Guidelines Emphasize Evidence for Some Fatigue-Management Strategies in Adult Cancer Survivors

A summary of recently updated guidelines published in the American Society of Clinical Oncology Educational Book acknowledges the growing popularity of and support for the incorporation of evidence-based integrative therapies, especially mindfulness-based interventions, across the cancer care continuum. 

The authors began by summarizing the evidence-based guideline from ASCO and the Society for Integrative Society (SIO) that focuses on the management of fatigue in adult survivors of cancer.  They wrote that strong recommendations were given to mindfulness-based stress reduction, mindfulness-based cognitive therapy, and tai chi or qigong. The authors also detailed a number of integrative medicine therapies with insufficient evidence, including acupuncture, reflexology, coenzyme Q10, massage, music therapy, and mistletoe.

The authors provided a summary of recommendations for the management of symptoms of anxiety and depression. They described the recommended modalities for managing anxiety during active treatment for cancer, which include the following:

• mindfulness-based intervention (MBI)
• yoga
• hypnosis
• relaxation therapies
• music therapy
• reflexology
• lavender essential oils.

Of those modalities, SIO-ASCO guidelines provide strong recommendation for MBI in patients with anxiety who are undergoing cancer treatment. Other modalities received moderate recommendation, such as hypnosis and the use of yoga, in patients specifically with breast cancer. According to the authors, the use of lavender essential oils received only a weak recommendation. 

The recommendations for interventions in patients who have completed cancer treatment are similar, with MBI having the strongest evidence base.

Although research into cannabis use is ongoing, the authors also wrote that evidence suggests that greater caution is warranted. They described the potential for drug interactions, as well as the risk of direct side effects such as psychosis, hyperemesis, anxiety, and cognitive impairment. As such, according to the authors, the updated guidelines suggest that clinicians should not recommend using cannabis or cannabinoids as cancer-directed treatment, unless it’s part of a clinical trial. 

“The evidence for integrative interventions in cancer care is growing, with research now supporting benefits of integrative interventions across the cancer care continuum,” the authors concluded. “Evidence-based discussion and open communication within health care teams, patients, and caregivers will continue to improve patients’ symptoms, treatment toxicity, and quality of life. ASCO-SIO collaboration and formation of further integrative guidelines will foster the expansion and responsible use of integrative practices globally.”

This article originally appeared on Oncology Nurse Advisor