Updated Cancer-Related Fatigue Guidelines List Helpful Interventions

New guidelines highlight modalities that may be used to mitigate cancer-related fatigue.

The updated 2024 guidelines from the American Society of Clinical Oncology-Society of Integrative Oncology (ASCO-SIO) included several interventions — such as exercise and acupressure — to help manage cancer-related fatigue in adult survivors of cancer.

Cancer-related fatigue is defined as the “experience of physical, emotional and/or mental exhaustion related to cancer or its treatment,” according to the National Comprehensive Cancer Network (NCCN) guidelines for patients. Of note, the guideline stated that cancer-related fatigue is not everyday tiredness; it is described as a lack of energy that can be distressing to survivors.

READ MORE: Cancer and Fatigue Go Together

This common side effect may stem from the cancer or the cancer treatment and does not improve after an average amount of sleep, which can significantly affect quality of life months or years after the end of treatment, the guideline reports.

In a recent review of the updated ASCO-SIO guidelines published in the Journal of Clinical Oncology, the authors identified effective ways survivors can manage their cancer-related fatigue, how to choose recommended interventions and also explained why some interventions may not be as helpful, including wakefulness agents for alertness.

Interventions to Help With Cancer-Related Fatigue

Interestingly, interventions were divided into groups based on the timing of treatment, according to the review.

For people actively receiving cancer treatment, recommended interventions for cancer-related fatigue with the strength of the organization’s recommendation include:

• Exercising with a combination of aerobic and resistance training (strong)
• Cognitive behavioral therapy (strong)
• Mindfulness-based programs (strong)
• Tai chi and qigong (strong)
• Psychoeducation, which is gaining information and support to cope and understand the disease (conditional)
• American ginseng (conditional)

After active treatment, six interventions were recommended for cancer-related fatigue with their strengths, including:

1. Combination exercise with aerobic and resistance exercises (strong)
2. Cognitive behavioral therapy (strong)
3. Mindfulness-based programs (strong)
4. Yoga (conditional)
5. Acupressure (conditional)
6. Moxibustion, which is burning dried mugwort leaves to warm pressure points (conditional)

How Survivors Can Choose Recommended Interventions

Deciding on an appropriate intervention for cancer-related fatigue is not straightforward, the authors noted.

“Exercise can be modulated to meet the needs of an individual patient, given that a range of exercise approaches have shown efficacy in managing [cancer-related fatigue],” the authors wrote. “Some patients may be unwilling or unable to participate in regular exercise or may have more severe and persistent fatigue that requires a different approach.”

For this population of survivors, they advised that trying cognitive behavioral therapy or a mindfulness-based program may be a better approach.

It’s also important for survivors to have a say in what intervention will be chosen, which will help with committing to the approach to achieve optimal outcomes: mitigating cancer-related fatigue.

Factors, such as accessibility and affordability of the intervention, matter, the authors emphasized. Having the severity of the fatigue evaluated will also help during the decision-making process.

When it comes to accessing these interventions, may cancer centers and community oncology practices in the U.S. offer many of these integrative interventions, the authors stated.

“However, the level of these services vary in terms of accessibility and quality,” they wrote. “Many cancer centers and community oncology practices struggle to source qualified professionals [who are] adept at delivering these therapies within an oncology setting and to fund these services long-term for all patients and survivors.”

Interventions for Cancer-Related Fatigue Deemed Unhelpful

During the 2024 ASCO-SIO panel review of appropriate interventions to help manage cancer-related fatigue, it was reported that no data support the effectiveness of certain medications.

Wakefulness agents (help with staying alert and awake), psychostimulants or antidepressants were not found effective for cancer-related fatigue during or after cancer treatment, the authors emphasized.

“Additionally, a stepped-care approach could be helpful in some circumstances, where medications are added to behavioral and integrative therapies if a survivor’s fatigue is not relieved by recommended first-line therapies alone,” they wrote. “In such cases, a judicious and short-term use of medications for patients with severe cancer-related fatigue with close monitoring for side effects can be considered.

“In addition, medications may be helpful for patients whose fatigue is driven by another medical or psychiatric condition, such as depression.”

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