From the Guidelines
Fatigue management should prioritize non-pharmacologic interventions, including exercise, psychosocial support, and education, as these have shown to be effective in reducing fatigue severity and improving quality of life.
Key Interventions
- Exercise programs, such as aerobic and resistance training, have been shown to be effective in reducing fatigue in cancer survivors and people with inflammatory rheumatic and musculoskeletal diseases 1.
- Psychosocial interventions, including cognitive-behavioral therapy (CBT) and mindfulness-based programs, have demonstrated benefits in managing fatigue during and after cancer treatment 1.
- Education and counseling on fatigue management strategies, such as energy conservation and finding meaning in life, can help patients and their families cope with fatigue 1.
Assessment and Monitoring
- Regular assessment of fatigue severity, impact, and coping strategies is essential in clinical consultations to inform management options and facilitate discussions between patients and healthcare professionals 1.
- Shared decision-making should be an important feature of fatigue management, allowing patients to be actively involved in health management decisions and increasing satisfaction with care and adherence to treatment recommendations 1.
Pharmacologic Interventions
- Pharmacologic interventions, such as wakefulness agents, psychostimulants, and antidepressants, have not been shown to be effective in reducing cancer-related fatigue and should not be routinely recommended 1.
- Corticosteroids may be considered to help manage fatigue in patients with advanced cancer, but their use should be carefully evaluated and monitored 1.
From the Research
Managing Fatigue
To manage fatigue, several strategies can be employed, including:
- Regular physical activity, such as stretching and aerobic exercise, like walking 2
- Practicing proper sleep hygiene, a healthy diet, and balancing energy expenditure to address physiologic fatigue 3
- Treating underlying conditions to improve secondary fatigue 3
- Utilizing cognitive behavior therapy, exercise therapy, and acupuncture to help with fatigue associated with chronic conditions 3
- Pacing activity to not exceed limited energy capacity, particularly for patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) 3
- Educating patients about postexertional malaise and prioritizing comorbidities and symptoms based on severity 3
Lifestyle Modifications
Lifestyle modifications can also play a crucial role in managing fatigue, including:
- Caffeine and modafinil for episodic situations requiring alertness 2
- Short naps as performance enhancers 2
- Selective serotonin reuptake inhibitors, such as fluoxetine, paroxetine, or sertraline, to improve energy in patients with depression 2
- Stress reduction techniques, pacing all activities, and increased rest and sleep as effective self-care actions 4
Workplace Fatigue Management
In the workplace, fatigue can be managed through:
- Implementing a fatigue risk management system (FRMS) to apply scientific evidence of sleep knowledge to manage workers' fatigue 5
- Understanding the circadian biologic clock, dynamics of transient and cumulative sleep loss, and recovery to effectively manage workplace fatigue 5
- Using occupational sleep medicine to maintain best productivity and safety in industrial settings 5