Fatigue management: evidence and guidelines for practice

Fatigue has been described as the most common, most debilitating side effect of cancer treatment and is frequently reported as a long-term complication of treatment as well. Despite the prevalence of fatigue and its profoundly negative effect on patients' quality of life, little is known about the specific mechanisms that underlie fatigue in cancer patients or how to prevent it and treat it effectively. The National Comprehensive Cancer Network (NCCN) Fatigue Practice Guidelines Panel has reviewed the available evidence and the consensus of practitioners regarding the management of fatigue and has developed clinical practice guidelines. These guidelines are presented in this article, with a discussion of levels of evidence for interventions recommended by the guidelines. Gaps exist in our knowledge of fatigue and further research is needed to support the NCCN Practice Guidelines for fatigue; however, there is a developing body of knowledge and consensus of clinicians regarding the management of fatigue in cancer patients. Additional research directed toward the knowledge gaps would strengthen the Practice Guidelines.