Management of Fatigue in Adult Survivors of Cancer: ASCO–Society for Integrative Oncology Guideline Update
- Study type
- Clinical guideline
- Study name
- ASCO-SIO Cancer-Related Fatigue 2024
- Design
- Clinical practice guideline update based on a systematic review of randomised controlled trials published from 2013 to 2023
- Sample size
- 113 randomised controlled trials (RCTs)
- Source
- JCO · 2024
In plain words
Tiredness (fatigue) is one of the most common and most troubling problems for people with cancer and cancer survivors. This guideline shows that physical activity and exercise, cognitive behavioural therapy and mindfulness programmes can help reduce fatigue both during and after treatment. Some other methods, such as tai chi, qigong, yoga and acupressure, have also helped at particular stages. Talk to your doctor before taking any supplement or medicine for fatigue, because many supplements and medicines have no proven benefit.
Key points
Key guideline recommendations
- Level of evidence and strength of recommendation in the full guideline
Clinicians should recommend exercise, cognitive behavioural therapy (CBT), mindfulness-based programmes and tai chi or qigong to reduce the severity of fatigue during cancer treatment.
- Level of evidence and strength of recommendation in the full guideline
Psychoeducation and American ginseng may be recommended for adults undergoing cancer treatment.
- Level of evidence and strength of recommendation in the full guideline
For survivors who have completed treatment, clinicians should recommend exercise, CBT and mindfulness-based programmes; CBT and mindfulness-based programmes in particular have shown efficacy in managing moderate to severe fatigue after treatment.
- Level of evidence and strength of recommendation in the full guideline
Yoga, acupressure and moxibustion may also be recommended.
- Level of evidence and strength of recommendation in the full guideline
Patients at the end of life may be offered CBT and corticosteroids.
- Level of evidence and strength of recommendation in the full guideline
Clinicians should not recommend L-carnitine, antidepressants or wakefulness agents, and should not routinely recommend psychostimulants, to manage the symptoms of cancer-related fatigue.
- Level of evidence and strength of recommendation in the full guideline
The evidence is insufficient to make a recommendation for or against other psychosocial, integrative or pharmacological interventions to manage fatigue.
Study population
Adult cancer survivors with cancer-related fatigue (CRF), including patients during cancer treatment, after completion of treatment and at the end of life.
Endpoints
The aim of the guideline was to update the recommendations for managing cancer-related fatigue in adult cancer survivors. Exercise, psychosocial, integrative (complementary) and pharmacological interventions were evaluated for improvement of fatigue. Details of each study's endpoints are not given in the abstract and appear in the full guideline.
Safety and side effects
The abstract gives no information on adverse events (grade 3 or higher); safety details are in the full guideline.
Clinical significance and place in guidelines
This update of the ASCO and Society for Integrative Oncology guideline recommends non-pharmacological interventions such as exercise, CBT and mindfulness programmes as the main strategies for managing cancer-related fatigue. By contrast, L-carnitine, antidepressants and wakefulness agents should not be recommended, and psychostimulants should not be prescribed routinely. The quality of evidence was low to moderate. The choice of intervention should take into account the phase of disease (during treatment, after treatment or end of life) and each patient's circumstances.
Limitations
The certainty and quality of evidence for interventions to manage cancer-related fatigue were reported as low to moderate. For many psychosocial, integrative and pharmacological interventions, the evidence is insufficient to recommend for or against them. Further details on limitations are given in the full guideline.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.