Moderators of the effect of psychosocial interventions on fatigue in women with breast cancer and men with prostate cancer: Individual patient data meta‐analyses

Abstract

Objective: Psychosocial interventions can reduce cancer-related fatigue effectively. However, it is still unclear if intervention effects differ across subgroups of patients. These meta-analyses aimed at evaluating moderator effects of (a) sociodemographic characteristics, (b) clinical characteristics, (c) baseline levels of fatigue and other symptoms, and (d) intervention-related characteristics on the effect of psychosocial interventions on cancer-related fatigue in patients with non-metastatic breast and prostate cancer. Methods: Data were retrieved from the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium. Potential moderators were studied with meta-analyses of pooled individual patient data from 14 randomized controlled trials through linear mixed-effects models with interaction tests. The analyses were conducted separately in patients with breast (n = 1091) and prostate cancer (n = 1008). Results: Statistically significant, small overall effects of psychosocial interventions on fatigue were found (breast cancer: β = −0.19 [95% confidence interval (95%CI) = −0.30; −0.08]; prostate cancer: β = −0.11 [95%CI = −0.21; −0.00]). In both patient groups, intervention effects did not differ significantly by sociodemographic or clinical characteristics, nor by baseline levels of fatigue or pain. For intervention-related moderators (only tested among women with breast cancer), statistically significant larger effects were found for cognitive behavioral therapy as intervention strategy (β = −0.27 [95%CI = −0.40; −0.15]), fatigue-specific interventions (β = −0.48 [95%CI = −0.79; −0.18]), and interventions that only targeted patients with clinically relevant fatigue (β = −0.85 [95%CI = −1.40; −0.30]). Conclusions: Our findings did not provide evidence that any selected demographic or clinical characteristic, or baseline levels of fatigue or pain, moderated effects of psychosocial interventions on fatigue. A specific focus on decreasing fatigue seems beneficial for patients with breast cancer with clinically relevant fatigue. K E Y W O R D S breast cancer, cancer, fatigue, individual patient data meta-analysis, moderators, oncology, prostate cancer, psycho-oncology, psychosocial interventions 1 | BACKGROUND Fatigue is one of the most commonly reported adverse effects of cancer and cancer treatment. 1 Cancer-related fatigue is associated with a compromised quality of life and can persist for many years after treatment completion. 1 Several interventions have been developed to manage cancer-related fatigue. Results of a recent meta-analysis indicated that psychosocial interventions (like cognitive behavioral

Psychosocial Interventions for the Treatment of Cancer-Related Fatigue: An Umbrella Review

“…The authors’ reports on the methodological quality of the primary sources are summarized in Appendix A . According to the levels of evidence reported, eight reviews were ranked as Level of Evidence 2B, due to low-quality RTCs [ 9 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Two of the reviews were ranked as Level 2B due to heterogeneous RTCs [ 52 , 53 ].…”

“…Regarding the certainty levels of the evidence reported, four of the reviews (36.36%) refer to moderate levels of certainty regarding the estimation of the effect [ 46 , 47 , 50 , 51 ]. Four of the reviews (36.36%) refer to a low level of certainty; that is, the confidence level in the effect estimate is limited [ 45 , 48 , 49 , 53 ]. One of the reviews (9.09%) reports a high level of certainty; namely, there is much confidence that the true effect is close to the estimate [ 52 ].…”

“…The direct and indirect effect sizes of the reviews were extracted [ 41 ], as well as the authors’ conclusions. Cognitive therapies [ 45 , 50 , 56 ] and, specifically, mindfulness [ 52 , 53 ] are those that report the best results in direct data in primary studies ( Table 1 ). Better results are found in specific treatments in patients with previous fatigue [ 45 , 51 ].…”

“…Higher levels of evidence and strength of evidence indicate that cognitive behavioural therapy benefits female breast cancer patients with clinically relevant fatigue [ 45 ]. Likewise, coping skills training and psychological support strategies focused on perpetuating factors of postcancer fatigue [ 50 , 56 , 57 , 58 ] benefit adult survivors of cancer without specifying the type.…”

“…Two (18.2%) show limited support for intervention programs [ 51 , 54 ] with low-power heterogeneity statistics or no data. Two (18.2%) reports found no evidence of improvement in fatigue in the interventions analysed [ 9 , 45 ] with heterogeneity data at follow-up but not between interventions or without data.…”