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NCCN survey identifies cancer-related fatigue as an area of need for education

By Jennifer M. Hinkel, eBulletin Editor-in-Chief

The June edition of the NCCN Trends Survey, which queries users of the NCCN.org website regarding clinical issues pertinent to the NCCN Clinical Practice Guidelines in Oncology™ and other relevant issues in oncology practice, identified that cancer-related fatigue is an area that may merit greater educational attention for medical professionals. Based on data from an NCCN survey, some clinicians may have a relatively low level of awareness of existing recommendations for cancer-related fatigue and the pharmacologic and non-pharmacologic interventions that are being routinely used to treat this condition.

Of more than 1,000 oncology clinicians who responded to the survey in a convenience sample, roughly a third was not aware of the NCCN Guidelines for Cancer-Related Fatigue as a reference for the topic of fatigue in cancer patients. Thirty-four percent of responding oncology specialist physicians (293 of 863 responding) were unaware of these guidelines, while only 17% of advanced practitioners and nurses (27 of 157 responding) were unaware of these guidelines. An additional 32% of responding oncologists were aware of these guidelines, but had not accessed them in the past month.

Additional questions in this survey asked about the pharmacologic and non-pharmacologic approaches clinicians are taking to address cancer-related fatigue in their patients. In the survey, respondents were able to check as many interventions as they routinely used for patients receiving active cancer treatment and who are experiencing moderate to severe fatigue.

For oncology physician respondents (n = 863), the most commonly selected answers were “exercise program” (51%), “nutrition consultation” (48%), and “support groups" (41%). Other recommendations selected by more than a third of respondents were “stress management,” “relaxation,” and “physical therapy.” The least frequently selected options (<10%) were “cognitive-behavioral therapy for sleep” and “attention-restoring therapy.” All of the interventions presented in the survey are listed in the NCCN Clinical Practice Guidelines in Oncology™ for Cancer-Related Fatigue.

Thirty-one percent of oncology physician respondents (n = 863) answered that they use psychostimulants as a therapy option. A subsequent question further explored this issue, asking respondents which psychostimulants they routinely use in the treatment of cancer-related fatigue and for patients at various points of care: Patients on Active Treatment, Patients in Follow-up (no active treatment), and Patients at End of Life. Psychostimulants listed as question choices were methylphenidate, modafinil, prednisone, dexamethasone, and “other agent.” For patients on active treatment, 45% (388 of 863) do not use psychostimulants for cancer-related fatigue, 26% (221 or 863) use dexamethasone, and 19% (161 of 863) use prednisone. The other psychostimulant options were used by fewer than 15% of the respondents.

For patients in follow-up, 45% (389 of 863) do not use psychostimulants for cancer-related fatigue. Ten percent or fewer of oncology physicians used any of the psychostimulants listed as treatment options for patients in this group. For patients at the end of life, more oncology physicians reported that they used psychostimulants for cancer-related fatigue. Dexamethasone was the most commonly selected agent, with 33% (282 of 863) of physicians answering that they used this agent for cancer-related fatigue at the end of life. Prednisone was selected by 23% of physicians (200 of 863), and methylphenidate was selected by 13% of physicians (115 of 863). Thirty-two percent did not use psychostimulants for cancer-related fatigue for these patients.