Version May 2024
| 1. Screening for cancer-related fatigue* |
| All health care providers should routinely screen for the presence of fatigue from the point of diagnosis onward. |
| All patients should be screened for fatigue at their initial visit, at appropriate intervals (for example, daily for inpatients, routine and follow-up visits for outpatients, and self-monitoring during post-treatment) and as clinically indicated, especially with changes in disease status. |
| Screen with a valid and reliable tool that includes reportable scores (dimensions) that are clinically meaningful and have established cut-offs-for example, Screening for Distress Tool, which includes the Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist (CPC). |
| For inpatients unable to assign a numeric value to rate their fatigue, a rating of mild, moderate, or severe may be used. |
| 2. Comprehensive and focused assessment of cancer-related fatigue¶ |
| Screen for fatigue, and if moderate or severe fatigue is detected through screening (ESAS tiredness greater than 4), individuals should have a comprehensive and a focused assessment to identify the nature and extent of the fatigue symptoms. |
| Medical and substance-induced causes of fatigue should be ruled out (for example, anemia, infection, nutrition deficiencies, medication, or treatment side effects). |
| Assessments should be a shared responsibility of the clinical team, with designation of those who are expected to conduct assessments based on scope of practice. |
| Assessment should include a history of fatigue (for example, disease status, pretreatment activity levels, fatigue onset, pattern, duration, changes over time, interference with function and daily living), contributing risk factors (for example, depression, anemia, pain, nausea, sleep disturbance, comorbidities), a physical exam, a review of symptoms, and a self-assessment of causes contributing to fatigue. |
| Promote open communication between the patient, family members, and the clinical team to facilitate discussions about the experience of fatigue and its effects on daily functioning. |
| As a shared responsibility, the clinical team must decide when referral to an appropriately trained professional is needed (that is, all patients with an ESAS score in the severe range, or with certain accompanying factors or symptoms, or with a cut-off score identified using valid and reliable tools for assessment of symptoms of fatigue). |
| 3. Treatment and care options for cancer-related fatigueΔ |
| Address all medical and substance-induced treatable contributing factors first (for example, pain, depression, anxiety, anemia, sleep disturbance, nutrition, activity level, medication side effects, and comorbidities). |
| Actively encourage all patients to engage in a moderate level of physical activity during and after cancer treatment (for example, 30 minutes of moderate-intensity activity most days) unless contraindicated. Moderate activity includes aerobic (for example, fast walking, cycling, or swimming) and resistance (for example, weights) training. |
| Additional nonpharmacologic interventions include nutrition consultation, optimizing sleep quality, psychosocial interventions to improve coping with fatigue (for example, cognitive behavioural therapy, stress management, or support groups), relaxation, massage and attention-restoring therapy (for example, exposure to natural environments). |
| For patients on active treatment or on long-term follow-up post treatment who have moderate-to-severe fatigue, consider referral to rehabilitation (for example, physical or occupational therapy, and physical medicine). |
| All patients should be offered specific education about fatigue before the start of treatment and when fatigue is identified, plus advice on strategies (for example, physical activity, energy conservation, stress reduction, and distraction) to manage fatigue. |
| At this time, the use of pharmacologic agents to treat cancer-related fatigue is considered experimental and is therefore not recommended (for example, psychostimulants, sleep medications, trials of low-dose corticosteroids such as prednisone or dexamethasone), except for selected patients at the end of life with severe fatigue. |
| Promote ongoing self-monitoring of fatigue levels as a late or long-term cancer or treatment problem in post-treatment survivors. |
| For those on active treatment and those with advanced, progressive disease, repeat ESAS screening and assessment as needed to determine any change in both subjective and objective aspects of fatigue. |
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