Framework of factors associated with cancer-related fatigue
Cancer-related fatigues (CRF) is multifactorial and all potential contributing factors are needed to be assessed to understand the unique presentation on the individual’s life. This framework proposes a number of factors associated with CRF. Of these factors, the medical status of fatigue, which is predetermined and cannot be modified by therapists, includes disease-related factors (e.g., type of disease), treatment-related factors (e.g., treatment required), comorbidities, and underlying biomedical factors. However, different from the medical status of fatigue, the fatigue experience is correlated to and can be modified by the patient’s own unique factors. These factors unique to the patient are physical/behavioral factors (e.g., poor nutrition, decreased activity, sleep disturbance, pain), psychological factors (e.g., anxiety and depression), and sociodemographic factors (e.g., social support, employment, education). As the experience of CRF varies in each individual, it is essential to assess these key factors to examine the potential contributing factor(s). The functional impacts of CRF also affects the client’s performance in one or more of life domains, such as activities of daily living, work, and health-related quality of life. These areas can be addressed by occupational therapists as part of other occupational therapy frameworks and models such as occupational performance model. Occupational therapists should examine the complex conditions of CRF in order to consider the unique presentation in the clients and to determine the optimal approaches for intervention management.
Domain of occupation
This framework serves as a guide for therapists to ensure that all key variables are considered when working with patients with CRF, and as a guide for research in this field.
Pureell, A., Fleming, J., Haines, T., & Bennett, S. (2009). Cancer-related fatigue: A review and a conceptual framework to guide therapists' understanding. British Journal of Occupational Therapy, 72(2), 79-86.
The psychoanalytic frame of reference (FOR) emphasizes on the unconscious aspect of what is done and said, and it is embedded in an occupational therapy relationship model of practice - the Vivaio model (MOVI). The central element of the MOVI is the recognition of constant emotions that exist in the interdependent relationship between the three elements of patient, therapist and ‘doing’.
The cognitive-behavioral frame of reference (FOR) emphasizes five aspects of life experience: thoughts, behaviors, emotion/mood, physiological responses, and the environment. These aspects are interrelated, meaning that changes in one factor can lead to improvement or deterioration in other(s). Each is influenced by the social and physical environments. One key theoretical component in this FOR is the hierarchical levels of cognition. Automatic thoughts is the most accessible, which are uninvited and immediate thoughts. Beliefs are conditional beliefs we hold about ourselves.
This framework aims to assist occupational therapists in describing aspects of work functioning in work assessments on different situations. There are three separate dimensions of work functioning. Dimension 1 is work participation and society. Work participation is an individual’s ability and opportunity he/she has, to acquire and maintain a work position in the society, and to fulfill a worker role. The complex interaction between personal, environmental, and temporal factors affects a person’s work participation.
The Accountability-Well-being-Ethics (AWE) framework incorporates the humanist and contextualist perspectives to create a balanced foundation of client-centered profession. The conceptual cores include sociocultural, well-being, social/occupational justice, promoting capabilities, accountability, qualitative stories, contingency, hope, solidarity, person directed, coach/partner, and facilitating empowerment, in contrast to different concepts of biomedical health care. This framework is structured for use in education, research, and clinical practice for occupational therapy globally.