Screening, Assessment, And Management Of Fatigue In Adult Survivors Of Cancer

Perform a focused fatigue history

Evaluate disease status

Assess treatable contributing factors.

As a shared responsibility, the clinical team must decide when referral to an appropriately trained professional (eg, cardiologist, endocrinologist, mental health professional, internist, and so on) is needed.

Consider performing laboratory evaluation based on presence of other symptoms and onset and severity of fatigue.

All patients should be offered specific education about fatigue after treatment (eg, information about the difference between normal and cancer-related fatigue, persistence of fatigue after treatment, and causes and contributing factors).

Patients should be offered advice on general strategies that help manage fatigue.

If treated for fatigue, patients should be observed and re-evaluated on a regular basis to determine whether treatment is effective or needs to be reassessed.

Address all medical and treatable contributing factors first (eg, pain, depression, anxiety, emotional distress, sleep disturbance, nutritional deficit, activity level, anemia, medication adverse effects, and comorbidities).

Initiating/maintaining adequate levels of physical activity can reduce cancer-related fatigue in post-treatment survivors.

Actively encourage all patients to engage in a moderate level of physical activity after cancer treatment (eg, 150 minutes of moderate aerobic exercise [such as fast walking, cycling, or swimming] per week with an additional two to three strength training [such as weight lifting] sessions per week, unless contraindicated).

Walking programs are generally safe for most cancer survivors; the American College of Sports Medicine recommends that cancer survivors can begin this type of program after consulting with their physicians but without any formal exercise testing (such as a stress test).

Survivors at higher risk of injury (eg, those living with neuropathy, cardiomyopathy, or other long-term effects of therapy) and patients with severe fatigue interfering with function should be referred to a physical therapist or exercise specialist. Breast cancer survivors with lymphedema should also consider meeting with an exercise specialist before initiating upper-body strength training.

Cognitive behavioral therapy/behavioral therapy can reduce cancer-related fatigue in post-treatment survivors.

Psychoeducational therapies/educational therapies can reduce cancer-related fatigue in post-treatment survivors.

Survivors should be referred to psychosocial service providers who specialize in cancer and are trained to deliver empirically based interventions. Psychosocial resources that address fatigue may also be available through the National Cancer Institute and other organizations.

There is some evidence that mindfulness-based approaches, yoga, and acupuncture can reduce fatigue in cancer survivors.

Additional research, particularly in the post-treatment population, is needed for biofield therapies (touch therapy), massage, music therapy, relaxation, reiki, and qigong.

Survivors should be referred to practitioners who specialize in cancer and who use protocols that have been empirically validated in cancer survivors.

Evidence suggests that psychostimulants (eg, methylphenidate) and other wakefulness agents (eg, modafinil) can be effectively used to manage fatigue in patients with advanced disease or those receiving active treatment. However, there is limited evidence of their effectiveness in reducing fatigue in patients after active treatment who are currently disease free.

Small pilot studies have evaluated the impact of supplements, such as ginseng, vitamin D, and others, on cancer-related fatigue. However, there is no consistent evidence of their effectiveness.