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Screening, Assessment, and Management of Fatigue in Adult Survivors of Cancer: An American Society of Clinical Oncology Clinical Practice Guideline Adaptation

Julienne E. Bower, Kate Bak, Ann Berger, William Breitbart, Carmelita P. Escalante, Patricia A. Ganz, Hester Hill Schnipper, Christina Lacchetti, Jennifer A. Ligibel, Gary H. Lyman, Mohammed S. Ogaily, William F. Pirl and Paul B. Jacobsen

Journal of Clinical Oncology, In Press, April 2014 

Editors' comments: Dr Carla Ripamonti

The concept of fatigue should be integrated with the wider area of quality of life (QoL) and of functioning. Fatigue itself has a negative impact on QoL and the underlying mechanisms of this connection are poorly understood. Fatigue is an underestimated symptom not only during treatment but also several months after primary diagnosis and among survivors.  The ASCO Clinical Practice Guideline Adaptation is specifically addressed to cancer survivors ≥ 18 years and has the intent to inform health care professionals involved in the delivery of care for survivors as well as patients, family members and caregivers of patients who have survived cancer.
All the patients should be routinely screened for the presence of fatigue starting from the diagnosis and at least annually as clinically indicated and by means of a simple assessment tool such as a 0-10 numerical rating scale. For patients with moderate (4 to 6) to severe fatigue (7 to 10) a multisymptom screening tool may have greater clinical utility. A comprehensive and focused assessment include a focused fatigue history, the evaluation of disease status and the assessment of treatable contributing factors, and laboratory evaluation. The Treatment and Care Map of Fatigue in cancer survivors include 1. the treatment of contributing factors, 2. interventions for Cancer-Related Fatigue, 3. physical activity,4. psychosocial interventions, 5. mind-body interventions, 6.pharmacologic interventions,7. ongoing monitoring and follow-up, 8. education and counseling.