title: Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.
abstract: OBJECTIVE
  This guideline presents screening, assessment, and treatment approaches for the management of adult cancer survivors who are experiencing symptoms of fatigue after completion of primary treatment.
  
  
  METHODS
  A systematic search of clinical practice guideline databases, guideline developer Web sites, and published health literature identified the pan-Canadian guideline on screening, assessment, and care of cancer-related fatigue in adults with cancer, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines In Oncology (NCCN Guidelines) for Cancer-Related Fatigue and the NCCN Guidelines for Survivorship. These three guidelines were appraised and selected for adaptation.
  
  
  RESULTS
  It is recommended that all patients with cancer be evaluated for the presence of fatigue after completion of primary treatment and be offered specific information and strategies for fatigue management. For those who report moderate to severe fatigue, comprehensive assessment should be conducted, and medical and treatable contributing factors should be addressed. In terms of treatment strategies, evidence indicates that physical activity interventions, psychosocial interventions, and mind-body interventions may reduce cancer-related fatigue in post-treatment patients. There is limited evidence for use of psychostimulants in the management of fatigue in patients who are disease free after active treatment.
  
  
  CONCLUSIONS
  Fatigue is prevalent in cancer survivors and often causes significant disruption in functioning and quality of life. Regular screening, assessment, and education and appropriate treatment of fatigue are important in managing this distressing symptom. Given the multiple factors contributing to post-treatment fatigue, interventions should be tailored to each patient's specific needs. In particular, a number of nonpharmacologic treatment approaches have demonstrated efficacy in cancer survivors.
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Julienne E
authors.initials: JE
authors.lastname: Bower
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Kate
authors.initials: K
authors.lastname: Bak
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Ann
authors.initials: A
authors.lastname: Berger
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: William
authors.initials: W
authors.lastname: Breitbart
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Carmelita P
authors.initials: CP
authors.lastname: Escalante
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Hester Hill
authors.initials: HH
authors.lastname: Schnipper
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Christina
authors.initials: C
authors.lastname: Lacchetti
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Ligibel
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Mohammed S
authors.initials: MS
authors.lastname: Ogaily
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
authors.affiliation: Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D005221:Fatigue / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome
references.citation: J Clin Oncol. 2000 Feb;18(4):743-53
references.pmid: 10673515
references.citation: Oncol Nurs Forum. 1998 May;25(4):677-84
references.pmid: 9599351
references.citation: Psychooncology. 2011 Feb;20(2):115-26
references.pmid: 20336645
references.citation: J Clin Oncol. 2012 Apr 20;30(12):1335-42
references.pmid: 22430268
references.citation: J Clin Oncol. 2012 Oct 20;30(30):3655-6
references.pmid: 23008327
references.citation: Anticancer Res. 2012 Sep;32(9):3875-84
references.pmid: 22993332
references.citation: Health Psychol. 2007 Nov;26(6):660-7
references.pmid: 18020836
references.citation: Nurs Res. 2007 Jan-Feb;56(1):18-27
references.pmid: 17179870
references.citation: Psychooncology. 2012 Mar;21(3):264-72
references.pmid: 22383268
references.citation: J Clin Oncol. 2013 Feb 10;31(5):631-40
references.pmid: 23295805
references.citation: J Pain Symptom Manage. 1997 Feb;13(2):63-74
references.pmid: 9095563
references.citation: Palliat Med. 2008 Mar;22(2):111-22
references.pmid: 18372376
references.citation: Integr Cancer Ther. 2013 Jul;12(4):276-90
references.pmid: 23632236
references.citation: Qual Life Res. 1998 May;7(4):301-10
references.pmid: 9610214
references.citation: Support Care Cancer. 2010 Jun;18(6):729-34
references.pmid: 19636595
references.citation: Cancer. 1999 Mar 1;85(5):1186-96
references.pmid: 10091805
references.citation: Med Sci Sports Exerc. 2010 Jul;42(7):1409-26
references.pmid: 20559064
references.citation: J Cancer Surviv. 2011 Dec;5(4):413-9
references.pmid: 21598023
references.citation: Breast Cancer Res Treat. 2012 Feb;132(1):205-13
references.pmid: 22113257
references.citation: Psychooncology. 2013 Jan;22(1):203-11
references.pmid: 22052746
references.citation: J Cancer Surviv. 2012 Jun;6(2):189-99
references.pmid: 22193780
references.citation: Eur J Cancer Care (Engl). 2012 Mar;21(2):233-41
references.pmid: 22060159
references.citation: Ann Oncol. 2002 Apr;13(4):589-98
references.pmid: 12056710
references.citation: BMC Complement Altern Med. 2011 Jun 25;11:49
references.pmid: 21703001
references.citation: PM R. 2010 May;2(5):364-83
references.pmid: 20656618
references.citation: CMAJ. 2010 Dec 14;182(18):E839-42
references.pmid: 20603348
references.citation: J Natl Cancer Inst. 1993 Mar 3;85(5):365-76
references.pmid: 8433390
references.citation: Psychol Bull. 2008 Sep;134(5):700-741
references.pmid: 18729569
references.citation: Cancer. 2010 Jul 15;116(14):3513-20
references.pmid: 20564068
references.citation: Cochrane Database Syst Rev. 2012 Nov 14;11:CD006145
references.pmid: 23152233
references.citation: Cancer Epidemiol Biomarkers Prev. 2011 Jan;20(1):123-33
references.pmid: 21051654
references.citation: Appl Physiol Nutr Metab. 2011 Dec;36(6):892-903
references.pmid: 22067010
references.citation: Clin J Oncol Nurs. 2007 Feb;11(1):99-113
references.pmid: 17441401
references.citation: Psychooncology. 2013 Jan;22(1):186-94
references.pmid: 23296635
references.citation: Cancer. 2012 Feb 1;118(3):777-87
references.pmid: 21823103
references.citation: Ann Oncol. 2009 Jan;20(1):17-25
references.pmid: 18678767
references.citation: J Adv Nurs. 2008 Mar;61(6):664-75
references.pmid: 18302607
references.citation: Cochrane Database Syst Rev. 2010 Jul 07;(7):CD006704
references.pmid: 20614448
references.citation: J Am Acad Nurse Pract. 2011 Mar;23(3):135-42
references.pmid: 21355946
references.citation: J Clin Oncol. 2012 Dec 20;30(36):4470-6
references.pmid: 23109700
references.citation: Support Care Cancer. 2008 Sep;16(9):987-97
references.pmid: 18274783
references.citation: J Psychosom Res. 1995 Apr;39(3):315-25
references.pmid: 7636775
references.citation: Sleep Med Rev. 2007 Jun;11(3):195-207
references.pmid: 17467312
references.citation: Cancer. 2012 Aug 1;118(15):3766-75
references.pmid: 22180393
references.citation: J Cancer Surviv. 2010 Jun;4(2):87-100
references.pmid: 20052559
references.citation: Oncol Nurs Forum. 1998 May;25(4):711-7
references.pmid: 9599354
references.citation: Curr Oncol. 2013 Jun;20(3):e233-46
references.pmid: 23737693
references.citation: Ann Oncol. 2010 Mar;21(3):608-614
references.pmid: 19880433
references.citation: J Support Oncol. 2012 Sep-Oct;10(5):171-7
references.pmid: 22579268
references.citation: Am J Prev Med. 2012 Aug;43(2):e1-24
references.pmid: 22813691
references.citation: Cancer Pract. 1998 May-Jun;6(3):143-52
references.pmid: 9652245
references.citation: J Psychosom Res. 1993;37(2):147-53
references.pmid: 8463991
references.citation: Br J Cancer. 2007 Sep 3;97(5):612-8
references.pmid: 17653075
references.citation: J Behav Med. 2012 Feb;35(1):86-94
references.pmid: 21506018
references.citation: J Clin Oncol. 2006 Nov 10;24(32):5101-4
references.pmid: 17093270
references.citation: J Clin Oncol. 2012 Apr 20;30(12):1296-303
references.pmid: 22412149
references.citation: Complement Ther Med. 2010 Oct;18(5):224-6
references.pmid: 21056846