New Cancer-Related Fatigue Treatment Guidelines Urge Exercise, Talk Therapy, Mindfulness, Tai Chi

Karen Mustian, PhD

Karen Mustian, PhD, MPH, a Wilmot Cancer Institute leader, is senior author on a new set of national guidelines for easing fatigue in cancer patients.

The clinical practice guidelines, which came about after an extensive review of 113 published clinical trials by a panel of experts, conclude that doctors should recommend exercise, cognitive behavioral therapy (CBT), mindfulness-based programs, Tai chi, qigong, and American ginseng to reduce fatigue severity during cancer treatment.

After completion of cancer treatment, the guidelines also suggest that exercise, CBT, and mindfulness-based programs help with cancer-related fatigue. Other post-treatment aids, according to evidence, include yoga, acupressure (a type of massage therapy), and moxibustion, a traditional Chinese medicine conducted by practitioners that involves burning mugwort leaves on or near the body’s acupuncture points. (All Wilmot patients can receive free services from the Pluta Integrative Oncology and Wellness Center in Henrietta.)  

Aside from American ginseng, other dietary supplements did not improve cancer-related fatigue, the experts said.

At the end of life, the guidelines recommend cognitive behavioral therapy and corticosteroids.

Also of note: Clinicians should not recommend L-carnitine, antidepressants, wakefulness agents, or routinely recommend psychostimulants to manage fatigue during any phase of cancer treatment or beyond, the guidelines stated.

The American Society of Clinical Oncology (ASCO), the largest organization for oncologists, published the guidelines in its Journal of Clinical Oncology ahead of the ASCO annual meeting from May 31 to June 4, 2024.

Mustian is an international expert in symptom management, specializing in exercise (yoga in particular) and integrative medicine to manage the side effects of cancer and its treatment. She is a tenured dean’s professor in the Division of Cancer Control, Department of Surgery at the University of Rochester Medical Center. In 2023, she was promoted to associate director of population science at Wilmot. In addition to Mustian’s leadership position on the guidelines panel, two other Wilmot members were co-authors: Kah Poh (Melissa) Loh, BMedSc, MBBCh, and Luke Peppone, PhD.

Several other Wilmot faculty and trainees are taking part in the ASCO annual meeting, by presenting data on posters, leading education sessions, and giving oral presentations. Most of the ASCO attendees from Wilmot are part of the Cancer Prevention and Control research program, which Mustian co-leads with Supriya Mohile, MD.

ASCO highlights:

• Viktor Clark, PhD, research assistant professor, is describing a mixed-method study on discrimination and disparities experienced by LGBTQ+ young adult cancer survivors and adult survivors aged 40 and older.
• Chunkit Fung, MD, professor, is co-chair of a newly created group called the ASCO LGBTQ+ Community of Practice and will co-chair panel presentations.
• Lauren Ghazal, PhD, FNP-BC, assistant professor, is co-author on a few oral presentations and was nominated for the Healio Disruptive Innovators award for oncology nursing.
• Nikesha Gilmore, PhD, assistant professor, is chairing a geriatric oncology session at ASCO.
• Po-Ju Lin, MPH, PhD, RD, research assistant professor, is giving a talk on data from a large study investigating the influence of yoga and cognitive behavioral therapy on insomnia and cancer-related fatigue.
• Lindsey Mattick, PhD, research assistant professor, is giving a talk on a national study measuring the walking dose required to achieve clinically meaningful reductions in cancer-related fatigue among breast cancer patients.
• Mostafa Mohamed, MBBCh, PhD, research assistant professor, is presenting a study on treatment modification strategies for older adults with advanced cancer.
• Sule Yilmaz, PhD, research assistant professor, is presenting a study on the importance of information-seeking styles among individuals with cancer, pre- and post-treatment.