How do integrative experts manage fatigue?

Both medical groups and integrative experts provide recommendations for managing fatigue. Learn more about the approaches and meanings of recommendations.

Clinical practice guidelines

Recommends yoga as part of multidisciplinary approach to treat fatigue

For training programs that last at least 12 weeks, engaging in moderate-intensity aerobic training three times per week can significantly reduce cancer-related fatigue both during and after treatment.

Moderate-intensity combined aerobic plus resistance training sessions performed two to three times per week or twice weekly moderate-intensity resistance training may also be effective, and the latter particularly in prostate cancer.

The effect of exercise was strongest for moderate- to vigorous-intensity exercise, whereas the effect for low-intensity training was weak.

Recommendations for cancer-related fatigue:


Mindfulness-based approaches


Psychosocial therapies:

  • Behavioral therapy
  • Cognitive behavioral therapy
  • Psychoeducational therapies/educational therapies
Recommendations during cancer treatment

Strongly recommended

  • Moving More (exercise)
  • Cognitive behavioral therapy
  • Mindfulness-based programs
  • Tai chi or qigong

Conditionally recommended

  • Psychoeducation or psychoeducational interventions
  • American ginseng

No recommendation either for or against use

  • Acupressure
  • Coenzyme Q10
  • Guarana
  • Brain wave vibration meditation
  • Minocycline
  • Music or music therapy
  • Progressive muscle relaxation
  • Reflexology
  • Solution-focused therapy
  • Yoga

Recommend against use

  • L-carnitine
  • Antidepressants
  • Psychostimulants
  • Wakefulness agents
Recommendations after cancer treatment

Strongly recommended

  • Moving More (exercise)
  • Cognitive behavioral therapy
  • Mindfulness-based programs

Conditionally recommended

  • Acupressure
  • Moxibustion
  • Yoga

No recommendation either for or against use

  • Acceptance and commitment (ACT)-based interventions
  • Acupuncture
  • Attention-based interventions
  • Bright light therapy
  • Ginseng
  • Massage
  • Mistletoe
  • Omega fatty acids
  • Psychoeducation or psychoeducational interventions
  • Self-management health app
  • Tai chi or qigong

Recommend against use

  • Psychostimulants
  • Wakefulness agents
Recommendations for advanced cancer or end of life

Conditionally recommended

  • Cognitive behavioral therapy
  • Corticosteroids

No recommendation either for or against use

  • Collaborative care intervention
  • Moving More (exercise)
  • Melatonin
  • Protocolized patient-tailored treatment

Recommend against use

  • Psychostimulants
  • Wakefulness agents

Moving More for non-cachectic patients with cancer (generally recommended):

  • Physical exercise of moderate intensity and aerobic and functional resistance exercise are recommended in patients with cancer-related fatigue
  • Physical activities like walking and home-based aerobic and resistance exercises are recommended to improve cancer-related fatigue and quality of life

Cognitive behavioral therapy: recommended to manage cancer-related fatigue

Information and counseling: recommended in cancer patients and their caregivers to help them in understanding CRF and to educate them about ways to either prevent fatigue, avoid it becoming a chronic condition or to manage it

Mind-body stress reduction: could be an option to improve cancer-related fatigue

Psychoeducation: recommended to manage cancer-related fatigue

Yoga: could be an option to improve cancer-related fatigue and quality of life

Not recommended due to moderate evidence against efficacy or for adverse outcome:

  • Astragalus
  • Coenzyme Q10
  • Guarana
  • L-carnitine

National Comprehensive Cancer Network

Two guidelines evaluate therapies for treating fatigue; login required.


NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 2.2022. ›

Therapies listed for treating fatigue:

Eating Well (active treatment or after treatment)

Moving More: 

  • Maintain optimal level of activity (active treatment or after treatment)
  • Optimize level of activity (end of life)

Acupuncture (after treatment)

Bright white light therapy to treat fatigue among people in active treatment or after treatment. 1250–10,000 lux is most frequently self-administered in the early morning for 30–90 minutes. Timing needs to be adjusted for those who sleep during the day

Massage therapy (active treatment)

Psychosocial therapies:

  • Cognitive behavioral therapy/behavior therapy (during active treatment or after treatment)
  • Cognitive behavioral therapy for insomnia (CBT-I) (active treatment or after treatment)
  • Mindfulness-based stress reduction (after treatment)
  • Psychoeducational therapy (active treatment or after treatment)
  • Supportive expressive therapies (active treatment or after treatment)
  • Stimulus control/sleep restriction/sleep hygiene (active treatment or after treatment)

Yoga (during active treatment or after treatment)

NCCN Guidelines for Patients®: Survivorship Care for Cancer-Related Late and Long-Term Effects, 2020. ›

Therapies listed for treating fatigue:

Eating Well


Psychosocial therapies:

  • Cognitive behavioral therapy (CBT)
  • Mindfulness-based stress reduction
  • Supportive expressive therapies
  • Psychoeducational therapy

Society for Integrative Oncology

Two guidelines discuss managing fatigue among people with cancer.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment ›

Recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences:

  • Acupuncture after treatment
  • Ginseng during treatment
  • Hypnosis during treatment
  • Yoga after treatment

Insufficient evidence to recommend for fatigue:

  • Moving More
  • Managing Stress
  • Acupressure
  • Biofield healing
  • Coenzyme Q10
  • Light treatment
  • Massage
  • Meditation
  • Mind-body cognitive therapy
  • Multivitamin
  • Polarity therapy
  • Qigong
  • Reflexology
  • Reishi mushroom
  • Relaxation

Recommends against use for fatigue:

  • Acetyl-L-carnitine during treatment
  • Guarana during treatment

Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals ›

Recommendations for treating fatigue:

  • Acupuncture (weak recommendation)
  • Energy therapies, including Therapeutic Touch™, healing touch, reiki, polarity therapy, external qigong & electromagnetics (strong recommendation)

Integrative programs and protocols

Lise Alschuler, ND, FABNO, and Karolyn Gazella

Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions including fatigue.

Keith Block, MD

Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.

The integrative Block Program has recommendations to people who are at different places along the cancer continuum:

  • Those who’ve been recently diagnosed
  • Those in treatment
  • Those who’ve concluded treatment and need to remain vigilant to prevent recurrence

Neil McKinney, BSc, ND

McKinney N. Naturopathic Oncology, Fourth Edition. Victoria, BC, Canada: Liaison Press. 2020.

This book includes descriptions and uses of many natural and complementary protocols for cancer in general and for specific cancers. It also includes information on integrative support during conventional cancer treatment.

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.

This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.

Traditional medicine

Practitioners of traditional medical systems, including traditional Chinese medicine and Ayurveda, offer therapies and approaches to manage fatigue. Some recommendations from traditional Chinese medicine are included in clinical practice guidelines on this page.

Learn more about traditional medicine and how to find practitioners.

Other expert assessments

Current Oncology Reports

An expert review of evidence suggests that some complementary and integrative medicine modalities might have a potential role in alleviating cancer-related fatigue:1David A, Hausner D, Frenkel M. Cancer-related fatigue-is there a role for complementary and integrative medicine? Current Oncology Reports. 2021 Nov 7;23(12):145.





Circadian rhythm balance

Diet based on vegetables, fruits, whole grains, and legumes, with omega-3-rich foods


Guided imagery

Homeopathic therapies


Meditation and mindfulness therapies


Physical activity

Tai chi or qigong

Touch modalities (massage, reiki, healing touch, Therapeutic Touch™, polarity therapy)


Supplements for people with a deficiency: vitamin D, calcium, vitamin B12, folate, iron, selenium, and magnesium


Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Last update: May 21, 2024

Last full literature review: April 2022

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care, and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies and self carelifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.