NCCN Categories of Evidence and Consensus
Category 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate.
Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.
All recommendations are category 2A unless otherwise noted.
Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
Ahlberg K, Ekman T, Gaston-Johansson F, Mock V. Assessment and management of cancer-related fatigue in adults. Lancet 2003;362:640–650.
Collins JJ, Devine TD, Dick GS et al.. The measurement of symptoms in young children with cancer: the validation of the Memorial Symptom Assessment Scale in children aged 7–12. J Pain Symptom Manage 2002;23:10–16.
Henry DH, Viswanathan HN, Elkin EP et al.. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer 2008;16:791–801.
Hofman M, Ryan JL, Figueroa-Moseley CD et al.. Cancer-related fatigue: the scale of the problem. Oncologist 2007;12(Suppl 1):4–10.
Portenoy RK, Kornblith AB, Wong G et al.. Pain in ovarian cancer patients. Prevalence, characteristics, and associated symptoms. Cancer 1994;74:907–915.
Ventafridda V, De Conno F, Ripamonti C et al.. Quality-of-life assessment during a palliative care programme. Ann Oncol 1990;1:415–420.
Portenoy RK, Thaler HT, Kornblith AB et al.. Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res 1994;3:183–189.
Wang XS, Zhao F, Fisch MJ et al.. Prevalence and characteristics of moderate to severe fatigue: a multicenter study in cancer patients and survivors. Cancer 2014;120:425–432.
Bower JE, Ganz PA, Aziz N et al.. T-cell homeostasis in breast cancer survivors with persistent fatigue. J Natl Cancer Inst 2003;95:1165–1168.
Bower JE, Ganz PA, Desmond KA et al.. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 2000;18:743–753.
Crom DB, Hinds PS, Gattuso JS et al.. Creating the basis for a breast health program for female survivors of Hodgkin disease using a participatory research approach. Oncol Nurs Forum 2005;32:1131–1141.
Fossa SD, Dahl AA, Loge JH. Fatigue, anxiety, and depression in long-term survivors of testicular cancer. J Clin Oncol 2003;21:1249–1254.
Haghighat S, Akbari ME, Holakouei K et al.. Factors predicting fatigue in breast cancer patients. Support Care Cancer 2003;11:533–538.
Ruffer JU, Flechtner H, Tralls P et al.. Fatigue in long-term survivors of Hodgkin's lymphoma; a report from the German Hodgkin Lymphoma Study Group (GHSG). Eur J Cancer 2003;39:2179–2186.
Servaes P, Verhagen S, Bleijenberg G. Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol 2002;13:589–598.
Servaes P, Verhagen S, Schreuder HW et al.. Fatigue after treatment for malignant and benign bone and soft tissue tumors. J Pain Symptom Manage 2003;26:1113–1122.
Olson K, Krawchuk A, Quddusi T. Fatigue in individuals with advanced cancer in active treatment and palliative settings. Cancer Nurs 2007;30:E1–10.
Hinds PS, Quargnenti A, Bush AJ et al.. An evaluation of the impact of a self-care coping intervention on psychological and clinical outcomes in adolescents with newly diagnosed cancer. Eur J Oncol Nurs 2000;4:6e–17; discussion 18–19.
Janda M, Gerstner N, Obermair A et al.. Quality of life changes during conformal radiation therapy for prostate carcinoma. Cancer 2000;89:1322–1328.
Bower JE. Cancer-related fatigue: links with inflammation in cancer patients and survivors. Brain Behav Immun 2007;21:863–871.
Schubert C, Hong S, Natarajan L et al.. The association between fatigue and inflammatory marker levels in cancer patients: a quantitative review. Brain Behav Immun 2007;21:413–427.
Miller AH, Ancoli-Israel S, Bower JE et al.. Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 2008;26:971–982.
Berger AM, Wielgus K, Hertzog M et al.. Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy. Support Care Cancer 2010;18:105–114.
al-Majid S, McCarthy DO. Cancer-induced fatigue and skeletal muscle wasting: the role of exercise. Biol Res Nurs 2001;2:186–197.
Rich TA. Symptom clusters in cancer patients and their relation to EGFR ligand modulation of the circadian axis. J Support Oncol 2007;5:167–174; discussion 176–167.
Mock V, Atkinson A, Barsevick A et al.. NCCN Practice Guidelines for Cancer-Related Fatigue. Oncology (Williston Park) 2000;14:151–161.
Given CW, Given B, Azzouz F et al.. Comparison of changes in physical functioning of elderly patients with new diagnoses of cancer. Med Care 2000;38:482–493.
Given B, Given CW, McCorkle R et al.. Pain and fatigue management: results of a nursing randomized clinical trial. Oncol Nurs Forum 2002;29:949–956.
Escalante CP, Grover T, Johnson BA et al.. A fatigue clinic in a comprehensive cancer center: design and experiences. Cancer 2001;92:1708–1713.
Hinds PS, Hockenberry M, Tong X et al.. Validity and reliability of a new instrument to measure cancer-related fatigue in adolescents. J Pain Symptom Manage 2007;34:607–618.
Hockenberry MJ, Hinds PS, Barrera P et al.. Three instruments to assess fatigue in children with cancer: the child, parent and staff perspectives. J Pain Symptom Manage 2003;25:319–328.
Varni JW, Burwinkle TM, Katz ER et al.. The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module. Cancer 2002;94:2090–2106.
Grant M. Fatigue and quality of life with cancer. In: Winningham ML, Barton-Burke M, eds. Fatigue in Cancer: A Multidimensional Approach. Sudbury, MA: Jones & Bartlett; 2000:353–364.
Barsevick AM, Whitmer K, Walker L. In their own words: using the common sense model to analyze patient descriptions of cancer-related fatigue. Oncol Nurs Forum 2001;28:1363–1369.
Curt GA, Breitbart W, Cella D et al.. Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 2000;5:353–360.
Mendoza TR, Wang XS, Cleeland CS et al.. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 1999;85:1186–1196.
Luciani A, Jacobsen PB, Extermann M et al.. Fatigue and functional dependence in older cancer patients. Am J Clin Oncol 2008;31:424–430.
van Ryn M, Sanders S, Kahn K et al.. Objective burden, resources, and other stressors among informal cancer caregivers: a hidden quality issue? Psychooncology 2011;20:44–52.
Ancoli-Israel S, Moore PJ, Jones V. The relationship between fatigue and sleep in cancer patients: a review. Eur J Cancer Care (Engl) 2001;10:245–255.
Berger AM, Walker SN. An explanatory model of fatigue in women receiving adjuvant breast cancer chemotherapy. Nurs Res 2001;50:42–52.
Dodd MJ, Miaskowski C, Paul SM. Symptom clusters and their effect on the functional status of patients with cancer. Oncol Nurs Forum 2001;28:465–470.
Hinds PS, Hockenberry M, Rai SN et al.. Nocturnal awakenings, sleep environment interruptions, and fatigue in hospitalized children with cancer. Oncol Nurs Forum 2007;34:393–402.
de Raaf PJ, de Klerk C, Timman R et al.. Systematic monitoring and treatment of physical symptoms to alleviate fatigue in patients with advanced cancer: a randomized controlled trial. J Clin Oncol 2013;31:716–723.
Hopwood P, Stephens RJ. Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. J Clin Oncol 2000;18:893–903.
Loge JH, Abrahamsen AF, Ekeberg, Kaasa S. Fatigue and psychiatric morbidity among Hodgkin's disease survivors. J Pain Symptom Manage 2000;19:91–99.
Berger AM, Parker KP, Young-McCaughan S et al.. Sleep wake disturbances in people with cancer and their caregivers: state of the science. Oncol Nurs Forum 2005;32:E98–126.
Palesh OG, Collie K, Batiuchok D et al.. A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biol Psychol 2007;75:37–44.
Mock V, Frangakis C, Davidson NE et al.. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psychooncology 2005;14:464–477.
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160:526–534.
Strasser F, Palmer JL, Schover LR et al.. The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer: a pilot study. Cancer 2006;107:2949–2957.
Mitchell SA, Beck SL, Hood LE et al.. Putting evidence into practice: evidence-based interventions for fatigue during and following cancer and its treatment. Clin J Oncol Nurs 2007;11:99–113.
Barsevick AM, Whitmer K, Sweeney C, Nail LM. A pilot study examining energy conservation for cancer treatment-related fatigue. Cancer Nurs 2002;25:333–341.
Barsevick AM, Dudley W, Beck S et al.. A randomized clinical trial of energy conservation for patients with cancer-related fatigue. Cancer 2004;100:1302–1310.
Mustian KM, Morrow GR, Carroll JK et al.. Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist 2007;12(Suppl 1):52–67.
Mitchell SA, Hoffman AJ, Clark JC et al.. Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment. Clin J Oncol Nurs 2014;18(Suppl):38–58.
Oncology Nursing Society Putting Evidence into Practice (PEP). Fatigue. Available at: https://www.ons.org/practice-resources/pep. Accessed April 24, 2015.
Irwin M, Johnson LA, eds. Putting Evidence Into Practice: A Pocket Guide to Cancer Symptom Management. Pittsburgh, PA: Oncology Nursing Society; 2014.
Bower JE, Bak K, Berger A et al.. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol 2014;32:1840–1850.
Howell D, Keller-Olaman S, Oliver TK et al.. A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue. Curr Oncol 2013;20:e233–246.
Mustian K, Palesh OG, Heckler CE et al.. Cancer-related fatigue interferes with activities of daily living among 753 patients receiving chemotherapy: a URCC CCOP study [abstract]. J Clin Oncol 2008;26(Suppl):Abstract 9500.
Puetz TW, Herring MP. Differential effects of exercise on cancer-related fatigue during and following treatment: a meta-analysis. Am J Prev Med 2012;43:e1–24.
Mishra SI, Scherer RW, Snyder C et al.. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 2012;8:CD008465.
Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol 2014;32:335–346.
Vermaete N, Wolter P, Verhoef G, Gosselink R. Physical activity, physical fitness and the effect of exercise training interventions in lymphoma patients: a systematic review. Ann Hematol 2013;92:1007–1021.
van Haren IE, Timmerman H, Potting CM et al.. Physical exercise for patients undergoing hematopoietic stem cell transplantation: systematic review and meta-analyses of randomized controlled trials. Phys Ther 2013;93:514–528.
Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008:CD006145.
Duijts SF, Faber MM, Oldenburg HS et al.. Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors—a meta-analysis. Psychooncology 2011;20:115–126.
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.
McMillan EM, Newhouse IJ. Exercise is an effective treatment modality for reducing cancer-related fatigue and improving physical capacity in cancer patients and survivors: a meta-analysis. Appl Physiol Nutr Metab 2011;36:892–903.
Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G, Wittink HM. The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials. Clin Oncol (R Coll Radiol) 2010;22:208–221.
U.S. Department of Health & Human Services. Physical Activity Guidelines for Americans. 2008. Available at: http://www.health.gov/paguidelines/. Accessed April 24, 2015.
Courneya KS, Friedenreich CM, Sela RA et al.. The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psychooncology 2003;12:357–374.
Courneya KS, Mackey JR, Bell GJ et al.. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol 2003;21:1660–1668.
Drouin JS, Armstrong H, Krause S. Effects of aerobic exercise training on peak aerobic capacity, fatigue, and psychological factors during radiation for breast cancer. Rehab Oncol 2005;23:11–17.
Schwartz AL, Mori M, Gao R et al.. Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Med Sci Sports Exerc 2001;33:718–723.
Segal RJ, Reid RD, Courneya KS et al.. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 2003;21:1653–1659.
Schmitz KH, Courneya KS, Matthews C et al.. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010;42:1409–1426.
Sood A, Barton DL, Bauer BA, Loprinzi CL. A critical review of complementary therapies for cancer-related fatigue. Integr Cancer Ther 2007;6:8–13.
Balk J, Day R, Rosenzweig M, Beriwal S. Pilot, randomized, modified, double-blind, placebo-controlled trial of acupuncture for cancer-related fatigue. J Soc Integr Oncol 2009;7:4–11.
Mao JJ, Styles T, Cheville A et al.. Acupuncture for nonpalliative radiation therapy-related fatigue: feasibility study. J Soc Integr Oncol 2009;7:52–58.
Molassiotis A, Sylt P, Diggins H. The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complement Ther Med 2007;15:228–237.
Vickers AJ, Straus DJ, Fearon B, Cassileth BR. Acupuncture for postchemotherapy fatigue: a phase II study. J Clin Oncol 2004;22:1731–1735.
Post-White J, Kinney ME, Savik K et al.. Therapeutic massage and healing touch improve symptoms in cancer. Integr Cancer Ther 2003;2:332–344.
Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. J Pain Symptom Manage 2004;28:244–249.
Towler P, Molassiotis A, Brearley SG. What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews. Support Care Cancer 2013;21:2913–2923.
Posadzki P, Moon TW, Choi TY et al.. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer 2013;21:2067–2073.
Ahles TA, Tope DM, Pinkson B et al.. Massage therapy for patients undergoing autologous bone marrow transplantation. J Pain Symptom Manage 1999;18:157–163.
Bower JE, Garet D, Sternlieb B et al.. Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer 2012;118:3766–3775.
Buffart LM, van Uffelen JG, Riphagen II et al.. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 2012;12:559.
Chandwani KD, Perkins G, Nagendra HR et al.. Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. J Clin Oncol 2014;32:1058–1065.
Kiecolt-Glaser JK, Bennett JM, Andridge R et al.. Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. J Clin Oncol 2014;32:1040–1049.
Sprod LK, Fernandez ID, Janelsins MC et al.. Effects of yoga on cancer-related fatigue and global side-effect burden in older cancer survivors. J Geriatr Oncol 2015;6:8–14.
Carlson LE, Garland SN. Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med 2005;12:278–285.
Lengacher CA, Reich RR, Post-White J et al.. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med 2012;35:86–94.
Hoffman CJ, Ersser SJ, Hopkinson JB et al.. Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. J Clin Oncol 2012;30:1335–1342.
- Search Google Scholar
- Export Citation
. Hoffman CJ Ersser SJ Hopkinson JB Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. J Clin Oncol 2012; 30: 1335– 1342.
Stark D, Kiely M, Smith A et al.. Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol 2002;20:3137–3148.
Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev 2009:CD006953.
Jacobsen PB, Donovan KA, Vadaparampil ST, Small BJ. Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychol 2007;26:660–667.
Eaton LH, Tipton JM, eds. Oncology Nursing Society Putting Evidence into Practice: Improving oncology patient outcomes. Pittsburgh, PA: Oncology Nursing Society; 2009.
Jacobsen PB, Meade CD, Stein KD et al.. Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. J Clin Oncol 2002;20:2851–2862.
Armes J, Chalder T, Addington-Hall J et al.. A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer-related fatigue. Cancer 2007;110:1385–1395.
Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psychooncology 2001;10:490–502.
Montgomery GH, Kangas M, David D et al.. Fatigue during breast cancer radiotherapy: an initial randomized study of cognitive-behavioral therapy plus hypnosis. Health Psychol 2009;28:317–322.
Boesen EH, Ross L, Frederiksen K et al.. Psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. J Clin Oncol 2005;23:1270–1277.
Gaston-Johansson F, Fall-Dickson JM, Nanda J et al.. The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. Cancer Nurs 2000;23:277–285.
Lindemalm C, Strang P, Lekander M. Support group for cancer patients. Does it improve their physical and psychological wellbeing? A pilot study. Support Care Cancer 2005;13:652–657.
Ream E, Richardson A, Alexander-Dann C. Supportive intervention for fatigue in patients undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manage 2006;31:148–161.
Yates P, Aranda S, Hargraves M et al.. Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 2005;23:6027–6036.
Allison PJ, Edgar L, Nicolau B et al.. Results of a feasibility study for a psycho-educational intervention in head and neck cancer. Psychooncology 2004;13:482–485.
Godino C, Jodar L, Duran A et al.. Nursing education as an intervention to decrease fatigue perception in oncology patients. Eur J Oncol Nurs 2006;10:150–155.
Yun YH, Lee KS, Kim YW et al.. Web-based tailored education program for disease-free cancer survivors with cancer-related fatigue: a randomized controlled trial. J Clin Oncol 2012;30:1296–1303.
Brown JK. A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia. Oncol Nurs Forum 2002;29:517–532.
Page MS, Berger AM, Johnson LB. Putting evidence into practice: evidence-based interventions for sleep-wake disturbances. Clin J Oncol Nurs 2006;10:753–767.
Berger AM, VonEssen S, Khun BR et al.. Feasibilty of a sleep intervention during adjuvant breast cancer chemotherapy. Oncol Nurs Forum 2002;29:1431–1441.
Food and Drug Administration. FDA News (March 14, 2007). Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108868.htm. Accessed April 24, 2015.
National Cancer Institute. Sleep Disorders PDQ (Health Professional Version). 2010. Available at: http://www.cancer.gov/cancertopics/pdq/supportivecare/sleepdisorders/HealthProfessional. Accessed April 24, 2015.
de la Cruz M, Hui D, Parsons HA, Bruera E. Placebo and nocebo effects in randomized double-blind clinical trials of agents for the therapy for fatigue in patients with advanced cancer. Cancer 2010;116:766–774.
Morrow GR, Hickok JT, Roscoe JA et al.. Differential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program. J Clin Oncol 2003;21:4635–4641.
Roscoe JA, Morrow GR, Hickok JT et al.. Effect of paroxetine hydrochloride (Paxil) on fatigue and depression in breast cancer patients receiving chemotherapy. Breast Cancer Res Treat 2005;89:243–249.
Schwartz AL, Thompson JA, Masood N. Interferon-induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate. Oncol Nurs Forum 2002;29:E85–90.
Butler JM Jr, Case LD, Atkins J et al.. A phase III, double-blind, placebo-controlled prospective randomized clinical trial of d-threo-methylphenidate HCl in brain tumor patients receiving radiation therapy. Int J Radiat Oncol Biol Phys 2007;69:1496–1501.
Mar Fan HG, Clemons M, Xu W et al.. A randomised, placebo-controlled, double-blind trial of the effects of d-methylphenidate on fatigue and cognitive dysfunction in women undergoing adjuvant chemotherapy for breast cancer. Support Care Cancer 2008;16:577–583.
Moraska AR, Sood A, Dakhil SR et al.. Phase III, randomized, double-blind, placebo-controlled study of long-acting methylphenidate for cancer-related fatigue: North Central Cancer Treatment Group NCCTG-N05C7 trial. J Clin Oncol 2010;28:3673–3679.
Minton O, Richardson A, Sharpe M et al.. Drug therapy for the management of cancer-related fatigue. Cochrane Database Syst Rev 2010;7:CD006704.
Jean-Pierre P, Morrow GR, Roscoe JA et al.. A phase 3 randomized, placebo-controlled, double-blind, clinical trial of the effect of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy: a University of Rochester Cancer Center Community Clinical Oncology Program Research base study. Cancer 2010;116:3513–3520.
- Search Google Scholar
- Export Citation
. Jean-Pierre P Morrow GR Roscoe JA A phase 3 randomized, placebo-controlled, double-blind, clinical trial of the effect of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy: a University of Rochester Cancer Center Community Clinical Oncology Program Research base study. Cancer 2010; 116: 3513– 3520.
Hovey E, de Souza P, Marx G et al.. Phase III, randomized, double-blind, placebo-controlled study of modafinil for fatigue in patients treated with docetaxel-based chemotherapy. Support Care Cancer 2014;22:1233–1242.
Lesser GJ, Case D, Stark N et al.. A randomized, double-blind, placebo-controlled study of oral coenzyme Q10 to relieve self-reported treatment-related fatigue in newly diagnosed patients with breast cancer. J Support Oncol 2013;11:31–42.
Cruciani RA, Dvorkin E, Homel P et al.. L-carnitine supplementation in patients with advanced cancer and carnitine deficiency: a double-blind, placebo-controlled study. J Pain Symptom Manage 2009;37:622–631.
Barton DL, Liu H, Dakhil SR et al.. Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. J Natl Cancer Inst 2013;105:1230–1238.
Knobel H, Loge JH, Nordoy T et al.. High level of fatigue in lymphoma patients treated with high dose therapy. J Pain Symptom Manage 2000;19:446–456.
Bower JE, Ganz PA, Aziz N, Fahey JL. Fatigue and proinflammatory cytokine activity in breast cancer survivors. Psychosom Med 2002;64:604–611.
Cella D, Davis K, Breitbart W et al.. Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol 2001;19:3385–3391.
Knobel H, Havard Loge J, Lund MB et al.. Late medical complications and fatigue in Hodgkin's disease survivors. J Clin Oncol 2001;19:3226–3233.
Stewart DE, Wong F, Duff S et al.. “What doesn't kill you makes you stronger”: an ovarian cancer survivor survey. Gynecol Oncol 2001;83:537–542.
Donovan KA, McGinty HL, Jacobsen PB. A systematic review of research using the diagnostic criteria for cancer-related fatigue. Psychooncology 2013;22:737–744.
Servaes P, Prins J, Verhagen S, Bleijenberg G. Fatigue after breast cancer and in chronic fatigue syndrome: similarities and differences. J Psychosom Res 2002;52:453–459.
Stone P, Richardson A, Ream E et al.. Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum. Ann Oncol 2000;11:971–975.
Hann DM, Jacobsen PB, Martin SC et al.. Fatigue in women treated with bone marrow transplantation for breast cancer: a comparison with women with no history of cancer. Support Care Cancer 1997;5:44–52.
Mock V, Cameron L, Tompkins C. Every Step Counts: A Walking Exercise Program for Persons Living With Cancer. Baltimore, MD: Johns Hopkins University; 1997.
Gielissen MF, Verhagen S, Witjes F, Bleijenberg G. Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. J Clin Oncol 2006;24:4882–4887.
- Search Google Scholar
- Export Citation
. Gielissen MF Verhagen S Witjes F Bleijenberg G Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. J Clin Oncol 2006; 24: 4882– 4887.
Geinitz H, Zimmermann FB, Thamm R et al.. Fatigue in patients with adjuvant radiation therapy for breast cancer: long-term follow-up. J Cancer Res Clin Oncol 2004;130:327–333.
Schneider CM, Hsieh CC, Sprod LK et al.. Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer 2007;110:918–925.
Vallance JK, Courneya KS, Plotnikoff RC et al.. Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. J Clin Oncol 2007;25:2352–2359.
Conn VS, Hafdahl AR, Porock DC et al.. A meta-analysis of exercise interventions among people treated for cancer. Support Care Cancer 2006;14:699–712.
Knols R, Aaronson NK, Uebelhart D et al.. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol 2005;23:3830–3842.
McNeely ML, Campbell KL, Rowe BH et al.. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 2006;175:34–41.
Stricker CT, Drake D, Hoyer KA, Mock V. Evidence-based practice for fatigue management in adults with cancer: exercise as an intervention. Oncol Nurs Forum 2004;31:963–976.
Cantarero-Villanueva I, Fernandez-Lao C, Cuesta-Vargas AI et al.. The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: a randomized controlled trial. Arch Phys Med Rehabil 2013;94:221–230.
Brown JC, Huedo-Medina TB, Pescatello LS et al.. Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2011;20:123–133.
Dolbeault S, Cayrou S, Bredart A et al.. The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. Psychooncology 2009;18:647–656.
Soares A, Biasoli I, Scheliga A et al.. Association of social network and social support with health-related quality of life and fatigue in long-term survivors of Hodgkin lymphoma. Support Care Cancer 2013;21:2153–2159.
Garssen B, Boomsma MF, Meezenbroek Ede J et al.. Stress management training for breast cancer surgery patients. Psychooncology 2013;22:572–580.
Reif K, de Vries U, Petermann F, Gorres S. A patient education program is effective in reducing cancer-related fatigue: a multi-centre randomised two-group waiting-list controlled intervention trial. Eur J Oncol Nurs 2013;17:204–213.
Davidson JR, Waisberg JL, Brundage MD, MacLean AW. Nonpharmacologic group treatment of insomnia: a preliminary study with cancer survivors. Psychooncology 2001;10:389–397.
Quesnel C, Savard J, Simard S et al.. Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. J Consult Clin Psychol 2003;71:189–200.
Savard J, Simard S, Ivers H, Morin CM. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: sleep and psychological effects. J Clin Oncol 2005;23:6083–6096.
Dirksen SR, Epstein DR. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. J Adv Nurs 2008;61:664–675.
Epstein DR, Dirksen SR. Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. Oncol Nurs Forum 2007;34:E51–59.
Espie CA, Fleming L, Cassidy J et al.. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol 2008;26:4651–4658.
Morgenthaler T, Kramer M, Alessi C et al.. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep 2006;29:1415–1419.
Schutte-Rodin S, Broch L, Buysse D et al.. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4:487–504.
Hanna A, Sledge G, Mayer ML et al.. A phase II study of methylphenidate for the treatment of fatigue. Support Care Cancer 2006;14:210–215.
Lower EE, Fleishman S, Cooper A et al.. Efficacy of dexmethylphenidate for the treatment of fatigue after cancer chemotherapy: a randomized clinical trial. J Pain Symptom Manage 2009;38:650–662.
Morrow GR, Gillies LJ, Hickok JT et al.. The positive effect of the psychostimulant modafinil on fatigue from cancer that persists after treatment is completed [abstract]. J Clin Oncol 2005;23(Suppl):Abstract 8012.
Kaleita T, Cloughesy J, Ford W. A pilot study of modafinil (Provigil®) for treatment of fatigue and neurobehavioral dysfunction in adult brain tumor patients [abstract]. Presented at the Ninth Annual Meeting of the Society for Neuro-Oncology; November 18–21, 2004; Toronto, Ontario, Canada. Abstract QL-06.
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. A pilot study of modafinil (Provigil®) for treatment of fatigue and neurobehavioral dysfunction in adult brain tumor patients [abstract]. Kaleita T Cloughesy J Ford W Presented at the Ninth Annual Meeting of the Society for Neuro-Oncology; November 18–21, 2004; Toronto, Ontario, Canada. Abstract QL-06.
Spathis A, Fife K, Blackhall F et al.. Modafinil for the treatment of fatigue in lung cancer: results of a placebo-controlled, double-blind, randomized trial. J Clin Oncol 2014;32:1882–1888.
Yennurajalingam S, Bruera E. Palliative management of fatigue at the close of life: “it feels like my body is just worn out”. JAMA 2007;297:295–304.
Lundh Hagelin C, Seiger A, Furst CJ. Quality of life in terminal care—with special reference to age, gender and marital status. Support Care Cancer 2006;14:320–328.
Walsh D, Donnelly S, Rybicki L. The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Support Care Cancer 2000;8:175–179.
Given B, Given C, Azzouz F, Stommel M. Physical functioning of elderly cancer patients prior to diagnosis and following initial treatment. Nurs Res 2001;50:222–232.
Wolfe J, Grier HE, Klar N et al.. Symptoms and suffering at the end of life in children with cancer. N Engl J Med 2000;342:326–333.
Wong RK, Franssen E, Szumacher E et al.. What do patients living with advanced cancer and their carers want to know? A needs assessment. Support Care Cancer 2002;10:408–415.
Mystakidou K, Parpa E, Katsouda E et al.. The role of physical and psychological symptoms in desire for death: a study of terminally ill cancer patients. Psychooncology 2006;15:355–360.
Brady MJ, Peterman AH, Fitchett G et al.. A case for including spirituality in quality of life measurement in oncology. Psychooncology 1999;8:417–428.
Breitbart W, Rosenfeld B, Gibson C et al.. Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology 2010;19:21–28.
Breitbart W, Poppito S, Rosenfeld B et al.. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. J Clin Oncol 2012;30:1304–1309.
Chochinov HM, Kristjanson LJ, Breitbart W et al.. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol 2011;12:753–762.
Oldervoll LM, Loge JH, Paltiel H et al.. The effect of a physical exercise program in palliative care: a phase II study. J Pain Symptom Manage 2006;31:421–430.
Porock D, Kristjanson LJ, Tinnelly K et al.. An exercise intervention for advanced cancer patients experiencing fatigue: a pilot study. J Palliat Care 2000;16:30–36.
Strong A, Karavatas G, Reicherter EA. Recommended exercise protocol to decrease cancer-related fatigue and muscle wasting in patients with multiple myeloma: an evidence-based systematic review. Top Geriatr Rehabil 2006;22:172–186.
Sarhill N, Walsh D, Nelson KA et al.. Methylphenidate for fatigue in advanced cancer: a prospective open-label pilot study. Am J Hosp Palliat Care 2001;18:187–192.
Bruera E, Driver L, Barnes EA et al.. Patient-controlled methylphenidate for the management of fatigue in patients with advanced cancer: a preliminary report. J Clin Oncol 2003;21:4439–4443.
Bruera E, Valero V, Driver L et al.. Patient-controlled methylphenidate for cancer fatigue: a double-blind, randomized, placebo-controlled trial. J Clin Oncol 2006;24:2073–2078.
Bruera E, Yennurajalingam S, Palmer JL et al.. Methylphenidate and/or a nursing telephone intervention for fatigue in patients with advanced cancer: a randomized, placebo-controlled, phase II trial. J Clin Oncol 2013;31:2421–2427.
Auret KA, Schug SA, Bremner AP, Bulsara M. A randomized, double-blind, placebo-controlled trial assessing the impact of dexamphetamine on fatigue in patients with advanced cancer. J Pain Symptom Manage 2009;37:613–621.
Hardy JR, Rees E, Ling J et al.. A prospective survey of the use of dexamethasone on a palliative care unit. Palliat Med 2001;15:3–8.
Peuckmann V, Elsner F, Krumm N et al.. Pharmacological treatments for fatigue associated with palliative care. Cochrane Database Syst Rev 2010:CD006788.
Matsuo N, Morita T, Iwase S. Physician-reported corticosteroid therapy practices in certified palliative care units in Japan: a nationwide survey. J Palliat Med 2012;15:1011–1016; quiz 1117–1018.
Matsuo N, Morita T, Iwase S. Efficacy and undesirable effects of corticosteroid therapy experienced by palliative care specialists in Japan: a nationwide survey. J Palliat Med 2011;14:840–845.
Yennurajalingam S, Frisbee-Hume S, Palmer JL et al.. Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. J Clin Oncol 2013;31:3076–3082.
Paulsen O, Klepstad P, Rosland JH et al.. Efficacy of methylprednisolone on pain, fatigue, and appetite loss in patients with advanced cancer using opioids: a randomized, placebo-controlled, double-blind trial. J Clin Oncol 2014;32:3221–3228.
Aaronson NK, Ahmedzai S, Bergman B et al.. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365–376.
Pascual Lopez A, Roque i Figuls M, Urrutia Cuchi G et al.. Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome. J Pain Symptom Manage 2004;27:360–369.
Minton O, Richardson A, Sharpe M et al.. A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst 2008;100:1155–1166.
Gong S, Sheng P, Jin H et al.. Effect of methylphenidate in patients with cancer-related fatigue: a systematic review and meta-analysis. PLoS One 2014;9:e84391.
Berger AM, Mitchell SA, Jacobsen PB, Pirl WF. Screening, evaluation, and management of cancer-related fatigue: Ready for implementation to practice? CA Cancer J Clin 2015;65:190–211.
Borneman T, Piper BF, Sun VC et al.. Implementing the Fatigue Guidelines at one NCCN member institution: process and outcomes. J Natl Compr Canc Netw 2007;5:1092–1101.
Piper BF, Borneman T, Sun VC et al.. Cancer-related fatigue: role of oncology nurses in translating National Comprehensive Cancer Network assessment guidelines into practice. Clin J Oncol Nurs 2008;12:37–47.