New cancer-related fatigue treatment guidelines urge exercise, talk therapy, mindfulness, tai chi

Karen Mustian, Ph.D., MPH, a Wilmot Cancer Institute leader, is senior author on a new set of national guidelines for easing fatigue in cancer patients.

The clinical practice guidelines, which came about after an extensive review of 113 published clinical trials by a panel of experts, conclude that doctors should recommend exercise, cognitive behavioral therapy (CBT), mindfulness-based programs, Tai chi, qigong, and American ginseng to reduce fatigue severity during cancer treatment.

After completion of cancer treatment, the guidelines also suggest that exercise, CBT, and mindfulness-based programs help with cancer-related fatigue. Other post-treatment aids, according to evidence, include yoga, acupressure (a type of massage therapy), and moxibustion, a traditional Chinese medicine conducted by practitioners that involves burning mugwort leaves on or near the body’s acupuncture points. (All Wilmot patients can receive free services from the Pluta Integrative Oncology and Wellness Center in Henrietta.)

Aside from American ginseng, other dietary supplements did not improve cancer-related fatigue, the experts said.

At the end of life, the guidelines recommend cognitive behavioral therapy and corticosteroids.

Also of note: Clinicians should not recommend L-carnitine, antidepressants, wakefulness agents, or routinely recommend psychostimulants to manage fatigue during any phase of cancer treatment or beyond, the guidelines stated.

The American Society of Clinical Oncology (ASCO), the largest organization for oncologists, published the guidelines in its Journal of Clinical Oncology ahead of the ASCO annual meeting held from May 31 to June 4, 2024.