What are the NCCN guidelines for screening, assessment, and management of fatigue in adult cancer survivors?

Updated: Feb 28, 2018
  • Author: Winston W Tan, MD, FACP; more...
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The NCCN recommendations include the following [16] :

  • All patients should be screened for fatigue using age-appropriate measures, at their initial visit, at regular intervals during and following cancer treatment, and as clinically indicated

  • Screening should be performed and documented using a quantitative or semi-quantitative assessment; because fatigue is rarely an isolated symptom, a multi-symptom screening tool may have greater clinical utility

  • Patients who report moderate to severe fatigue should undergo a comprehensive and focused assessment

  • All patients should be offered specific education about fatigue after treatment (eg, information about the difference between normal and cancer-related fatigue, persistence of fatigue after treatment, and causes and contributing factors)

  • Patients should be offered advice on general strategies that help manage fatigue (eg, physical activity, guidance on self-monitoring of fatigue levels)

  • If treated for fatigue, patients should be observed and reevaluated on a regular basis to determine whether treatment is effective or needs to be reassessed

  • Address all medical and substance-induced treatable contributing factors first (eg, comorbidities, medications, nutritional issues, activity level)

  • Maintain adequate levels of physical activity (category 1 recommendation)

  • Survivors at higher risk of injury (eg, those with neuropathy, cardiomyopathy, or other long-term effects of therapy) should be referred to a physical therapist or exercise specialist

  • Provide psychosocial interventions, including cognitive-behavioral therapy (CBT), behavior therapy, mindfulness-based stress reduction, psycho-educational therapies, and supportive therapies (category 1)

  • Nutritional consultation and cognitive behavioral therapy for sleep disturbances (category 1) are also options

  • Psychostimulants (methylphenidate) should be prescribed only after the exclusion of other causes of fatigue and failure of other interventions

  • Modafinil is not recommended

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