Cancer-related fatigue

These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue using a brief screening instrument and are treated as indicated by their fatigue level. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point, the patient is assessed for current disease and treatment status and undergoes a review of body systems and an in-depth fatigue evaluation. In addition, the patient is assessed for the presence of treatable factors known to contribute to fatigue. If any of these conditions are present, they should be treated according to practice guidelines, with referral to other care professionals as appropriate, and the patient's fatigue should be reevaluated regularly. If none of the factors are present or if the fatigue is unresolved, appropriate fatigue management and treatment strategies are selected based on the patient's clinical status (e.g., undergoing active cancer treatment, posttreatment, at the end of life). Management of fatigue is cause-specific when conditions known to cause fatigue can be identified and treated. When specific causes of fatigue cannot be identified and corrected, the fatigue can still be treated with nonpharmacologic and pharmacologic interventions. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, psychosocial programs to manage stress and increase support, energy conservation to maintain energy, and nutritional and sleep interventions for patients with disturbances in eating or sleeping. Pharmacologic therapy may include drugs, such as antidepressants for depression or erythropoietin for anemia. A few clinical reports suggest the need for further research on the use of psychostimulants as potential treatment modalities for managing fatigue. Effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients' fatigue levels regularly, counsels and educates patients regarding strategies for coping with fatigue,²¹⁶ and refers patients with unresolved fatigue to institutional experts.⁴⁵ The oncology care team must recognize the many patient-, provider-, and system-related behaviors that can impede effective fatigue management. Using available resources and evidence-based guidelines to reduce barriers increases benefits to patients experiencing fatigue. ^217,218