Welcome to the CME testing site for the NIH State-of-the-Scicence conference on Symptom Management in Cancer: Pain, Depression and Fatigue The National Institutes of Health/Foundation for Advanced Education in the Sciences is accredited by the Accreditation Councilfor Continuing Medical Education to provide continuing medical education for physicians. The National Institutes of Health/Foundation for Advanced Education in the Sciences designates this educational activity for a maximum of 1 category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the educational activity. The authors of the conference statement (conference panelists) have signed disclosure forms indicating that they have no conflicts of interest (commercial, financial or scientific) with respect to the topic or the conference questions under consideration. Individuals with conflicts are eliminated from consideration as panelists in the Consensus Development Program process. Click here to view off-label or investigational drugs or devices that were discussed in the statement. These CME materials were approved on October 15, 2003 and will expire on October 15, 2006. We need to have the information below in order to process your CME credit, required fields are in RED. Read the statement (click here to retrieve statement) The consensus statement contains the correct answers to all of the questions listed below. Answer ALL of the test questions. If you are not sure of an answer after reading the statement, just click on the help link next to each question and reread the appropriate section. If you achieve a score of 70% or more, you will be able to print your CME certificate from this online site, but if you don't manage to achieve a passing score, you are welcome to try again. If you have any trouble printing out your certificate, please call 301-496-1144 or email: maskes@od.nih.gov. Good Luck! First Name Middle Initial Last Name Degree Street Address City State Zip Country Phone FAX E-mail Month/Day of Birth (mm/dd) M.D or non-M.D. participant? Choose One non-M.D. participant M.D. participant

System Requirements----Sponsors----Privacy Statement----Contact Information 1. Of the 1.3 million people diagnosed with cancer in 2002, what percentage will survive at least five years after diagnosis? help Choose from the answers below a. 10% b. 30% c. 60% d. 90% 2. Estimates of the frequency of pain, depression and fatigue in cancer patients are well established.help Choose from the answers below a. true b. false 3. The most common clinical assessment for pain, depression and fatigue is: help Choose from the answers below a. physical examination b. interview by clinical social worker c. interview with patient and caregiver(s) d. patient self-report 4. Which of the following patient characteristics should be considered as possibly affecting presentation and treatment of symptoms? help Choose from the answers below a. age b. ethnicity c. geographical distance from providers d. coexisting conditions e. all of the above 5. Asking patients about pain severity and impairment due to pain may be feasible and useful for recommending treatments for pain. help Choose from the answers below a. true b. false 6. Which of the following are types of instruments are most commonly used for assessing depression? help Choose from the answers below a. structured instruments for diagnosis of major depression b. symptom scales c. health-related-quality-of-life (HRQL) surveys d. a and b 7. The common-sense WHO three-step analgesic ladder is: help Choose from the answers below a. 1) NSAIDs 2) weak opioid plus NSAID 3) strong opioid b. 1) biofeedback 2) NSAIDs 3) weak opioid c. 1) cognitive therapy 2) NSAIDs 3) NSAIDs and a weak opioid d. none of the above 8. Randomized controlled trials of antidepressants have shown benefit when used at an adequate dose and duration. help Choose from the answers below a. true b. false 9. Convincing evidence for effective treatment of fatigue exists for which of the following: help Choose from the answers below a. exercise b. Epoetin alfa c. amphetamines d. little convincing evidence exists 10. Provider barriers to effective management include all but which of the following: help Choose from the answers below a. lack of awareness of patient's pain b. inadequate training and education on the management of cancer pain c. lack of time and resources to address pain d. straightforward access to opioids 11. Which of the following are barriers to effective pain management that affect patients and families: help Choose from the answers below a. belief that pain is an inevitable part of dealing with cancer b. belief that nothing can be done for cancer pain c. fear of addiction and that the drugs will lose their effectiveness d. all of the above 12. System barrier to effective pain management include all but the following: help Choose from the answers below a. lack of communication between specialists and primary care providers b. lack of coordination of care in transition to hospice c. emphasis on curing cancer over caring for cancer patients d. generous reimbursement for symptom management 13. Lack of recognition of depression and inadequate resources for treatment is a serious impediment to management. help Choose from the answers below a. true b. false 14. Serious barriers to management of fatigue include all but which of the following: help Choose from the answers below a. lack of awareness of fatigue as the most prevalent symptom b. lack of knowledge of the causes of fatigue c. lack of proven methods to treat fatigue d. all of the above are serious barriers 15. Strategies for improving symptom management involve: help Choose from the answers below a. regular assessment with a visual analog or numerical rating scale b. continuous quality improvement interventions c. a and not b d. a and b 16. Strategies for alleviating system barriers include: help Choose from the answers below a. organizations need to raise the priority of symptom management b. quadruplicate prescriptions should be introduced c. regulatory barriers need to be revised to maximize benefit d. a and c 17. All patients should have access to adequate and timely pain control. help Choose from the answers below a. true b. false 18. Education and awareness of the need for adequate pain management: help Choose from the answers below a. are necessary first steps to pain management b. has been achieved in most hospitals c. is an unattainable goal at this time d. none of the above 19. Triplicate prescriptions have been shown to efficaciously reduce fraud. help Choose from the answers below a. true b. false Your response to the following questions, while greatly appreciated, is optional and will have no effecton the test score Rating of Objectives and Program Please rate the attainment of objectives. Upon completion of this CME activity how well did you feel you can describe the issues related to the following conference questions: a) What is the occurrence of pain, depression, and fatigue, alone and in combination, in people with cancer? Choose from the answers belowa. not at allb. very littlec. somewhatd. considerablye. completely b) What are the methods used for clinical assessment of these symptoms throughout the course of cancer, and what is the evidence for their reliability and validity in cancer patients? Choose from the answers belowa. not at allb. very littlec. somewhatd. considerablye. completely c)What are the treatments for cancer-related pain, depression, and fatigue, and what is the evidence for their effectiveness? Choose from the answers belowa. not at allb. very littlec. somewhatd. considerablye. completely d) What are the impediments to effective symptom management in people diagnosed with cancer, and what are optimal strategies to overcome these impediments? Choose from the answers belowa. not at allb. very littlec. somewhatd. considerablye. completely The overall quality of the instructional process was an asset to this CME program Choose from the answers belowa. not at allb. very littlec. somewhatd. considerablye. completely To what extent will participation in this CME activity enhance your professional effectiveness? Choose from the answers belowa. not at allb. very littlec. somewhatd. considerablye. completely Did you perceive any commercial bias; Choose from the answers belowa. nob. yes If yes, please explain: What comments or suggstions do you have for the faculty (statement authors)? What will you do differently as a result of this educational activity? Are there new topics you would like covered in this activity or in a related activity? Do you have additional comments to enhance the utility or impact of the activity? Office of Medical Applications of Research 6100 Executive Blvd. Room 2B03 Bethesda, MD 20892 Phone: 301-496-1144 Fax: 301-402-0420

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