Howell, D., Keller-Olaman, S., Oliver, T.K., Hack, T.F., Broadfield, L., Biggs, K., . . . Olson, K. (2013). A pan-Canadian practice guideline and algorithm: Screening, assessment, and supportive care of adults with cancer-related fatigue. Current Oncology, 20, e233–e246. 

STUDY PURPOSE: To develop a practice guideline to inform healthcare providers about screening, assessment, and effective management of cancer-related fatigue (CRF) in adults

 

TYPE OF STUDY: Systematic review

DATABASES USED: The Guidelines International Network (http://www.g-i-n.net), the National Guidelines Clearinghouse (http://www.guideline.gov), and the Canadian Partnership Against Cancer Sage Inventory of Cancer Guidelines (http://www.cancerview.ca) web sites, the U.K. National Institute for Health and Clinical Excellence, the Scottish Intercollegiate Guideline Network, the U.S. National Comprehensive Cancer Network, and provincial guideline organizations [Cancer Care Ontario, the Vancouver Island Health Authority and Fraser Health in British Columbia, and Cancer Care Nova Scotia] to December 2009. In addition, CINAHL and the Cochrane Library were used.

 

KEYWORDS: Fatigue, cancer, neoplasm, asthenia, interventions, guidelines, recommendations, practice guidelines, management of CRF, pharmacological treatments, non-pharmacological treatments screening, and assessment 

 

INCLUSION CRITERIA: Clinical practice guidelines, systematic reviews, and other guidance documents with explicit links to the evidence and a focus on anyone or a combination of screening, assessment, or management of adult CRF (pharmacologic or non-pharmacologic) were included. In addition, patients 18 years of age or older, any cancer type, studies published after 2003, English, and systematic reviews (with or without meta-analyses) published from 2004–2009.

 

EXCLUSION CRITERIA: Developed prior to 2003; no guidelines for practice; not specific to cancer population; did not address CRF management in comprehensive manner, lay information, or clinical knowledge summary

TOTAL REFERENCES RETRIEVED: 19

 

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: A multidisciplinary panel of experts from across Canada used the ADAPT methodology and AGREE II instrument. The AGREE II is a critical appraisal tool that guides the selection of the best quality guidelines for use in an adapted guideline. It evaluates the quality of the guidelines being adapted based on six domains: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. A nominal group consensus method was used to reach final expert panel agreement on guideline recommendations. A multidisciplinary panel of experts that included cancer survivors served in an advisory capacity. 

• FINAL NUMBER STUDIES INCLUDED = 7 (two primary guidelines)
• TOTAL PATIENTS INCLUDED IN REVIEW: Not provided
• SAMPLE RANGE ACROSS STUDIES: Not provided
• KEY SAMPLE CHARACTERISTICS: 18 years of age and older

Two clinical practice guidelines were identified for adaptation. Seven guidance documents and four systematic reviews also provided supplementary evidence to inform guideline recommendations. Health professionals across Canada provided expert feedback on the adapted recommendations in the practice guideline and algorithm through a participatory external review process. New guideline developed to include screening, comprehensive and focused assessment, and treatment and care options.

 

Treatment portion of results: Recommendations were based on NCCN and the Oncology Nursing Society (ONS). NCCN recommends exercise, CBT, and psychosocial interventions. ONS recommends exercise. Energy conservation, education, CBT, and relaxation are likely to be effective. A Cochrane review reported mixed results for methylphenidate. NCI recommends the use of psychostimulants on for severe fatigue. Erythropoietin and darbepoetin were reported to be effective but effective dose size and duration were not established.