Bower, J.E., Bak, K., Berger, A., Breitbart, W., Escalante, C.P., Ganz, P.A., . . . American Society of Clinical Oncology. (2014). Screening, assessment, and management of fatigue in adult survivors of cancer: An American Society of Clinical Oncology clinical practice guideline adaptation. Journal of Clinical Oncology, 32, 1840–1850. 

DOI Link

Purpose & Patient Population

PURPOSE: To present screening, assessment, and treatment procedures for adult survivors of cancer who have completed treatment
 
TYPES OF PATIENTS ADDRESSED: Cancer survivors diagnosed at age 18 or older who completed curative treatment, are considered in remission, or are disease-free and on maintenance therapy.

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Consensus-based guideline  
 
PROCESS OF DEVELOPMENT: Two content experts reviewed and recommended use of pan-Canadian guideline; the ASCO panel suggested use of National Comprehensive Cancer Network (NCCN) articles. The Appraisal of Guidelines for Research and Evaluation (AGREE) II subscale was then used on three articles. Experts issued recommendations based on guidelines and modified based on local context and practice beliefs.
 
DATABASES USED: MEDLINE and Embase
 
KEYWORDS: Fatigue, cancer, survivor, post-treatment, late effects, long-term effects
 
INCLUSION CRITERIA: Cancer survivors diagnosed at age 18 or older who completed curative treatment, are considered in remission, or are disease-free and on maintenance therapy.
 
EXCLUSION CRITERIA: None

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

Results Provided in the Reference

Adapted from three guidelines by multidisciplinary experts using supplementary evidence and clinical experience. Most recommendations listed verbatim but some modified to include updated evidence or current practice beliefs.

Guidelines & Recommendations

Recommendations focused on patients who have completed active treatment or are considered in clinical remission. Treat underlying causes, moderate physical activity after cancer treatment with PT and lymphedema referrals as needed (meta-analysis, systematic review, [randomized controlled trial [RCT]; 10 cited), cognitive behavioral therapy (meta-analysis, RCT, systematic reviews; 6 cited), psychoeducational therapies (systematic, RCT; 3 cited), psychosocial services, mindfulness-based interventions (RCT; 3 cited), yoga (RCT; 2 cited), acupuncture (RCT; 2 cited), psychostimulants/wakefulness agents (limited evidence in patients who are post-treatment disease-free). Additional areas in which research needed include biofield therapies, massage, music therapy, relaxation, Reiki, Qigong, ginseng, and vitamin D.

Limitations

Guidelines were tailored to survivors with current evidence as not all evidence done is survivors.

Nursing Implications

Screening, assessment, and treatment guidelines summarized for use in cancer survivors.