Management Of Fatigue In Adult Survivors Of Cancer

Publication Date: May 15, 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.

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.
3710401

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)
3710401

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)
3710401

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)
3710401

Recommendation 1.5

Clinicians may recommend psychoeducation to reduce the severity of cancer-related fatigue in adults undergoing cancer treatment. (M, C)
3710401

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)
3710401

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)
3710401

Recommendation 1.8

Clinicians should not recommend L-carnitine to manage symptoms of cancer-related fatigue in adults undergoing cancer treatment. (L, C)
3710401

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)
3710401

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)
3710401

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)
3710401

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)
3710401

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)
3710401

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)
3710401

Recommendation 2.5

Clinicians may recommend acupressure to manage symptoms of cancer-related fatigue in adults who have completed cancer treatment. (L, C)
3710401

Recommendation 2.6

Clinicians may recommend moxibustion to manage symptoms of cancer-related fatigue in adults who have completed cancer treatment. (L, C)
3710401

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)
3710401

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)
3710401

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.

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)
3710401

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)
3710401

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)
3710401

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)
3710401

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.

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 15, 2024

Last Updated Month/Year

November 8, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

To update the ASCO guideline on the management of cancer-related fatigue (CRF) in adult survivors of cancer.

Target Patient Population

All adult cancer survivors with fatigue symptoms occurring at any stage: from diagnosis throughout treatment, treatment completion, and end of life.

Target Provider Population

Medical, surgical, and radiation oncologists, psychosocial and rehabilitation professionals, primary care providers, nurses, and others

PICO Questions

What are the recommended treatment approaches in the management of adult cancer survivors with symptoms of CRF?

Inclusion Criteria

Male, Female, 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 Supplement, Evidence Tables

Methodology

Number of Source Documents
65
Literature Search Start Date
December 30, 2008
Literature Search End Date
February 27, 2013