The gap between guidelines and clinical practice in cancer-related fatigue management: a mixed-methods systematic review.

Abstract

Purpose: Cancer-related fatigue (CRF) is the most prevalent and disruptive side effect of cancer and its treatment, significantly impairing patients' quality of life. While guidelines mandate periodic screening, in-depth assessments, and non-pharmacological treatments for fatigue, the adherence of healthcare professionals (HCPs) to these guidelines is unknown. Therefore, this review aims to synthesize existing knowledge on HCPs' adherence to CRF guidelines.

Methods: A systematic review was conducted, encompassing searches across six databases and Google Scholar. Studies reporting on CRF management, barriers to CRF care experienced by HCPs, or interventions aimed at improving CRF management were included. A narrative synthesis approach was employed to analyze findings.

Results: Of the 7039 identified publications, seventy-seven studies met the inclusion criteria. Findings reveal notable discrepancies between guideline recommendations and clinical practice. Specifically, fatigue screening was inconsistently performed across healthcare settings, comprehensive fatigue assessments were scarce, and pharmacological interventions were commonly used to alleviate fatigue. Barriers such as time constraints and insufficient knowledge hindered optimal CRF management.

Conclusion: Findings of this review suggest that HCPs do generally not adhere to clinical guidelines for fatigue management.

Implications for cancer survivors: There is ample room to improve CRF management, with systematic changes essential to addressing barriers to effective fatigue management. As part of these changes, enhancing HCP education can help to frame CRF as a manageable, multifaceted symptom. These improvements will contribute to better fatigue communication, recognition, timely support, and a more coordinated approach to care for patients affected by this debilitating condition.