Here is a summary of the guideline update from the American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology (SIO) for the management of cancer-related fatigue (CRF) in adult survivors of cancer, based on systematic reviews of randomized controlled trials (RCTs) published from 2013 to 2023.
Main Findings:
- Cancer-Related Fatigue (CRF) Overview:
- CRF is a common and distressing symptom affecting 30%-60% of patients during treatment and 20%-30% post-treatment.
- CRF significantly impacts physical, emotional, social, and occupational functioning.
- Multiple contributing factors include cancer itself, treatment side effects, psychological conditions, sleep disturbances, and deconditioning.
2. Key Interventions and Their Efficacy:
- Exercise (aerobic, resistance, or combined): Consistently reduces CRF during and after treatment.
- Cognitive Behavioral Therapy (CBT): Effective in managing moderate to severe fatigue.
- Mindfulness-based programs (including mindfulness-based stress reduction – MBSR): Significantly reduce fatigue.
- Tai Chi and Qigong: Show benefits in reducing CRF during treatment.
- Yoga, Acupressure, and Moxibustion: Recommended post-treatment.
- American Ginseng: May help during treatment.
Psychoeducation: Can provide benefits in fatigue management.
Recommendations:
- During Treatment:
- Strong Recommendations: Exercise, CBT (with/without hypnosis), mindfulness-based programs, tai chi, qigong.
- Conditional Recommendations: Psychoeducation, American ginseng.
- Not Recommended: Wakefulness agents, L-carnitine, antidepressants, psychostimulants.
- Insufficient Evidence: Acupressure, yoga, dietary supplements, music therapy, reflexology.
- After Treatment:
- Strong Recommendations: Exercise, CBT, mindfulness-based programs.
- Conditional Recommendations: Yoga, acupressure, moxibustion.
Not Recommended: Psychostimulants, wakefulness agents.
Conclusion
The most effective strategies for managing CRF in cancer survivors include exercise, CBT, mindfulness-based programs, and integrative therapies such as tai chi, qigong, yoga, and acupressure. Pharmacological interventions are generally not recommended, except for corticosteroids at end-of-life care. These recommendations highlight the importance of non-pharmacological approaches and individualized care plans to improve quality of life in cancer survivors.
