Bower Julienne E, Bak Kate, Berger Ann, Breitbart William, Escalante Carmelita P, Ganz Patricia A, Schnipper Hester Hill, Lacchetti Christina, Ligibel Jennifer A, Lyman Gary H, Ogaily Mohammed S, Pirl William F, Jacobsen Paul B
Julienne E. Bower and Patricia A. Ganz, University of California at Los Angeles, Los Angeles, CA; Kate Bak and Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Ann Berger, National Institutes of Health Clinical Center, Bethesda, MD; William Breitbart, Memorial Sloan-Kettering Cancer Center, New York, NY; Carmelita P. Escalante, University of Texas MD Anderson Cancer Center, Houston, TX; Hester Hill Schnipper, Beth Israel Deaconess Medical Center; Jennifer A. Ligibel, Dana-Farber Cancer Institute; William F. Pirl, Massachusetts General Hospital, Boston, MA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA; Mohammed S. Ogaily, Oakwood Center for Hematology and Oncology-Downriver, Brownstown, MI; and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
J Clin Oncol. 2014 Jun 10;32(17):1840-50. doi: 10.1200/JCO.2013.53.4495. Epub 2014 Apr 14.
This guideline presents screening, assessment, and treatment approaches for the management of adult cancer survivors who are experiencing symptoms of fatigue after completion of primary treatment.
A systematic search of clinical practice guideline databases, guideline developer Web sites, and published health literature identified the pan-Canadian guideline on screening, assessment, and care of cancer-related fatigue in adults with cancer, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines In Oncology (NCCN Guidelines) for Cancer-Related Fatigue and the NCCN Guidelines for Survivorship. These three guidelines were appraised and selected for adaptation.
It is recommended that all patients with cancer be evaluated for the presence of fatigue after completion of primary treatment and be offered specific information and strategies for fatigue management. For those who report moderate to severe fatigue, comprehensive assessment should be conducted, and medical and treatable contributing factors should be addressed. In terms of treatment strategies, evidence indicates that physical activity interventions, psychosocial interventions, and mind-body interventions may reduce cancer-related fatigue in post-treatment patients. There is limited evidence for use of psychostimulants in the management of fatigue in patients who are disease free after active treatment.
Fatigue is prevalent in cancer survivors and often causes significant disruption in functioning and quality of life. Regular screening, assessment, and education and appropriate treatment of fatigue are important in managing this distressing symptom. Given the multiple factors contributing to post-treatment fatigue, interventions should be tailored to each patient's specific needs. In particular, a number of nonpharmacologic treatment approaches have demonstrated efficacy in cancer survivors.
本指南介绍了针对完成初始治疗后出现疲劳症状的成年癌症幸存者的筛查、评估和治疗方法。
对临床实践指南数据库、指南制定者网站和已发表的健康文献进行系统检索，确定了关于癌症成年患者癌症相关疲劳的筛查、评估和护理的全加拿大指南、美国国立综合癌症网络（NCCN）肿瘤临床实践指南（NCCN指南）中关于癌症相关疲劳的内容以及NCCN生存指南。对这三项指南进行评估并选择进行改编。
建议对所有癌症患者在完成初始治疗后评估是否存在疲劳，并为其提供有关疲劳管理的具体信息和策略。对于报告中度至重度疲劳的患者，应进行全面评估，并处理医学上可治疗的促成因素。在治疗策略方面，证据表明体育活动干预、心理社会干预和身心干预可能会减轻治疗后患者的癌症相关疲劳。在积极治疗后无疾病的患者中，使用精神兴奋剂治疗疲劳的证据有限。
疲劳在癌症幸存者中普遍存在，常常对功能和生活质量造成严重干扰。定期筛查、评估和教育以及对疲劳进行适当治疗对于管理这种令人痛苦的症状很重要。鉴于导致治疗后疲劳的因素众多，干预措施应根据每个患者的具体需求进行调整。特别是，一些非药物治疗方法已在癌症幸存者中证明有效。
