Consensus Recommendations for Disease- and Treatment-Related Fatigue in Patients With Advanced Prostate Cancer: A Modified Delphi Panel

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.