<< View All Contributors
Susan Krigel, PhD, is a licensed clinical psychologist with the Midwest Cancer Alliance. Her cancer-related career has spanned 10 years, and began when she worked as a Cancer Information Specialist for the National Cancer Institute. In her role at the Midwest Cancer Alliance, she utilizes her clinical and research skills to create and conduct programs with cancer patients across Kansas and western Missouri, focusing on improving the quality of life during survivorship. Programs are delivered both in person and via telemedicine. She also participates in professional development programs for healthcare providers.

Cancer-Related Fatigue: NCCN Guidelines and Treatments

This portion of the blog will provide information on NCCN Guidelines and various treatments for CRF.
PUBLISHED: 7:49 PM, MON JANUARY 19, 2015
Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
The first section of this blog focused on several facets of cancer-related fatigue (CRF): an overview, definition, prevalence, etiology, and the impact on patients’ lives. This portion of the blog will provide information on NCCN Guidelines and various treatments for CRF.

ARE THERE ESTABLISHED GUIDELINES FOR HELPING PATIENTS WITH CRF?
Fortunately, the NCCN has released evidence-based guidelines for addressing CRF2. The guidelines are quite comprehensive and state that cancer patients should be screened and treated for CRF from diagnosis onward. Also, patients and their families should be educated about CRF, including the information that CRF may persist after treatment has ended.  In addition, the standards recommend the utilization of CRF as a quality improvement outcome measure. Finally, the standards call for reimbursement for managing CRF as part of medical contracts with insurance companies.

IS THERE A “GOLD STANDARD” FOR MANAGING CRF? 
Unfortunately, there is no magic bullet for dealing with CRF.  As with many disease-related symptoms, a first step should be addressing possible co-occurring symptoms, such as sleep disturbances, distress, or pain.  Next, strategies should be provided to “manage” CRF.  The NCCN Guidelines include an excellent list of management strategies, beginning with monitoring levels of fatigue and prioritizing activities, adjusting expectations, enlisting social support, limiting naps, and encouraging acceptance of the current situation2.

WHAT ARE SOME SPECIFIC INTERVENTIONS FOR CRF?
Interventions fall into two broad categories: pharmacological and non-pharmacological, which includes a range of options, ranging from psychological and psychosocial interventions, referrals to rehabilitation, and exercise.

WOULDN’T TREATING CRF WITH DRUGS BE AN EASY SOLUTION?
Yes, prescribing drugs for CRF would be expedient, but scientific evidence supporting pharmacologic management of CRF is lacking.  Drugs used to treat CRF have included psychostimulants, bupropion, dexamethasone, and growth factors.  Hemopoietic growth factors have been shown to cause safety issues which outweigh the possible benefits7. Although small studies have demonstrated some patients with severe CRF may benefit from the use of psychostimulants, currently the evidence supporting the widespread use of drugs to treat CRF is lacking8.

SO WHAT OTHER OPTIONS ARE RECOMMENDED FOR TREATING CRF? 
There are several non-pharmacologic methods for treating CRF.  Strategies include addressing concerns with a multidisciplinary team, and when appropriate, making referrals to nutritionists, physical therapists, occupational therapists, etc.

The most studied intervention for treating CRF is exercise. Recent meta-analyses 9-10 have documented that exercise interventions can offer significant benefits to a wide variety of cancer patients both during and after treatment.

Therefore, if at all possible, patients should be encouraged to establish a regular exercise routine.Patients may face barriers which make exercise difficult, and referrals to the appropriate therapists may be helpful. It is also important to assist patients in creating realistic goals for exercise so they don’t get discouraged.  Advise them to “start low and go slow,” and to be specific and realistic when setting goals.

Psychosocial interventions for CRF have been shown to have small but clinically meaningful effects9 and include a variety of treatments, including education and counseling, Cognitive Behavioral Therapy for sleep, supportive-expressive therapy, and behavioral/relaxation therapies.  Common elements in the programs include educating patients and families on CRF, prioritization of activities, energy management, and coping strategies11.


References (continued)
  1. Minton O, Richardson A, Sharpe M, et al. Drug therapy for the management of cancer-related fatigue.  Cochrane Database Syst Rev. 2010;7:CD006704.
  2. Minton O, Richardson A, Sharpe M, et al. Psychostimulants for the management of cancer-related fatigue:  a systematic review and meta-analysis.  J Pain Sympt Manag. 2011;41:761-767.
  3. Kangas M, Bovbjerg DH, Montgomery GH. Cancer-related fatigue:  a systematic and meta-analytic review of non-pharmacological therapies for cancer patients.  Psychol Bull. 2008;134:700-741.
  4. Cramp F, Byron-Daniel  J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012;11:CD006145.
  5. Goedendorp MM, Gielissen MFM, Verhagen C AHHVM, et al. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev. 2009;1:CD006953.


Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
More from Susan Krigel, PhD
This second installment of this blog on loneliness focuses on how loneliness may compromise health and can be combatted against.
PUBLISHED: Fri March 24 2017
Exploring loneliness and its effect on health. Part 1 of 2.
PUBLISHED: Wed February 22 2017
The first section of this blog provided statistics on suicide and warning signs,
PUBLISHED: Thu August 13 2015
Have you encountered patients who have voiced the wish to kill themselves?
PUBLISHED: Wed July 15 2015
External Resources

MJH Associates
American Journal of Managed Care
Cure
MD Magazine
Pharmacy Times
Physicians' Education Resource
Specialty Pharmacy Times
TargetedOnc
OncNurse Resources

Blogs
Continuing Education
Discussions
Web Exclusives


About Us
Advertise
Advisory Board
Careers
Contact Us
Privacy Policy
Terms & Conditions
Intellisphere, LLC
2 Clarke Drive
Suite 100
Cranbury, NJ 08512
P: 609-716-7777
F: 609-716-4747

Copyright OncNursing 2006-2017
Intellisphere, LLC. All Rights Reserved.