Management Of Fatigue In Adult Survivors Of Cancer
Publication Date: May 16, 2024
Last Updated: May 16, 2024
Treatment
Summary of Recommendations During Active Cancer Treatment
General Note: The following recommendations (strong or conditional) represent reasonable options for patients depending on clinical circumstances and in the context of individual patient preferences.
Recommended care should be accessible to patients whenever possible.
Recommended care should be accessible to patients whenever possible.
Recommendation 1.1
Clinicians should recommend exercise (aerobic, resistance, or a combination) to reduce the severity of fatigue during cancer treatment. Exercise should be tailored according to the individual patient’s abilities and may be either supervised or unsupervised. (M, S)
Note: Benefits for fatigue have consistently been seen with interventions that combine aerobic and resistance training, as well as resistance-only interventions. The choice of exercise modality, intensity, and duration should be based on several important considerations, including patient preference, availability, accessibility, likelihood of adherence, safety, and cost.
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Recommendation 1.2
Clinicians should recommend cognitive behavioral therapy (CBT) with or without hypnosis to reduce the severity of cancer-related fatigue in adults undergoing cancer treatment. (M, S)
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Recommendation 1.3
Clinicians should recommend mindfulness-based programs to reduce the severity of cancer-related fatigue in adults undergoing cancer treatment. Mindfulness-based programs may include mindfulness-based stress reduction (MBSR). (M, S)
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Recommendation 1.4
Clinicians should recommend tai chi or qigong, practiced at a low to moderate intensity, to reduce the severity of cancer-related fatigue in adults undergoing cancer treatment. (M, S)
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Recommendation 1.5
Clinicians may recommend psychoeducation to reduce the severity of cancer-related fatigue in adults undergoing cancer treatment. (M, C)
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Recommendation 1.6
Clinicians may recommend American ginseng (Panax quinquefolius) at a dose of 2000 mg daily to manage symptoms of cancer-related fatigue in adults undergoing cancer treatment. (L, C)
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Recommendation 1.7
Clinicians should not recommend wakefulness agents, such as modafinil or armodafinil, to manage symptoms of cancer-related fatigue in adults undergoing cancer treatment. (M, S)
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Recommendation 1.8
Clinicians should not recommend L-carnitine to manage symptoms of cancer-related fatigue in adults undergoing cancer treatment. (L, C)
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Recommendation 1.9
Clinicians should not routinely recommend psychostimulants, such as methylphenidate, to manage symptoms of cancer-related fatigue in adults undergoing cancer treatment. (M, C)
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Recommendation 1.10
Clinicians should not recommend antidepressants, such as paroxetine, to manage symptoms of cancer-related fatigue in adults undergoing cancer treatment. (M, C)
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No Recommendation
There is insufficient evidence to make recommendations for or against acupressure, coenzyme Q10, guarana, brain wave vibration meditation, minocycline, music or music therapy, progressive muscle relaxation, reflexology, solution-focused therapy, or yoga to reduce the severity of cancer-related fatigue in adults undergoing cancer treatment. (No recommendation for or against; Ins)
Summary of Recommendations After Active Cancer Treatment
General Note: The following recommendations (strong or conditional) represent reasonable options for patients depending on clinical circumstances and in the context of individual patient preferences. Recommended care should be accessible to patients whenever possible.
Recommendation 2.1
Clinicians should recommend exercise (aerobic, resistance, or a combination) to reduce the severity of cancer-related fatigue symptoms in adults who have completed cancer treatment. Whenever possible, exercise should be tailored according to the abilities of the individual patient and may be either supervised or unsupervised. (M, S)
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Recommendation 2.2
Clinicians should recommend CBT to manage symptoms of cancer related fatigue in adults who have completed cancer treatment. CBT may be delivered in person or via a web-based program. (M, S)
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Recommendation 2.3
Clinicians should recommend mindfulness-based programs to reduce the severity of fatigue in adults who have completed cancer treatment. Mindfulness-based programs may include MBSR, mindfulness-based cognitive therapy (MBCT), and mindful awareness practices (MAPs) and may be delivered in person or via a web-based program. (M, S)
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Recommendation 2.4
Clinicians may recommend yoga to reduce the severity of cancer-related fatigue in adults who have completed cancer treatment, especially in women with breast cancer. (L, C)
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Recommendation 2.5
Clinicians may recommend acupressure to manage symptoms of cancer-related fatigue in adults who have completed cancer treatment. (L, C)
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Recommendation 2.6
Clinicians may recommend moxibustion to manage symptoms of cancer-related fatigue in adults who have completed cancer treatment. (L, C)
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Recommendation 2.7
Clinicians should not recommend wakefulness agents, such as modafinil or armodafinil, to manage symptoms of cancer-related fatigue in adults who have completed cancer treatment. (M, C)
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Recommendation 2.8
Clinicians should not routinely recommend psychostimulants, such as methylphenidate, to manage symptoms of cancer-related fatigue in adults who have completed cancer treatment. (M, C)
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No Recommendation
There is insufficient or inconclusive evidence to make recommendations for or against acceptance and commitment (ACT) -based or attention-based interventions, acupuncture, bright light therapy, ginseng, massage, mistletoe, omega fatty acids, psychoeducational interventions, self-management health app, tai chi or qigong to reduce the severity of cancer-related fatigue in adults who have completed cancer treatment. (No recommendation for or against; Ins)
Summary of Recommendations for Advanced Cancer or End of Life
General Note: The following recommendations (strong or conditional) represent reasonable options for patients depending on clinical circumstances and in the context of individual patient preferences.
Recommended care should be accessible to patients whenever possible.
Recommended care should be accessible to patients whenever possible.
Recommendation 3.1
Clinicians may recommend CBT to manage symptoms of cancer-related fatigue in adults with advanced cancer and/or receiving treatment with palliative intent. (L, C)
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Recommendation 3.2
Clinicians may recommend corticosteroids to manage symptoms of cancer-related fatigue in patients at the end of life where no contraindications exist. The risk-benefit ratio of corticosteroid use should be assessed over time. (L, C)
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Recommendation 3.3
Clinicians should not recommend wakefulness agents, such as modafinil or armodafinil, to manage symptoms of cancer-related fatigue in adults with advanced cancer or at the end of life. (M, C)
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Recommendation 3.4
Clinicians should not routinely recommend psychostimulants, such as methylphenidate, to manage symptoms of cancer-related fatigue in adults with advanced cancer or at the end of life. (M, C)
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No Recommendation
There is insufficient evidence to make recommendations for or against collaborative care intervention, exercise, melatonin, or protocolized patient-tailored treatment to manage symptoms of cancer-related fatigue among adults with advanced cancer or at the end of life. (No recommendation for or against; Ins)
ASCO believes that cancer clinical trials are vital to inform medical decisions and improve cancer care and that all patients should have the opportunity to participate.
Additional information, which may include data supplements, slide sets, and other clinical tools and resources, is available at www.asco.org/survivorship-guidelines.
Additional information, which may include data supplements, slide sets, and other clinical tools and resources, is available at www.asco.org/survivorship-guidelines.
Recommendation Grading
Overview
Title
Management Of Fatigue In Adult Survivors Of Cancer
Authoring Organizations
American Society of Clinical Oncology
Society for Integrative Oncology
Publication Month/Year
May 16, 2024
Last Updated Month/Year
May 17, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Target Patient Population
Cancer survivors diagnosed at age ≥ 18 years who have completed primary cancer treatment with curative intent
Target Provider Population
Medical, surgical, and radiation oncologists, psychosocial and rehabilitation professionals, primary care providers, nurses, and others
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Long term care
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management
Keywords
cancer, cancer survivors, fatigue
Source Citation
Bower JE, Lacchetti C, Alici Y, et al. Management of Fatigue in Adult Survivors of Cancer: SIO-ASCO Guideline. J Clin Oncol. 2024 May 16. doi: 10.1200/JCO.24.00541
Supplemental Methodology Resources
Methodology
Number of Source Documents
65
Literature Search Start Date
December 31, 2008
Literature Search End Date
February 28, 2013