Developing Fatigue Management Guidance for Prostate Cancer Patients With Stephen Freedland, MD

At the recent American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, Dr. Stephen Freedland, Professor of Urology at Cedars-Sinai Medical Center, presented his research regarding patient perspectives on fatigue management in prostate cancer. In this follow-up interview, he elaborates on the current lack of information geared toward patients experiencing fatigue while receiving novel hormonal agents and his goal of creating guidance to fill this gap.  

Oncology Data Advisor: So, my first question is, what prompted you to investigate patient perspectives on management of fatigue in prostate cancer?

Stephen Freedland, MD: So, we’ve known for quite a while that fatigue is a major issue for prostate cancer patients. It can be from the cancer itself or from the therapy they are receiving, particularly the novel hormonal agents that we use. That’s one of the known side effects. There has been a lot of research into understanding risk factors for fatigue and identifying what we can do to improve it.

But what we felt was lacking was the patient’s voice—hearing from the patients how much they know about fatigue, what they thought the causes were, how they were treating it, and importantly, how much information they were given before receiving these therapies. We wanted to figure out where the gaps were so that we could ultimately come back to them with additional research and help fill in those gaps.

Oncology Data Advisor: What were the results that the study found?

Dr. Freedland: What we found is that most of the patients reported their fatigue as “fatigue,” not necessarily emotional or physical. Often it was physical, more so than simply emotional fatigue, but the fact that they prefer the word “fatigue” is one finding. Second is how little information about fatigue management they received going into getting these therapies. The doctor may have mentioned, “You may get some fatigue,” but really there wasn’t specific literature that they were receiving, such as pamphlets or guidelines, in terms of what to do to treat or prevent the fatigue. There’s definitely a gap we identified there.

Then the other thing was what to do when they got fatigue. Everyone had a slightly different answer. Often it was to eat better and try exercising. Sometimes the exercise may help treat the fatigue, but sometimes it actually made them more fatigued. It wasn’t clear that there was one strategy that they had all found that worked miraculously. Again, another gap that we identified was figuring out what the best treatments are for fatigue. So, patient education and then actual interventions that work were the two key gaps that we identified.

Oncology Data Advisor: So, now that you have those results, are there any next steps or future directions for this research?

Dr. Freedland: We’re working towards trying to develop some guidance. I don’t want us to say “guidelines,” but some guidance in the form of patient handout–type information that patients can be given at the time when they’re prescribed these therapies, to help them try to reduce the fatigue, or ideally, prevent it. We’re working in that direction. It takes time to develop that guidance, but that’s the direction we’re moving.

Oncology Data Advisor: That’s great. In the meantime, do you have any other suggestions for where health care providers can look to find resources to share with their patients on this?

Dr. Freedland: It’s a great question, I don’t know the answer because I’m not sure what’s out there, and that’s the problem. If you look at basic guidelines, they don’t have a lot. I do think the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS) have some guidance for cancer survivors in general, but there’s really nothing that we came across specifically for novel hormonal agent–induced fatigue. It’s just general fatigue guidance for cancer patients.

Oncology Data Advisor: Right, so we’ll stay tuned for those future guidelines.

Dr. Freedland: Exactly, exactly. We’ll be talking again at some point once we figure out some good guidance for these patients. It’s a tough one.

Oncology Data Advisor: It’s definitely very important. Thank you so much again for sharing all this, I really appreciate it.

Dr. Freedland: Thanks for the interest and taking the time to talk with me.

About Dr. Freedland

Stephen Freedland, MD, is a Professor of Urology and the Warschaw Robertson Law Families Chair in Prostate Cancer at Cedars-Sinai Medical Center in Los Angeles, California. In addition, he is the Director of the Center for Integrated Research on Cancer and Lifestyles, Co-Director of the Cancer Genetics and Prevention Program, and Associate Director for Education and Training at Samuel Oschin Comprehensive Cancer Institute. He also has a joint appointment as a staff physician at the Durham VA Medical Center in Durham, North Carolina. Dr. Freedland specializes in the treatment of patients with prostate cancer and benign prostatic hyperplasia. His research focuses on the roles of diet and lifestyle in prostate cancer development and progression, disparities among racial groups, risk stratification, and adverse event management.

For More Information

Freedland SJ, Chakoian M, Wells E, et al (2023). Patient (pt) perspective on fatigue and its management for advanced prostate cancer (PC) treated with androgen receptor inhibitors (ARIs). J Clin Oncol, 40(suppl 16). Abstract 5084. DOI:10.1200/JCO.2022.40.16_suppl.5084

National Comprehensive Cancer Network (2023). Clinical Practice Guidelines in Oncology: cancer-related fatigue. Version 2.2023. Available at:

American Cancer Society (2023). Fatigue and weakness. Available at:

Transcript edited for clarity. Any views expressed above are the speaker’s own and do not necessarily reflect those of Oncology Data Advisor. 

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