Fatigue in Adult Survivors of Cancer

Patient Guideline

Publication Date: May 15, 2024
Last Updated: November 6, 2024

Objective

Objective

  • This patient summary is about the key takeaways from the American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology (SIO) guideline update for the management of fatigue in adult survivors of cancer.
  • This patient summary provides new, evidence-based recommendations. These recommendations help adult survivors of cancer and caregivers make informed decisions about treatment plans.

Overview

Overview

  • Cancer-related fatigue (CRF) is one of the most common side effects of cancer and cancer treatment.
  • CRF is a persistent feeling of physical, mental, and emotional exhaustion.
  • It is usually not relieved by rest or sleep.
  • Causes of CRF:
    • The cancer itself
    • Cancer treatments. For example, chemotherapy and radiation therapy
    • Depression
    • Pain
    • Sleep problems
    • Physical inactivity
  • Your cancer care team can help you manage the CRF

Management of CRF During Active Cancer Treatment

Management of CRF During Active Cancer Treatment

Recommended strategies

  • Exercise (aerobic, resistance, or both). Exercise should be customized to your situation. It may be supervised or unsupervised.
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  • Cognitive behavioral therapy (CBT) with or without hypnosis.
    • CBT is a form of talk therapy that helps individuals reframe their thoughts.
    • Talk with a counselor about the option of CBT.
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  • Mindfulness. A practice where you focus on your thoughts and feelings without judgment.
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  • Tai chi or qigong is practiced at a low to moderate intensity. These are two separate but similar practices. They involve slow movements and deep breathing.
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  • Psychoeducation. It is a therapy that educates the patients about mental health. It is often a part of “chemotherapy teaching sessions” provided to patients before starting the treatment to prepare them for the likelihood of fatigue.
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  • American ginseng at a dose of 2000 mg every day. It is an extract from a type of spice. Talk with your cancer care team about precautions before taking supplements.
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Strategies not recommended

  • Wakefulness (alertness) medications, such as modafinil or armodafinil
  • L-carnitine (a dietary supplement)
  • Routine psychostimulant medications, such as methylphenidate
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Management of CRF After Active Cancer Treatment

Management of CRF After Active Cancer Treatment

Recommended strategies

  • Exercise (aerobic, resistance, or both). Exercise should be customized to your situation. It may be supervised or unsupervised.
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  • Cognitive behavioral therapy (CBT). CBT may be in person or online.
    • CBT is a form of talk therapy that helps individuals reframe their thoughts.
    • Talk with a counselor about the option of CBT.
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  • Mindfulness. A practice where you focus on your thoughts and feelings without judgment.
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  • Yoga especially in women with breast cancer.
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  • Acupressure.
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  • Moxibustion.
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Strategies not recommended

  • Wakefulness (alertness) medications, such as modafinil or armodafinil
  • Routine psychostimulant medications, such as methylphenidate
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Management of CRF for Advanced Cancer or End of Life

Management of CRF for Advanced Cancer or End of Life

Recommended strategies

  • Cognitive behavioral therapy (CBT) in adults with advanced cancer and/or adults receiving treatment with palliative intent.
    • CBT is a form of talk therapy that helps individuals reframe their thoughts.
    • Talk with a counselor about the option of CBT
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  • Corticosteroids (steroids) in patients at the end of life when there is no medical reason not to give them. Your cancer care provider will assess the risks and benefits of steroid use over time.
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Strategies not recommended

  • Wakefulness (alertness) medications, such as modafinil or armodafinil in adults with advanced cancer or at the end of life.
  • Routine psychostimulant medications, such as methylphenidate in adults with advanced cancer or at the end of life.
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Questions you may want to ask your cancer care team

Questions you may want to ask your cancer care team

  • What could be the reason for the fatigue I have?
  • Do I need lab tests to find out more about the cause of my fatigue?
  • What can I do to help cope with the fatigue?
  • Can you refer me to a registered dietitian, counselor, physical therapist, acupuncturist or any other care provider to help me manage the fatigue?

Additional resources

Additional resources

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