Management of Fatigue in Adult Survivors of Cancer: ASCO–Society for Integrative Oncology Guideline Update

Author:

Bower Julienne E.1ORCID,Lacchetti Christina2ORCID,Alici Yesne3,Barton Debra L.4ORCID,Bruner Deborah5ORCID,Canin Beverly E.6ORCID,Escalante Carmelita P.7,Ganz Patricia A.1ORCID,Garland Sheila N.8ORCID,Gupta Shilpi9,Jim Heather10ORCID,Ligibel Jennifer A.11ORCID,Loh Kah Poh12ORCID,Peppone Luke13ORCID,Tripathy Debu7ORCID,Yennu Sriram7ORCID,Zick Suzanna14ORCID,Mustian Karen12

Affiliation:

1. University of California, Los Angeles, CA

2. American Society of Clinical Oncology, Alexandria, VA

3. Memorial Sloan Kettering Cancer Center, New York, NY

4. University of Tennessee, College of Nursing, Knoxville, TN

5. Emory University, Atlanta, GA

6. Breast Cancer Options, Kingston, NY

7. MD Anderson Cancer Center, Houston, TX

8. Memorial University, St John's, NL, Canada

9. Morristown Medical Center, Morristown, NJ

10. Moffitt Cancer Center, Tampa, FL

11. Dana Farber Cancer Institute, Boston, MA

12. University of Rochester Medical Center, Rochester, NY

13. Wilmot Cancer Institute, University of Rochester, Rochester, NY

14. University of Michigan, Ann Arbor, MI

Abstract

ASCO–Society for Integrative Oncology (SIO) Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO Guidelines Methodology Manual . ASCO-SIO Guidelines follow the ASCO Conflict of Interest Policy for Clinical Practice Guidelines . Clinical Practice Guidelines and other guidance (“Guidance”) provided by ASCO and SIO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by providers and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases or stages of diseases. Guidance is based on review and analysis of relevant literature, and is not intended as a statement of the standard of care. ASCO and SIO do not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in Appendix 1 and 2 (online only) for more. PURPOSE To update the ASCO guideline on the management of cancer-related fatigue (CRF) in adult survivors of cancer. METHODS A multidisciplinary panel of medical oncology, geriatric oncology, internal medicine, psychology, psychiatry, exercise oncology, integrative medicine, behavioral oncology, nursing, and advocacy experts was convened. Guideline development involved a systematic literature review of randomized controlled trials (RCTs) published in 2013-2023. RESULTS The evidence base consisted of 113 RCTs. Exercise, cognitive behavioral therapy (CBT), and mindfulness-based programs led to improvements in CRF both during and after the completion of cancer treatment. Tai chi, qigong, and American ginseng showed benefits during treatment, whereas yoga, acupressure, and moxibustion helped to manage CRF after completion of treatment. Use of other dietary supplements did not improve CRF during or after cancer treatment. In patients at the end of life, CBT and corticosteroids showed benefits. Certainty and quality of evidence were low to moderate for CRF management interventions. RECOMMENDATIONS Clinicians should recommend exercise, CBT, mindfulness-based programs, and tai chi or qigong to reduce the severity of fatigue during cancer treatment. Psychoeducation and American ginseng may be recommended in adults undergoing cancer treatment. For survivors after completion of treatment, clinicians should recommend exercise, CBT, and mindfulness-based programs; in particular, CBT and mindfulness-based programs have shown efficacy for managing moderate to severe fatigue after treatment. Yoga, acupressure, and moxibustion may also be recommended. Patients at the end of life may be offered CBT and corticosteroids. Clinicians should not recommend L-carnitine, antidepressants, wakefulness agents, or routinely recommend psychostimulants to manage symptoms of CRF. There is insufficient evidence to make recommendations for or against other psychosocial, integrative, or pharmacological interventions for the management of fatigue. Additional information is available at www.asco.org/survivorship-guidelines .

Publisher

American Society of Clinical Oncology (ASCO)

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