Among patients with advanced prostate cancer (aPC), fatigue is a commonly experienced symptom that may be associated with the disease itself or occur as a side effect of treatment. We aimed to develop evidence-based, consensus-driven statements to support shared decision-making for managing fatigue in patients with aPC.
To identify potential fatigue-management strategies, we performed a targeted literature review followed by expert advisor interviews, and then conducted a modified Delphi panel. In both the interviews and the modified Delphi panel, participants included oncologists, urologists, exercise scientists, psychologists, nutritionists/dietitians, and nurse practitioners/nurses. The modified Delphi panel comprised 2 survey rounds, with a live panel discussion between them, intended to drive consensus on the statements. In determining consensus for the final statements, each strategy's effectiveness, accessibility for patients, and feasibility for both patients and health care providers were taken into account. Consensus was predefined as ≥75% agreement or disagreement with each statement.
The targeted literature review identified 14 fatigue-management strategies derived from 32 articles. These strategies were further refined and expanded by the expert advisors and modified Delphi panelists, who ultimately compiled a final list of 15 statements, each achieving ≥75% agreement. The 15 statements were grouped into 4 categories of fatigue-management strategies: exercise (eg, endurance, strength, aerobic, and resistance training), diet and nutrition (eg, hydration and healthy eating), clinical management (eg, counseling and support groups), and "other strategies" (eg, acupuncture and adopting good sleep habits).
These recommendations and considerations provide practical guidance-grounded in evidence and expert opinion-for managing fatigue in patients with aPC, with the goal of improving quality of life. Future research should prioritize high-quality studies evaluating fatigue-management strategies in aPC, particularly in areas where published evidence remains limited.
Journal of the National Comprehensive Cancer Network : JNCCN. 2026 Mar 31 [Epub ahead of print]
Stephen J Freedland, William Aronson, Arash Asher, Mitch Golant, Emily Lemke, Alicia K Morgans, David Morris, Carol Sullivan, Jennifer Sutton, Cynthia A Thomson, Przemyslaw Twardowski, Jeffrey S Wefel, Kerri Winters-Stone, Marty Chakoian, Ted Wells, Dina ElSouda, James Turnbull, Joanne Buzaglo, Claire Mobley, Jasmina Ivanova, Jason Cohen, Susan Hogue, Nader El-Chaar, Maelys Touya
1Department of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA., 3Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA., 5Department of Medicine and Physical Medicine and Rehabilitation and Patient and Family Support Program, Cedars-Sinai Cancer, Los Angeles, CA., 6Cancer Support Community, Washington, DC., 7Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI., 8Dana-Farber Cancer Institute, Boston, MA., 9Urology Associates, P.C., Nashville, TN., 10Harvard Medical School, Massachusetts General Hospital, Boston, MA., 11Carolina Urologic Research Center, Myrtle Beach, SC., 12Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ., 13Department of Urologic Oncology, Saint John's Cancer Institute, Santa Monica, CA., 14Department of Neuro-Oncology and Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., 15Division of Oncological Sciences, Oregon Health & Science University, Portland, OR., 17Us TOO in Seattle, Prostate Cancer Support, Education, and Advocacy, Seattle, WA., 18IQVIA, New York, NY., 19Astellas Pharma Inc., Northbrook, IL., 20Pfizer Inc., New York, NY., 21Aesara, Chapel Hill, NC.