Management of Fatigue in Adult Survivors of Cancer

Published online ahead of print May 16, 2024. DOI: 10.1200/JCO.24.00541

Julienne E. Bower, Christina Lacchetti, Yesne Alici, Debra L. Barton, Deborah Bruner, Beverly E. Canin Carmelita P. Escalante, Patricia A. Ganz, Sheila N. Garland, Shilpi Gupta, Heather Jim, Jennifer A. Ligibel, Kah Poh Loh, Luke Peppone, Debu Tripathy, Sriram Yennu, Suzanna Zick, and Karen Mustian

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

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