parker PA, Urbauer D, Fisch MJ, Fellman B, Hough H, Miller J, Lanzotti V, Whisnant M, Weiss M, Fellenz L, Bury M, Kokx P, Finn K, Daily M, Cohen L. A Multi-Site, Community Oncology-Based Randomized Trial of a Brief Educational Intervention to Increase Communication Regarding Complementary and Alternative Medicine. Cancer, 7/2013. e-Pub 9/2013. NIHMSID: NIHMS494226. |
| 2. | Mendoza TR, Zhao F, Cleeland CS, Wagner LI, Patrick-Miller LJ, Fisch MJ. The Validity and Utility of the M.D. Anderson Symptom Inventory in Patients with Breast Cancer: Evidence From The Symptom Outcomes and Practice Patterns Data From the Eastern Cooperative Oncology Group. Clin Breast Cancer. e-Pub 6/2013. PMCID: PMC3775936. |
| 3. | Cruciani RA, Zhang JJ, Manola J, Cella D, Ansari B, Fisch MJ. L-Carnitine Supplementation for the Management of Fatigue in Patients With Cancer: An Eastern Cooperative Oncology Group Phase III, Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Oncol 30(31):3864-9, http://www.ncbi.nlm.nih.gov/pubmed/22987089, 11/2012. PMCID: PMC3478577. |
| 4. | Dizon D, Graham D, Thompson M, Johnson L, Johnston C, Fisch M, Miller R. Practical Guidance: The Use of Social Media in Oncology Practice. J Oncol Pract 8(5):114-24, 9/2012. e-Pub 7/2012. PMCID: PMC3439237. |
| 5. | Hwang JP, Fisch MJ, Zhang H, Kallen MA, Routbort MJ, Lal L, Vierling JM, Suarez-Almazor ME. Low rates of hepatitis B virus screening at the onset of chemotherapy. J Oncol Pract 8(4):32-9, 7/2012. e-Pub 6/2012. PMCID: PMC3396827. |
| 6. | Lal LS, Zhuang A, Hung F, Feng C, Arbuckle R, Fisch MJ. Evaluation of drug interactions in patients treated with antidepressants at a tertiary care cancer center. Support Care Cancer 20(5):983-9, 5/2012. e-Pub 4/2011. PMID: 21519946. |
| 7. | Fisch MJ, Lee JW, Weiss M, Wagner LI, Chang VT, Cella D, Manola JB, Minasian LM, McCaskill-Stevens W, Mendoza TR, Cleeland CS. Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol, 4/2012. PMCID: PMC3383175. |
| 8. | Ritchie CS, Kvale E, Fisch MJ. Multimorbidity: an issue of growing importance for oncologists. J Oncol Pract 7(37):371-4, 2011. PMCID: PMC3219463. |
Abstracts |
|
| 1. | Tevaarwerk AJ, Lee JW, Sesto ME, Buhr KA, Cleeland CS, Manola J, Wagner Ll, Chang VT, Fisch MJ. Employment outcomes among survivors of common cancers: the Symptom Outcomes and Practice Patterns (SOAPP) study. J Cancer Surviv 7(2):191-202, 6/2013. PMCID: PMC3638888. |
| 2. | Hwang J, Fisch M, Zhang H, Kallen M, Routbort M, Lal L, Vierling J, Suarez-Almazor M. Low Rates of Hepatitis B Virus Screening at the Onset of Chemotherapy. Journal of Oncology Practice 8(4):32-9, 6/2012. e-Pub 6/2012. PMCID: PMC23180996. |
| 3. | Chang VT, Zhao F, Tevaarwerk A, Mitchell EP, Patterson E, Ritchie C, Manola J, Wagner LI, Fisch MJ. Determinants of driving in cancer patients: an analysis for SOAPP (ECOG E2Z02: Symptom Outcomes and Practice Patterns)(MASCC Annual Meeting). Support Care Cancer 20(S151) (#639), 2012. |
| 4. | Zhao F, Chang VT, Cleeland C, Cleary JF, Mitchell EP, Patterson E, Wagner LI, Fisch MJ. Determinants of pain changes in ambulatory cancer patients by baseline pain severity: An analysis from ECOG E2Z02 (SOAPP Study)(MASCC Annual Meeting). Support Care Cancer 20(S151) (#638), 2012. |
Last updated: 10/31/2013
SOURCE
http://faculty.mdanderson.org/Michael_Fisch/Default.asp?SNID=0
BOOKS
Cancer Symptom Science
Product Details
ISBN: 9780521869010Publisher: Cambridge Year of publishing: 2010 Format: HardcoverNo of Pages: 376 Language: English
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