Monitor fatigue as a vital sign in cancer patients. (Updated Guidelines).

HOLLYWOOD, FLA.--Fatigue should be evaluated as a vital sign at every encounter with cancer patients, according to updated treatment guidelines issued at the annual conference of the National Comprehensive Cancer Network.

Many studies have shown that fatigue is the most prevalent and distressing complaint among cancer patients. The problem is exacerbated by the growing use of multimodal, high-intensity regimens. Fatigue often extends for months or years following treatment, said Victoria Mock D.N.Sc., director of the Center for Nursing Research, Johns Hopkins University Baltimore.

The guidelines, developed by a 27-member panel of experts from leading cancer centers and first published in 2000, were designed to help clinicians improve quality of life in cancer patients by managing treatment-related fatigue, said Dr. Mock, who also is director of nursing research at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. The update will appear this summer in the Journal of the National Comprehensive Cancer Network.

The guidelines address the needs of patients in three treatment categories: those in active treatment, those in long-term follow-up, and those at the end of life.

Only two recommendations are based on high-level (category 1) evidence: one on activity enhancement during active treatment or long-term follow-up, and one on psychosocial intervention in all three treatment categories. All other recommendations are category 2A, indicating consensus among panel members based on lower-level evidence, Dr. Carmen P. Escalante said.

For patients in all three treatment categories, the guidelines call for fatigue screening at every visit.

Patients with mild fatigue (a score of 13 on a severity scale of 0-10, with 10 being the worst fatigue imaginable) should be educated about management strategies; evaluation should be ongoing. ...