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J Clin Oncol. 2014 Jun 10;32(17):1840-50. doi: 10.1200/JCO.2013.53.4495. Epub 2014 Apr 14.

Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.

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  • 1Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.



This guideline presents screening, assessment, and treatment approaches for the management of adult cancer survivors who are experiencing symptoms of fatigue after completion of primary treatment.


A systematic search of clinical practice guideline databases, guideline developer Web sites, and published health literature identified the pan-Canadian guideline on screening, assessment, and care of cancer-related fatigue in adults with cancer, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines In Oncology (NCCN Guidelines) for Cancer-Related Fatigue and the NCCN Guidelines for Survivorship. These three guidelines were appraised and selected for adaptation.


It is recommended that all patients with cancer be evaluated for the presence of fatigue after completion of primary treatment and be offered specific information and strategies for fatigue management. For those who report moderate to severe fatigue, comprehensive assessment should be conducted, and medical and treatable contributing factors should be addressed. In terms of treatment strategies, evidence indicates that physical activity interventions, psychosocial interventions, and mind-body interventions may reduce cancer-related fatigue in post-treatment patients. There is limited evidence for use of psychostimulants in the management of fatigue in patients who are disease free after active treatment.


Fatigue is prevalent in cancer survivors and often causes significant disruption in functioning and quality of life. Regular screening, assessment, and education and appropriate treatment of fatigue are important in managing this distressing symptom. Given the multiple factors contributing to post-treatment fatigue, interventions should be tailored to each patient's specific needs. In particular, a number of nonpharmacologic treatment approaches have demonstrated efficacy in cancer survivors.

© 2014 by American Society of Clinical Oncology.

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