A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue

Abstract

Purpose: The purpose of the present systematic review was to develop a practice guideline to inform health care providers about screening, assessment, and effective management of cancer-related fatigue (crf) in adults.

Methods: The internationally endorsed adapte methodology was used to develop a practice guideline for pan-Canadian use. A systematic search of the literature identified a broad range of evidence: clinical practice guidelines, systematic reviews, and other guidance documents on the screening, assessment, and management of crf. The search included medline, embase, cinahl, the Cochrane Library, and other guideline and data sources to December 2009.

Results: Two clinical practice guidelines were identified for adaptation. Seven guidance documents and four systematic reviews also provided supplementary evidence to inform guideline recommendations. Health professionals across Canada provided expert feedback on the adapted recommendations in the practice guideline and algorithm through a participatory external review process.

Conclusions: Practice guidelines can facilitate the adoption of evidence-based assessment and interventions for adult cancer patients experiencing fatigue. Development of an algorithm to guide decision-making in practice may also foster the uptake of a guideline into routine care.

Keywords: Fatigue; adapted guideline; assessment; cancer; screening; supportive care; survivor; survivorship.

Figures

FIGURE 1

Screening and assessment—cancer-related fatigue in adults with cancer (please see the full guideline for copyright and disclaimer before use). Use screening for distress tool, which includes the esas and the Canadian Problem Checklist. At initial diagnosis, start of treatment, regular intervals during treatment, end of treatment, post-treatment or at transition to survivorship, at recurrence or progression, advanced disease, when dying, and during times of personal transition or re-appraisal such as family crisis, during survivorship, when approaching death. The health care team for cancer patients may include surgeons, oncologists, family physicians, nurses, social workers, psychologists, patient navigators, and other health care professionals. OPQRSTU(I)V, where O = onset; P = provoking/palliating; Q = quality; R = region or radiating; S = severity and duration; T = treatment; U = understanding; I = impact; V = values (Fraser Health guideline template). esas = Edmonton Symptom Assessment System; fact-F = Functional Assessment of Cancer Therapy–Fatigue.

FIGURE 2

Care map—cancer-related fatigue in adults with cancer (please see the full guideline for copyright and disclaimer before use).