Physicians’ Perspectives on Cancer-related Fatigue Management and Their Suggestions for Improvements in Medical Training: A Cross-sectional Survey Study in Germany

Purpose: Contrary to guidelines, many cancer patients are not screened for cancer-related fatigue (CRF) and do not receive information or adequate treatment. As physicians play a key role in cancer therapy, their knowledge of this common sequela and perspectives on its management are of major interest. Methods: For an online survey, physicians working in oncology in Germany were systematically drawn from registers and invited by using institutional newsletters or colleagues. Descriptive analyses, logistic regression analysis of physicians’ knowledge, and Mann‒Whitney U tests were performed. Results: T wo-thirds of the 148 surveyed physicians felt (rather) well informed about CRF and capable of counseling patients. Although most of the physicians werenot aware of CRF-specific guidelines (68%), they rated the scientific evidence for recommending physical activity, exercise, and psychotherapeutic interventions in accordance with guidelines as being mostly (very) strong. However, despite 82.4% of the physicians being (rather) aware of its evidence, only 56.1% often to almost always recommended psychotherapeutic interventions. CRF was rarely covered in basic and specialist medical training. The completion of advanced training for palliative care increased the likelihood of knowing guidelines (OR=2.6, 95% CI [1.1-6.0], p <0.05). Suggestions for improving training included the mandatory coverage of CRF in medical training or its consideration in interprofessional supportive care workshops. Conclusion: Although awareness and recommendation rates were adequate for some interventions in CRF treatment (such as physical activity), there were lower rates for others, including psychotherapy. To overcome this knowledge-to-practice gap and the overall scarcity of guidelines knowledge among physicians training on guidelines is needed.