Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus.
Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus.
Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement).
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way.
© National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN.
At the beginning of each NCCN Guidelines panel meeting, panel members disclosed any financial support they have received from industry. Through 2008, this information was published in an aggregate statement in JNCCN and online. Furthering NCCN's commitment to public transparency, this disclosure process has now been expanded by listing all potential conflicts of interest respective to each individual expert panel member.
Individual disclosures for the NCCN Guidelines on Cancer-Related Fatigue panel members can be found on page 931. (The most recent version of these guidelines and accompanying disclosures, including levels of compensation, are available on the NCCN Web site at www.NCCN.org.)
These guidelines are also available on the Internet. For the latest update, please visit www.NCCN.org.
Ahlberg K, Ekman T, Gaston-Johansson F, Mock V. Assessment and management of cancer-related fatigue in adults. Lancet 2003;362:640–650.
Cella D. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 1997;34:13–19.
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.
Hann DM, Garovoy N, Finkelstein B et al.. Fatigue and quality of life in breast cancer patients undergoing autologous stem cell transplantation: a longitudinal comparative study. J Pain Symptom Manage 1999;17:311–319.
Irvine D, Vincent L, Graydon JE et al.. The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals. Cancer Nurs 1994;17:367–378.
Jacobsen PB, Hann DM, Azzarello LM et al.. Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. J Pain Symptom Manage 1999;18:233–242.
Longman AJ, Braden CJ, Mishel MH. Side-effects burden, psychological adjustment, and life quality in women with breast cancer: pattern of association over time. Oncol Nurs Forum 1999;26:909–915.
Sitzia J, Huggins L. Side effects of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy for breast cancer. Cancer Pract 1998;6:13–21.
Hofman M, Ryan JL, Figueroa-Moseley CD et al.. Cancer-related fatigue: the scale of the problem. Oncologist 2007;12(Suppl 1):4–10.
Andrykowski MA, Curran SL, Lightner R. Off-treatment fatigue in breast cancer survivors: a controlled comparison. J Behav Med 1998;21:1–18.
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.
Broeckel JA, Jacobsen PB, Horton J et al.. Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. J Clin Oncol 1998;16:1689–1696.
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;4:6–17; discussion 18–19.
Vogelzang NJ, Breitbart W, Cella D et al.. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 1997;34:4–12.
Ferrell BR, Grant M, Dean GE. Bone tired: the experience of fatigue and its impact on quality of life. Oncol Nurs Forum 1996;23:1539–1547.
Janda M, Gerstner N, Obermair A et al.. Quality of life changes during conformal radiation therapy for prostate carcinoma. Cancer 2000;89:1322–1328.
Nail L, Jones L. Fatigue as a side effect of cancer treatment: impact on quality of life. Quality of life: a nursing challenge. 1995;4:8–13.
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.. Neuroendocrineimmune 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 2009;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.
Stone P, Hardy J, Broadley K et al.. Fatigue in advanced cancer: a prospective controlled cross-sectional study. Br J Cancer 1999;79:1479–1486.
Glaus A, Crow R, Hammond S. A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. Eur J Cancer Care (Engl) 1996;5:8–23.
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.
Hinds PS, Hockenberry-Eaton M, Gilger E et al.. Comparing patient, parent, and staff descriptions of fatigue in pediatric oncology patients. Cancer Nurs 1999;22:277–288; quiz 288–279.
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.
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.
Piper BF, Dodd MJ, Ream E. Improving the clinical measurement of cancer treatment-related fatigue. Better health through nursing research: international state of the science, Vol. 99. Washington, DC: American Nurses Association; 1999.
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: Jones & Bartlett; 2000:353–364.
Cella D, Peterman A, Passik S et al.. Progress toward guidelines for the management of fatigue. Oncology (Williston Park) 1998;12:369–377.
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.
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.
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.
Newell S, Sanson-Fisher RW, Girgis A, Ackland S. The physical and psycho-social experiences of patients attending an outpatient medical oncology department: a cross-sectional study. Eur J Cancer Care (Engl) 1999;8:73–82.
Loge JH, Abrahamsen AF, Ekeberg, Kaasa S. Fatigue and psychiatric morbidity among Hodgkin's disease survivors. J Pain Symptom Manage 2000;19:91–99.
Visser MR, Smets EM. Fatigue, depression and quality of life in cancer patients: how are they related? Support Care Cancer 1998;6:101–108.
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.
Berger AM. Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncol Nurs Forum 1998;25:51–62.
Berger AM, Farr L. The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncol Nurs Forum 1999;26:1663–1671.
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.
Dimeo FC, Stieglitz RD, Novelli-Fischer U et al.. Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 1999;85:2273–2277.
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.
Richardson A, Ream E, Wilson-Barnett J. Fatigue in patients receiving chemotherapy: patterns of change. Cancer Nurs 1998;21:17–30.
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.
Graydon JE, Bubela N, Irvine D, Vincent L. Fatigue-reducing strategies used by patients receiving treatment for cancer. Cancer Nurs 1995;18:23–28.
Richardson A, Ream EK. Self-care behaviours initiated by chemotherapy patients in response to fatigue. Int J Nurs Stud 1997;34:35–43.
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.
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 1):Abstract 9500.
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.
Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008;CD006145.
U.S. Department of Health & Human Services. HHS Announces Physical Activity Guidelines for Americans [news release]. Available at: http://www.hhs.gov/news/press/2008pres/10/20081007a.html. Accessed January 6, 2010.
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.
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.
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: Oncology Nursing Society; 2009.
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.
Cohen M, Fried G. Comparing relaxation training and cognitive-behavioral group therapy for women with breast cancer. Res Soc Work Pract 2007;17:313–323.
Decker TW, Cline-Elsen J, Gallagher M. Relaxation therapy as an adjunct in radiation oncology. J Clin Psychol 1992;48:388–393.
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.
Kim Y, Roscoe JA, Morrow GR. The effects of information and negative affect on severity of side effects from radiation therapy for prostate cancer. Support Care Cancer 2002;10:416–421.
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.
Williams SA, Schreier AM. The role of education in managing fatigue, anxiety, and sleep disorders in women undergoing chemotherapy for breast cancer. Appl Nurs Res 2005;18:138–147.
Yesilbalkan OU, Karadakovan A, Goker E. The effectiveness of nursing education as an intervention to decrease fatigue in Turkish patients receiving chemotherapy. Oncol Nurs Forum 2009;36:E215–222.
Forester B, Kornfeld DS, Fleiss JL. Psychotherapy during radiotherapy: effects on emotional and physical distress. Am J Psychiatry 1985;142:22–27.
Brown JK. A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia. Oncol Nurs Forum 2002;29:517–532.
Owen DC, Parker KP, McGuire DB. Comparison of subjective sleep quality in patients with cancer and healthy subjects. Oncol Nurs Forum 1999;26:1649–1651.
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.
Bootzin RR, Epstein D, Wood J. Stimulus control instructions. In: Hauri P, ed. Case Studies in Insomnia. New York: Plenum Press; 1991:19–28.
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.
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.
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.
Cohen L, Warneke C, Fouladi RT et al.. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 2004;100:2253–2260.
Kim SD, Kim HS. Effects of a relaxation breathing exercise on fatigue in haemopoietic stem cell transplantation patients. J Clin Nurs 2005;14:51–55.
Kim SD, Kim HS. Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. Cancer Nurs 2005;28:79–83.
Cannici J, Malcolm R, Peek LA. Treatment of insomnia in cancer patients using muscle relaxation training. J Behav Ther Exp Psychiatry 1983;14:251–256.
Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med 2003;65:571–581.
Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 2004;29:448–474.
- Search Google Scholar
- Export Citation
. Carlson LE Speca M Patel KD Goodey E Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 2004; 29: 448– 474.
Shapiro SL, Bootzin RR, Figueredo AJ et al.. The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study. J Psychosom Res 2003;54:85–91.
U.S. Food and Drug Administration. FDA Requests Label Change for All Sleep Disorder Drug Products. FDA News. March 14, 2007. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108868.htm. Accessed August 12, 2007.
National Cancer Institute. Sleep Disturbance in Cancer Patients. Available at: http://www.nci.nih.gov/cancertopics/pdq/supportivecare/sleepdisorders/HealthProfessional/. Accessed January 6, 2010.
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.
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.
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, Curt G. 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, Brit Lund M 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.
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.
Woo B, Dibble SL, Piper BF et al.. Differences in fatigue by treatment methods in women with breast cancer. Oncol Nurs Forum 1998;25:915–920.
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: 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.
Loge JH, Ekeberg O, Kaasa S. Fatigue in the general Norwegian population: normative data and associations. J Psychosom Res 1998;45:53–65.
Dimeo FC, Tilmann MH, Bertz H et al.. Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation. Cancer 1997;79:1717–1722.
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.
Oldervoll LM, Kaasa S, Knobel H, Loge JH. Exercise reduces fatigue in chronic fatigued Hodgkins disease survivors--results from a pilot study. Eur J Cancer 2003;39:57–63.
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.
Fawzy FI, Cousins N, Fawzy NW et al.. A structured psychiatric intervention for cancer patients. I. Changes over time in methods of coping and affective disturbance. Arch Gen Psychiatry 1990;47:720–725.
Fawzy NW. A psychoeducational nursing intervention to enhance coping and affective state in newly diagnosed malignant melanoma patients. Cancer Nurs 1995;18:427–438.
Spiegel D, Bloom JR, Yalom I. Group support for patients with metastatic cancer. A randomized outcome study. Arch Gen Psychiatry 1981;38:527–533.
Telch CF, Telch MJ. Group coping skills instruction and supportive group therapy for cancer patients: a comparison of strategies. J Consult Clin Psychol 1986;54:802–808.
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.
Fillion L, Gagnon P, Leblond F et al.. A brief intervention for fatigue management in breast cancer survivors. Cancer Nurs 2008;31:145–159.
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.
Rose KE. A qualitative analysis of the information needs of informal carers of terminally ill cancer patients. J Clin Nurs 1999;8:81–88.
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.
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. Topics in Geriatric Rehabilitation 2006;22:172–186.
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.
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.
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.
Breitbart W, Rosenfeld B, Kaim M, Funesti-Esch J. A randomized, double-blind, placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease. Arch Intern Med 2001;161:411–420.
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.
Morrow GR, Ryan JL, Kohli S. Modafinil (Provigil®) for persistent post-treatment fatigue: an open label study of 82 women with breast cancer [abstract]. MASCC International Symposia; June 22–24, 2006; Toronto, Canada. Abstract 11-070.
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]. Ninth Annual Meeting of the Society for Neuro-Oncology; November 18–21, 2004; Toronto, Canada. Abstract QL-06.
- Search Google Scholar
- Export Citation
. 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 Ninth Annual Meeting of the Society for Neuro-Oncology; November 18–21, 2004; Toronto, Canada. Abstract QL-06.
Caraceni A, Simonetti F. Psychostimulants: new concepts for palliative care from the modafinil experience? J Pain Symptom Manage 2004;28:97–99.
Loprinzi CL, Michalak JC, Schaid DJ et al.. Phase III evaluation of four doses of megestrol acetate as therapy for patients with cancer anorexia and/or cachexia. J Clin Oncol 1993;11:762–767.
Loprinzi CL, Kugler JW, Sloan JA et al.. Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. J Clin Oncol 1999;17:3299–3306.
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.
Bruera E, Ernst S, Hagen N et al.. Effectiveness of megestrol acetate in patients with advanced cancer: a randomized, double-blind, crossover study. Cancer Prev Control 1998;2:74–78.
De Conno F, Martini C, Zecca E et al.. Megestrol acetate for anorexia in patients with far-advanced cancer: a double-blind controlled clinical trial. Eur J Cancer 1998;34:1705–1709.
Simons JP, Aaronson NK, Vansteenkiste JF et al.. Effects of medroxyprogesterone acetate on appetite, weight, and quality of life in advanced-stage non-hormone-sensitive cancer: a placebo-controlled multicenter study. J Clin Oncol 1996;14:1077–1084.
Westman G, Bergman B, Albertsson M et al.. Megestrol acetate in advanced, progressive, hormone-insensitive cancer. Effects on the quality of life: a placebo-controlled, randomised, multicentre trial. Eur J Cancer 1999;35:586–595.
Graziano F, Bisonni R, Catalano V et al.. Potential role of levocarnitine supplementation for the treatment of chemotherapy-induced fatigue in non-anaemic cancer patients. Br J Cancer 2002;86:1854–1857.
Cruciani RA, Dvorkin E, Homel P et al.. L-carnitine supplementation for the treatment of fatigue and depressed mood in cancer patients with carnitine deficiency: a preliminary analysis. Ann N Y Acad Sci 2004;1033:168–176.
Cruciani RA, Dvorkin E, Homel P et al.. Safety, tolerability and symptom outcomes associated with L-carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: a phase I/II study. J Pain Symptom Manage 2006;32:551–559.
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.
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.
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.