Recommendations for Cancer Related Fatigue in Survivorship Care: A cross-sectional analysis of guidelines

Background/Objective: Cancer-related fatigue (CRF) remains a significant challenge in survivorship care, with no universally accepted management approach. Existing guidelines vary in recommendations, levels of evidence and strength of endorsement. This study aims to evaluate, compare, and synthesize recommendations to provide clear, evidence-based insights that promote standardization in CRF management for both healthcare providers and patients. Methods : A systematic search was conducted across PubMed, the Cochrane Library, and professional society websites. Included were all guidelines from professional oncology societies addressing CRF management in adult cancer survivors and published in English between 2000 and December 2024. From 523 references screened, ten (10) guidelines from seven (7) professional societies met the inclusion criteria and were analysed. The quality of the guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) criteria. Recommendations, their strength of evidence and strength of recommendations were extracted and standardized into the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The screening, grading, and extraction process was performed by two reviewers independently. Result : The quality of the ten guidelines was high in two (20%), moderate in seven (70%), and poor in one (10%) . CRF should be screened at every patient encounter by all healthcare providers, with positive screens followed by referral to appropriate professionals for further assessment using one of several validated tools. A strong recommendation based on moderate evidence was for exercise. In particular, aerobic and resistance training of low to moderate intensity, three times per week for 12 weeks. Guidelines consistently issued a strong recommendation for CBT (moderate evidence), and for psychotherapy (variable evidence). CBT was recommended, especially with structured coping strategies or web-based delivery. Guidelines cautiously recommended mind-body interventions such as Yoga, Tai Chi, and Qigong based on variable strength of evidence and recommendation. Education, counselling (particularly for depression-related fatigue) is mainly based on expert consensus rather than strong clinical trials. Other options may be considered in individual patients but are not based on strong evidence. Conclusion: CRF should be screened at every patient encounter. If positive, underlying contributing factors should also be assessed. Exercise (especially aerobic and resistance training) and CBT should be prioritized in managing CRF in cancer survivors. Psychoeducation and counselling are also beneficial, especially for fatigue linked to mental health conditions. Pharmacological treatments are not recommended due to insufficient evidence and side effects.