Clinician report as source of apathy information on cancer-related fatigue (CRF) patients.

Abstract

e19540 Background: Interventions for CRF require patient commitment, particularly if incorporating lifestyle change. Apathy, or lack of motivation, may diminish prospects for a successful outcome, yet few studies have addressed apathy in cancer patients. We conducted an observational study in our CRF Clinic and report on 79 patients evaluated for apathy. Our objective was to determine the apathy information source (clinician vs. patient) most associated with fatigue-related symptoms. Methods: New CRF patients were evaluated for apathy using the Apathy Evaluation Scale (AES); its scores (range 18-72) can be used to classify patients as apathetic or not (≥38 = clinically significant apathy). Two AES versions were employed: Clinician (AES-C) and Patient (AES-S). Scores and reliability were compared, then scores correlated (Spearman's rho) with five symptoms commonly experienced by CRF patients (fatigue, pain, depression, anxiety, sleep disturbance). Apathetic patient symptoms were compared (Mann-Whitney U) to non-apathetic per apathy measure, and agreement on apathy classification assessed. Results: 79 new CRF patients were evaluated for apathy by both clinician and patient. Median age was 59 years (range 26-84), 72% (n = 57) were female, 76% (n = 60) white, and 71% (n = 56) married. Leading cancer diagnoses were breast (37%, n = 29) and leukemia/lymphoma/myeloma (16%, n = 13). Median AES-C was 25 (range 18-61), with 19% (n = 15) clinically apathetic. AES-S range was 18-61, but median was 31 and 27% (n = 21) classified apathetic. Alpha reliability was .96 (AES-C) and .89 (AES-S). AES-C was correlated (p<.05) with fatigue (.27), depression (.41), and anxiety (.29); AES-S was correlated with depression (.49), anxiety (.33), and sleep disturbance (.26). Apathetic patients (AES-C) had greater fatigue (p =.021), depression (p =.001), and anxiety (p =.014) than non-apathetic. Apathetic patients (AES-S) had greater depression (p<.001) than non-apathetic. Apathy classification discordance was 18%. Conclusions: Clinician-reported apathy exhibited symptom correlations and greater discrimination of apathetic vs. not symptom burden. This suggests clinician-reported apathy may have important clinical and research use. No significant financial relationships to disclose.