Cancer-related fatigue clinical practice guidelines in oncology

Victoria Mock, Amy Pickar Abernethy, Ashley Atkinson, Andrea M. Barsevick, Ann Malone Berger, David Cella, Bernadine Cimprich, Charles Cleeland, Mario A. Eisenberger, Carmen P. Escalante, Pamela Hinds, Paul B. Jacobsen, Phyllis Kaldor, Tracey O'Connor, Shirley A. Otis-Green, Barbara F. Piper, William F. Pirl, Hope S. Rugo, Paul Sabbatini, F. Marc StewartLynne I. Wagner

Research output: Contribution to journalReview article

66 Citations (Scopus)

Abstract

These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue using a brief screening instrument and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point, the patient is assessed for current disease and treatment status and undergoes a review of body systems and an in-depth fatigue evaluation. In addition, the patient is assessed for the presence of 7 treatable factors known to contribute to fatigue: pain, emotional distress, sleep disturbance, anemia, alteration in nutrition, deconditioning, and comorbidities. If any of these conditions are present, they should be treated according to practice guidelines, with referral to other care professionals as appropriate, and the patient's fatigue should be reevaluated regularly. If none of the 7 factors is present or if the fatigue is unresolved, appropriate fatigue management and treatment strategies are selected within the context of the patient's clinical status (e.g., undergoing active cancer treatment, disease-free long-term follow-up, or care at end of life). Management of fatigue is cause-specific when conditions known to cause fatigue (e.g., infection, fluid and electrolyte imbalances, cardiac dysfunction) can be identified and treated. When specific causes of fatigue cannot be identified and corrected, the fatigue can still be treated with nonpharmacologic and pharmacologic interventions. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, psychosocial programs to manage stress and increase support, attention-restoring therapies to decrease cognitive alterations and improve mood state, energy conservation to maintain energy, and nutritional and sleep interventions for patients with disturbances in eating or sleeping. Pharmacologic therapy may include drugs, such as antidepressants for depression or erythropoietin for anemia. A few clinical reports on the use of psychostimulants suggest the need for further research on these agents as potential treatment modalities in managing fatigue. Effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients' fatigue levels regularly, counsels and educates patients on strategies for coping with fatigue,194 and uses institutional experts for referral of patients with unresolved fatigue.43.

Original languageEnglish (US)
Pages (from-to)1054-1078
Number of pages25
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume5
Issue number10
StatePublished - Nov 1 2007

Fingerprint

Practice Guidelines
Fatigue
Neoplasms
Therapeutics
Anemia
Sleep
Referral and Consultation
Aftercare
Patient Care Team
Erythropoietin
Electrolytes
Antidepressive Agents

Keywords

  • Bone marrow transplantation
  • Carcinoma treatment
  • Chemotherapy
  • Fatigue
  • NCCN clinical practice guidelines
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology

Cite this

Mock, V., Abernethy, A. P., Atkinson, A., Barsevick, A. M., Berger, A. M., Cella, D., ... Wagner, L. I. (2007). Cancer-related fatigue clinical practice guidelines in oncology. JNCCN Journal of the National Comprehensive Cancer Network, 5(10), 1054-1078.

Cancer-related fatigue clinical practice guidelines in oncology. / Mock, Victoria; Abernethy, Amy Pickar; Atkinson, Ashley; Barsevick, Andrea M.; Berger, Ann Malone; Cella, David; Cimprich, Bernadine; Cleeland, Charles; Eisenberger, Mario A.; Escalante, Carmen P.; Hinds, Pamela; Jacobsen, Paul B.; Kaldor, Phyllis; O'Connor, Tracey; Otis-Green, Shirley A.; Piper, Barbara F.; Pirl, William F.; Rugo, Hope S.; Sabbatini, Paul; Stewart, F. Marc; Wagner, Lynne I.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 5, No. 10, 01.11.2007, p. 1054-1078.

Research output: Contribution to journalReview article

Mock, V, Abernethy, AP, Atkinson, A, Barsevick, AM, Berger, AM, Cella, D, Cimprich, B, Cleeland, C, Eisenberger, MA, Escalante, CP, Hinds, P, Jacobsen, PB, Kaldor, P, O'Connor, T, Otis-Green, SA, Piper, BF, Pirl, WF, Rugo, HS, Sabbatini, P, Stewart, FM & Wagner, LI 2007, 'Cancer-related fatigue clinical practice guidelines in oncology', JNCCN Journal of the National Comprehensive Cancer Network, vol. 5, no. 10, pp. 1054-1078.
Mock V, Abernethy AP, Atkinson A, Barsevick AM, Berger AM, Cella D et al. Cancer-related fatigue clinical practice guidelines in oncology. JNCCN Journal of the National Comprehensive Cancer Network. 2007 Nov 1;5(10):1054-1078.
Mock, Victoria ; Abernethy, Amy Pickar ; Atkinson, Ashley ; Barsevick, Andrea M. ; Berger, Ann Malone ; Cella, David ; Cimprich, Bernadine ; Cleeland, Charles ; Eisenberger, Mario A. ; Escalante, Carmen P. ; Hinds, Pamela ; Jacobsen, Paul B. ; Kaldor, Phyllis ; O'Connor, Tracey ; Otis-Green, Shirley A. ; Piper, Barbara F. ; Pirl, William F. ; Rugo, Hope S. ; Sabbatini, Paul ; Stewart, F. Marc ; Wagner, Lynne I. / Cancer-related fatigue clinical practice guidelines in oncology. In: JNCCN Journal of the National Comprehensive Cancer Network. 2007 ; Vol. 5, No. 10. pp. 1054-1078.
@article{ed6b7dc6d48b4601a5b1ed91f49e78af,
title = "Cancer-related fatigue clinical practice guidelines in oncology",
abstract = "These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue using a brief screening instrument and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point, the patient is assessed for current disease and treatment status and undergoes a review of body systems and an in-depth fatigue evaluation. In addition, the patient is assessed for the presence of 7 treatable factors known to contribute to fatigue: pain, emotional distress, sleep disturbance, anemia, alteration in nutrition, deconditioning, and comorbidities. If any of these conditions are present, they should be treated according to practice guidelines, with referral to other care professionals as appropriate, and the patient's fatigue should be reevaluated regularly. If none of the 7 factors is present or if the fatigue is unresolved, appropriate fatigue management and treatment strategies are selected within the context of the patient's clinical status (e.g., undergoing active cancer treatment, disease-free long-term follow-up, or care at end of life). Management of fatigue is cause-specific when conditions known to cause fatigue (e.g., infection, fluid and electrolyte imbalances, cardiac dysfunction) can be identified and treated. When specific causes of fatigue cannot be identified and corrected, the fatigue can still be treated with nonpharmacologic and pharmacologic interventions. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, psychosocial programs to manage stress and increase support, attention-restoring therapies to decrease cognitive alterations and improve mood state, energy conservation to maintain energy, and nutritional and sleep interventions for patients with disturbances in eating or sleeping. Pharmacologic therapy may include drugs, such as antidepressants for depression or erythropoietin for anemia. A few clinical reports on the use of psychostimulants suggest the need for further research on these agents as potential treatment modalities in managing fatigue. Effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients' fatigue levels regularly, counsels and educates patients on strategies for coping with fatigue,194 and uses institutional experts for referral of patients with unresolved fatigue.43.",
keywords = "Bone marrow transplantation, Carcinoma treatment, Chemotherapy, Fatigue, NCCN clinical practice guidelines, Radiation therapy",
author = "Victoria Mock and Abernethy, {Amy Pickar} and Ashley Atkinson and Barsevick, {Andrea M.} and Berger, {Ann Malone} and David Cella and Bernadine Cimprich and Charles Cleeland and Eisenberger, {Mario A.} and Escalante, {Carmen P.} and Pamela Hinds and Jacobsen, {Paul B.} and Phyllis Kaldor and Tracey O'Connor and Otis-Green, {Shirley A.} and Piper, {Barbara F.} and Pirl, {William F.} and Rugo, {Hope S.} and Paul Sabbatini and Stewart, {F. Marc} and Wagner, {Lynne I.}",
year = "2007",
month = "11",
day = "1",
language = "English (US)",
volume = "5",
pages = "1054--1078",
journal = "JNCCN Journal of the National Comprehensive Cancer Network",
issn = "1540-1405",
publisher = "Cold Spring Publishing LLC",
number = "10",

}

TY - JOUR

T1 - Cancer-related fatigue clinical practice guidelines in oncology

AU - Mock, Victoria

AU - Abernethy, Amy Pickar

AU - Atkinson, Ashley

AU - Barsevick, Andrea M.

AU - Berger, Ann Malone

AU - Cella, David

AU - Cimprich, Bernadine

AU - Cleeland, Charles

AU - Eisenberger, Mario A.

AU - Escalante, Carmen P.

AU - Hinds, Pamela

AU - Jacobsen, Paul B.

AU - Kaldor, Phyllis

AU - O'Connor, Tracey

AU - Otis-Green, Shirley A.

AU - Piper, Barbara F.

AU - Pirl, William F.

AU - Rugo, Hope S.

AU - Sabbatini, Paul

AU - Stewart, F. Marc

AU - Wagner, Lynne I.

PY - 2007/11/1

Y1 - 2007/11/1

N2 - These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue using a brief screening instrument and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point, the patient is assessed for current disease and treatment status and undergoes a review of body systems and an in-depth fatigue evaluation. In addition, the patient is assessed for the presence of 7 treatable factors known to contribute to fatigue: pain, emotional distress, sleep disturbance, anemia, alteration in nutrition, deconditioning, and comorbidities. If any of these conditions are present, they should be treated according to practice guidelines, with referral to other care professionals as appropriate, and the patient's fatigue should be reevaluated regularly. If none of the 7 factors is present or if the fatigue is unresolved, appropriate fatigue management and treatment strategies are selected within the context of the patient's clinical status (e.g., undergoing active cancer treatment, disease-free long-term follow-up, or care at end of life). Management of fatigue is cause-specific when conditions known to cause fatigue (e.g., infection, fluid and electrolyte imbalances, cardiac dysfunction) can be identified and treated. When specific causes of fatigue cannot be identified and corrected, the fatigue can still be treated with nonpharmacologic and pharmacologic interventions. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, psychosocial programs to manage stress and increase support, attention-restoring therapies to decrease cognitive alterations and improve mood state, energy conservation to maintain energy, and nutritional and sleep interventions for patients with disturbances in eating or sleeping. Pharmacologic therapy may include drugs, such as antidepressants for depression or erythropoietin for anemia. A few clinical reports on the use of psychostimulants suggest the need for further research on these agents as potential treatment modalities in managing fatigue. Effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients' fatigue levels regularly, counsels and educates patients on strategies for coping with fatigue,194 and uses institutional experts for referral of patients with unresolved fatigue.43.

AB - These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue using a brief screening instrument and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point, the patient is assessed for current disease and treatment status and undergoes a review of body systems and an in-depth fatigue evaluation. In addition, the patient is assessed for the presence of 7 treatable factors known to contribute to fatigue: pain, emotional distress, sleep disturbance, anemia, alteration in nutrition, deconditioning, and comorbidities. If any of these conditions are present, they should be treated according to practice guidelines, with referral to other care professionals as appropriate, and the patient's fatigue should be reevaluated regularly. If none of the 7 factors is present or if the fatigue is unresolved, appropriate fatigue management and treatment strategies are selected within the context of the patient's clinical status (e.g., undergoing active cancer treatment, disease-free long-term follow-up, or care at end of life). Management of fatigue is cause-specific when conditions known to cause fatigue (e.g., infection, fluid and electrolyte imbalances, cardiac dysfunction) can be identified and treated. When specific causes of fatigue cannot be identified and corrected, the fatigue can still be treated with nonpharmacologic and pharmacologic interventions. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, psychosocial programs to manage stress and increase support, attention-restoring therapies to decrease cognitive alterations and improve mood state, energy conservation to maintain energy, and nutritional and sleep interventions for patients with disturbances in eating or sleeping. Pharmacologic therapy may include drugs, such as antidepressants for depression or erythropoietin for anemia. A few clinical reports on the use of psychostimulants suggest the need for further research on these agents as potential treatment modalities in managing fatigue. Effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients' fatigue levels regularly, counsels and educates patients on strategies for coping with fatigue,194 and uses institutional experts for referral of patients with unresolved fatigue.43.

KW - Bone marrow transplantation

KW - Carcinoma treatment

KW - Chemotherapy

KW - Fatigue

KW - NCCN clinical practice guidelines

KW - Radiation therapy

UR - http://www.scopus.com/inward/record.url?scp=37049000175&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=37049000175&partnerID=8YFLogxK

M3 - Review article

C2 - 18053429

AN - SCOPUS:37049000175

VL - 5

SP - 1054

EP - 1078

JO - JNCCN Journal of the National Comprehensive Cancer Network

JF - JNCCN Journal of the National Comprehensive Cancer Network

SN - 1540-1405

IS - 10

ER -