Guideline recommends exercise, cognitive behavioral therapy for cancer-related fatigue
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ASCO and the Society for Integrative Oncology released new clinical practice guidelines for management of cancer-related fatigue.
A multidisciplinary panel of experts developed the guidelines based on a systematic literature review of 113 published clinical trials.
The guidelines — intended for people undergoing active treatment, as well as cancer survivors — support the use of exercise, cognitive behavioral therapy (CBT) and other interventions.
Healio spoke with guideline co-chair Karen Mustian, PhD, MPH, professor in the division of cancer control at University of Rochester Medical Center and associate director of population science at Wilmot Cancer Institute, about the key components of the new guidelines and how they may benefit people living with cancer-related fatigue.
Healio: Can you describe the need for this guideline update?
Mustian: Cancer-related fatigue is an overwhelming sense of tiredness that doesn’t go away. In some instances, it’s so debilitating it prevents a patient from being able to adhere to their treatment. At other times, this fatigue requires that we make dose reductions or treatment adjustments, which can negatively affect a patient’s prognosis.
A prior ASCO guideline focused only on patients who had completed primary treatment. Now, we have considerably more published research available to help us make recommendations for patients in active treatment, as well as those with advanced cancer.
Healio: What are some key recommendations?
Mustian: There is fairly strong evidence behind exercise, CBT, mindfulness-based programs, and tai chi or Qigong to reduce severity of fatigue during cancer treatment. The evidence is not quite as strong for psychoeducation or American ginseng, but they look very promising and we think they can be suggested for patients during treatment.
For people who completed active treatment, we suggest exercise, CBT and mindfulness-based programs. There is strong evidence for these interventions for people experiencing mild to severe fatigue after treatment. We also recommend yoga and moxibustion, an interesting therapy that is used in conjunction with acupuncture and is supported by promising evidence.
For people with advanced cancer who are at the end of life, we recommend patients be offered CBT and corticosteroids.
Healio: Is there anything else you would like to highlight?
Mustian: We are only recommending a pharmaceutical product for an end-of-life setting. That is a big change. Polypharmacy can become a very serious consideration and create additional problems.
This guideline also addresses interventions that should not be used. These include L-carnitine, antidepressants, wakefulness agents and psychostimulants. Historically, these had been recommended, but there is insufficient evidence to support them. There are other interventions for which we can’t definitively say whether they are useful. We might see a study on hypnosis, for example, but we can’t make recommendations because the evidence isn’t strong enough.
Healio: How can oncologists use these recommendations to help their patients?
Mustian: We don’t expect oncologists or oncology nurses to be experts in exercise, CBT, acupuncture or Qigong. However, we hope they become knowledgeable about what’s available in their community so they can refer their patients to these resources.
Clinicians should be familiar with integrative medicine — especially integrative oncology programs within their communities — and they should refer their patients to these services as early as possible. Patients should be told about these services shortly after diagnosis, while they are going through treatment, after they finish treatment and during follow-up visits. It should be a continual process, because you never know when a patient might be ready, able and willing to take advantage of these services.
Reference:
For more information:
Karen Mustian, PhD, MPH, can be reached at karen_mustian@urmc.rochester.edu.
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