# Cancer-related fatigue: screening, treatable causes and management

Source: https://onco.cc/protocols/cancer-related-fatigue-screening-and-management/  
OnCo record `cancer-related-fatigue-screening-and-management` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Tiredness that rest does not fix is one of the commonest effects of cancer and its treatment, for months or years. Your team should ask about it and look for treatable causes such as anaemia, low thyroid, pain, poor sleep, low mood or a medicine. What helps most is exercise suited to you, cognitive behavioural therapy and mindfulness. Modafinil is not recommended, nor methylphenidate routinely.

## Summary

The ASCO-SIO guideline update (2024) covers adults from diagnosis onward and sorts recommendations by phase. During treatment, clinicians should recommend exercise (aerobic, resistance or both), CBT, mindfulness-based programmes and tai chi or qigong (each moderate evidence, strong recommendation); psychoeducation and American ginseng 2,000 mg daily may be recommended (conditional). After treatment, exercise, CBT and mindfulness-based programmes are strong recommendations, and yoga, acupressure and moxibustion conditional. In advanced cancer or at the end of life, CBT and corticosteroids may be offered (low evidence, conditional). In every phase, wakefulness agents (modafinil, armodafinil) should not be recommended, and psychostimulants (methylphenidate) should not be used routinely; during treatment, L-carnitine and antidepressants such as paroxetine are also recommended against.

Screening and assessment were not re-examined in 2024; the panel referred readers to the 2014 ASCO adaptation, which recommends that everyone be evaluated for fatigue after primary treatment and that those with moderate to severe fatigue have a comprehensive assessment with medical and treatable contributing factors addressed. The APTA guideline (2022) grades the tools: the EORTC QLQ-C30 is the only screening tool graded A, and the Piper Fatigue Scale-Revised, FACIT-Fatigue and PROMIS Fatigue short forms are graded A for fuller assessment. The ESMO 2020 guideline could not be read.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: cancer-related fatigue; CRF management; fatigue during chemotherapy; tiredness after cancer treatment; exercise for cancer fatigue; CBT for cancer fatigue
- Tags: protocol; fatigue; supportive-care; survivorship

## Connected records

- protocols: [Exercise during and after cancer treatment: assessment, dose and referral](https://onco.cc/protocols/exercise-during-and-after-cancer-treatment/)
- drugs: [Dexamethasone](https://onco.cc/drugs/dexamethasone/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [American ginseng for cancer-related fatigue](https://onco.cc/technologies/american-ginseng-fatigue/), [Cognitive behavioural therapy for fatigue and distress](https://onco.cc/technologies/cbt-fatigue-distress/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Exercise during chemotherapy and radiotherapy](https://onco.cc/technologies/exercise-during-chemotherapy/), [Fatigue after cancer treatment: what actually works](https://onco.cc/technologies/cancer-related-fatigue-management/), [Mindfulness-based stress reduction and cognitive therapy](https://onco.cc/technologies/mindfulness-based-interventions/), [Tai chi and qigong](https://onco.cc/technologies/tai-chi-qigong/), [Yoga during and after cancer treatment](https://onco.cc/technologies/yoga-cancer/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/)
- terms: [Cancer-related fatigue (tiredness)](https://onco.cc/terms/cancer-related-fatigue/)

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