Skip to content
My WebMD Sign In, Sign Up

Cancer Health Center

Font Size

Fatigue (PDQ®): Supportive care - Health Professional Information [NCI] - Intervention

Table 2. Centrally Acting Stimulants for Adult Cancer Patients continued...

In a controlled trial of patients who reported the symptom cluster of pain and fatigue while receiving chemotherapy, a nursing behavioral intervention produced improvements in quality of life and decreased symptom burden relative to usual care.[56,57][Level of evidence: I] These intriguing results need to be further explored in patient populations other than women with breast or gynecologic malignancies.

As researchers and practitioners learned with pain, misconceptions and a lack of knowledge may prove to be patient- and provider-related barriers to successful assessment and management. A quasi-experimental study tested a multisystem educational approach to improving both pain and fatigue management.[58] The approach consisted of the following:

  • Education and assessment of patients regarding the management of pain and fatigue, with phone calls every 2 weeks for 3 months.
  • Education of providers about pain and fatigue assessment and management, including monthly newsletters.
  • An effort to engage with an internal advisory board.
  • Efforts aimed toward research nurses to refer earlier to supportive care services.

Over a 3-month period, the educational intervention resulted in increases in knowledge and a decrease in barriers related to management of pain and fatigue. Of note, important patient barriers related to fatigue management included the following beliefs:[58][Level of evidence: II]

  • Fatigue is inevitable.
  • Fatigue can indicate worsening of disease.
  • Treating the cancer is more important than treating fatigue.
  • Reporting fatigue will cause a patient to be perceived as a complainer.

Current Clinical Trials

Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about fatigue and anemia that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.


  1. Arendt J, Borbely AA, Franey C, et al.: The effects of chronic, small doses of melatonin given in the late afternoon on fatigue in man: a preliminary study. Neurosci Lett 45 (3): 317-21, 1984.
  2. Glaspy J, Bukowski R, Steinberg D, et al.: Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. Procrit Study Group. J Clin Oncol 15 (3): 1218-34, 1997.
  3. Gibson H, Edwards RH: Muscular exercise and fatigue. Sports Med 2 (2): 120-32, 1985 Mar-Apr.
  4. Hart LK: Fatigue in the patient with multiple sclerosis. Res Nurs Health 1 (4): 147-57, 1978.
  5. Lower EE, Fleishman S, Cooper A, et al.: Efficacy of dexmethylphenidate for the treatment of fatigue after cancer chemotherapy: a randomized clinical trial. J Pain Symptom Manage 38 (5): 650-62, 2009.
  6. Roth AJ, Nelson C, Rosenfeld B, et al.: Methylphenidate for fatigue in ambulatory men with prostate cancer. Cancer 116 (21): 5102-10, 2010.
  7. Jean-Pierre P, Morrow GR, Roscoe JA, et al.: A phase 3 randomized, placebo-controlled, double-blind, clinical trial of the effect of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy: a University of Rochester Cancer Center Community Clinical Oncology Program Research base study. Cancer 116 (14): 3513-20, 2010.
  8. Moraska AR, Sood A, Dakhil SR, et al.: Phase III, randomized, double-blind, placebo-controlled study of long-acting methylphenidate for cancer-related fatigue: North Central Cancer Treatment Group NCCTG-N05C7 trial. J Clin Oncol 28 (23): 3673-9, 2010.
  9. Medication Guide: PROVIGIL (modafinil) Tablets. Frazer, Pa: Cephalon, Inc., 2010. Available online. Last accessed January 23, 2013.
  10. Medication Guide: NUVIGIL (armodafinil) Tablets. Frazer, Pa: Cephalon, Inc., 2010. Available online. Last accessed January 23, 2013.
  11. Blackhall L, Petroni G, Shu J, et al.: A pilot study evaluating the safety and efficacy of modafinal for cancer-related fatigue. J Palliat Med 12 (5): 433-9, 2009.
  12. Spathis A, Dhillan R, Booden D, et al.: Modafinil for the treatment of fatigue in lung cancer: a pilot study. Palliat Med 23 (4): 325-31, 2009.
  13. Medication Guide: CONCERTA. Titusville, NJ: Ortho-McNeil-Janssen Pharmaceuticals, Inc., 2010. Available online. Last accessed January 23, 2013.
  14. Prommer E: Modafinil: is it ready for prime time? J Opioid Manag 2 (3): 130-6, 2006 May-Jun.
  15. ADDERALL XR: capsules. Wayne, Pa: Shire US Inc., 2011. Available online. Last accessed January 23, 2013.
  16. Moss EL, Simpson JS, Pelletier G, et al.: An open-label study of the effects of bupropion SR on fatigue, depression and quality of life of mixed-site cancer patients and their partners. Psychooncology 15 (3): 259-67, 2006.
  17. Armitage JO: Management of anemia in patients with cancer. Clinical Oncology Updates 1: 1-12, 1998.
  18. Kotasek D, Steger G, Faught W, et al.: Darbepoetin alfa administered every 3 weeks alleviates anaemia in patients with solid tumours receiving chemotherapy; results of a double-blind, placebo-controlled, randomised study. Eur J Cancer 39 (14): 2026-34, 2003.
  19. Hedenus M, Adriansson M, San Miguel J, et al.: Efficacy and safety of darbepoetin alfa in anaemic patients with lymphoproliferative malignancies: a randomized, double-blind, placebo-controlled study. Br J Haematol 122 (3): 394-403, 2003.
  20. Demetri GD, Kris M, Wade J, et al.: Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: results from a prospective community oncology study. Procrit Study Group. J Clin Oncol 16 (10): 3412-25, 1998.
  21. Osterborg A, Brandberg Y, Molostova V, et al.: Randomized, double-blind, placebo-controlled trial of recombinant human erythropoietin, epoetin Beta, in hematologic malignancies. J Clin Oncol 20 (10): 2486-94, 2002.
  22. Minton O, Richardson A, Sharpe M, et al.: Drug therapy for the management of cancer-related fatigue. Cochrane Database Syst Rev 7: CD006704, 2010.
  23. U.S. Food and Drug Administration.: FDA Drug Safety Communication: Erythropoiesis-stimulating Agents (ESAs): Procrit, Epogen and Aranesp. Rockville, Md: U.S. Food and Drug Administration, 2010. Available online. Last accessed January 23, 2013.
  24. Rizzo JD, Brouwers M, Hurley P, et al.: American Society of Clinical Oncology/American Society of Hematology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer. J Clin Oncol 28 (33): 4996-5010, 2010.
  25. Medication Guide: Aranesp (darbepoetin alfa). Thousand Oaks, Calif: Amgen Inc., 2011. Available online. Last accessed January 23, 2013.
  26. Procrit Label and Epogen Label. Silver Spring, Md: U.S. Food and Drug Administration, 2010. Available online. Last accessed January 23, 2013.
  27. Aranesp (darbepoetin alfa) Label. Silver Spring, Md: U.S. Food and Drug Administration, 2010. Available online. Last accessed January 23, 2013.
  28. U.S. Food and Drug Administration.: FDA announces new safety plan for agents used to treat chemotherapy-related anemia. Rockville, Md: U.S. Food and Drug Administration, 2010. Available online. Last accessed January 23, 2013.
  29. U.S. Food and Drug Administration.: Information on Erythropoiesis-stimulating Agents (ESAs): Epoetin alfa (marketed as Procrit, Epogen), Darbepoetin alfa (marketed as Aranesp). Rockville, Md: Food and Drug Administration, 2010. Available online. Last accessed January 23, 2013.
  30. Segal R, Evans W, Johnson D, et al.: Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. J Clin Oncol 19 (3): 657-65, 2001.
  31. Milne HM, Wallman KE, Gordon S, et al.: Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 108 (2): 279-88, 2008.
  32. Courneya KS, Friedenreich CM, Sela RA, et al.: The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psychooncology 12 (4): 357-74, 2003.
  33. Schneider CM, Hsieh CC, Sprod LK, et al.: Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer 110 (4): 918-25, 2007.
  34. Friendenreich CM, Courneya KS: Exercise as rehabilitation for cancer patients. Clin J Sport Med 6 (4): 237-44, 1996.
  35. Mustian KM, Griggs JJ, Morrow GR, et al.: Exercise and side effects among 749 patients during and after treatment for cancer: a University of Rochester Cancer Center Community Clinical Oncology Program Study. Support Care Cancer 14 (7): 732-41, 2006.
  36. Winningham ML: Walking program for people with cancer. Getting started. Cancer Nurs 14 (5): 270-6, 1991.
  37. Galvão DA, Newton RU: Review of exercise intervention studies in cancer patients. J Clin Oncol 23 (4): 899-909, 2005.
  38. Cramp F, Daniel J: Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev (2): CD006145, 2008.
  39. Kangas M, Bovbjerg DH, Montgomery GH: Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull 134 (5): 700-41, 2008.
  40. Berger AM, Abernethy AP, Atkinson A, et al.: Cancer-related fatigue. J Natl Compr Canc Netw 8 (8): 904-31, 2010.
  41. Jacobsen PB, Donovan KA, Vadaparampil ST, et al.: Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychol 26 (6): 660-7, 2007.
  42. Pickett M, Mock V, Ropka ME, et al.: Adherence to moderate-intensity exercise during breast cancer therapy. Cancer Pract 10 (6): 284-92, 2002 Nov-Dec.
  43. Dimeo FC, Stieglitz RD, Novelli-Fischer U, et al.: Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 85 (10): 2273-7, 1999.
  44. Mock V, Pickett M, Ropka ME, et al.: Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Pract 9 (3): 119-27, 2001 May-Jun.
  45. Mutrie N, Campbell AM, Whyte F, et al.: Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ 334 (7592): 517, 2007.
  46. Matthews CE, Wilcox S, Hanby CL, et al.: Evaluation of a 12-week home-based walking intervention for breast cancer survivors. Support Care Cancer 15 (2): 203-11, 2007.
  47. Daley AJ, Crank H, Saxton JM, et al.: Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol 25 (13): 1713-21, 2007.
  48. Alfano CM, Smith AW, Irwin ML, et al.: Physical activity, long-term symptoms, and physical health-related quality of life among breast cancer survivors: a prospective analysis. J Cancer Surviv 1 (2): 116-28, 2007.
  49. Yoshioka H: Rehabilitation for the terminal cancer patient. Am J Phys Med Rehabil 73 (3): 199-206, 1994.
  50. Mock V, Frangakis C, Davidson NE, et al.: Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psychooncology 14 (6): 464-77, 2005.
  51. Oh B, Butow P, Mullan B, et al.: Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial. Ann Oncol 21 (3): 608-14, 2010.
  52. Gielissen MF, Verhagen S, Witjes F, et al.: Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. J Clin Oncol 24 (30): 4882-7, 2006.
  53. Nail LM, Jones LS, Greene D, et al.: Use and perceived efficacy of self-care activities in patients receiving chemotherapy. Oncol Nurs Forum 18 (5): 883-7, 1991.
  54. Dy SM, Lorenz KA, Naeim A, et al.: Evidence-based recommendations for cancer fatigue, anorexia, depression, and dyspnea. J Clin Oncol 26 (23): 3886-95, 2008.
  55. Winningham ML, Nail LM, Burke MB, et al.: Fatigue and the cancer experience: the state of the knowledge. Oncol Nurs Forum 21 (1): 23-36, 1994 Jan-Feb.
  56. Given B, Given CW, McCorkle R, et al.: Pain and fatigue management: results of a nursing randomized clinical trial. Oncol Nurs Forum 29 (6): 949-56, 2002.
  57. Ream E, Richardson A, Alexander-Dann C: Supportive intervention for fatigue in patients undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manage 31 (2): 148-61, 2006.
  58. Borneman T, Koczywas M, Sun VC, et al.: Reducing patient barriers to pain and fatigue management. J Pain Symptom Manage 39 (3): 486-501, 2010.

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
Next Article:

Today on WebMD

Building a Support System
cancer fighting foods
precancerous lesions slideshow
quit smoking tips
Jennifer Goodman Linn self-portrait
what is your cancer risk
colorectal cancer treatment advances
breast cancer overview slideshow
prostate cancer overview
lung cancer overview slideshow
ovarian cancer overview slideshow
Actor Michael Douglas