Table 2.

Adverse event management strategies—fatigue

Fatigue
Prophylaxis
Provide patient education about fatigue, management tools, and available support [72]
Establish baseline fatigue levels with a fatigue scale and remeasure regularly during patient visits [72]
Ensure adequate fluid and nutritional intake [72]
Advise behavioral modifications, balancing rest with physical activity; recommendations include relaxation, massage, yoga, aerobic or resistance exercise programs, and energy conservation strategies [67–71]
Assess thyroid function prior to treatment, and monitor during treatment [66, 112]
Supportive care
Rule out alternative causes of fatigue (e.g., anemia, endocrine disorders such as hypothyroidism, pain, dehydration, hypercalcemia, or depression/anxiety) [67, 72]
Advise patient to increase activity; consider referral to a physical therapist [67]
Consider referral to nutritional counselor for nutritional therapy [67]
Incorporate psychosocial measures, including cognitive therapy, social support, biofeedback, and sleep therapy [67]
Incorporate management with psychostimulants (e.g., methylphenidate) [67, 73] or corticosteroids (e.g., methylprednisolone) [74]
Owing to effects on CYP3A4/5 substrates, including cabozantinib, long-term use of modafinil should be avoided [78]

CYP3A4 cytochrome P450 3A4, CYP2C19 cytochrome P450 2C19