Background <p>Cancer-related fatigue (CRF) is one of the most common consequences of cancer and its treatment. Despite international clinical guidelines, CRF remains insufficiently recognized and managed in oncological care in Germany.</p> Objective <p>Thisarticle describes the current state of CRF care in Germany in the context of international guidelines and derives practical guidance for clinical practice.</p> Materials and methods <p>Key recommendations from the guidelines on CRF and findings from several studies of the LIFT project on real-world care in Germany are presented. These studies examined prevalence, knowledge across professional groups, communication, and structural conditions related to CRF management.</p> Results <p>Fatigueis prevalent during and after cancer treatment and substantially impairs quality of life and functional status. Nevertheless, it is often not systematically assessed or managed according to guidelines. Our studies reveal knowledge gaps across professional groups, unclear responsibilities within multiprofessional teams, and insufficient structural implementation of screening and treatment processes.</p> Conclusion <p>Practical approaches to improving care are presented, including routine patient education, low-threshold screening, structured differential diagnostics, and referral to evidence-based interventions. Even under limited time and personnel resources, such measures can noticeably improve care. In the long term, however, clearly defined responsibilities and structural integration of fatigue management into clinical workflows are required.</p>