Non-pharmacological interventions for cancer-related fatigue in terminal cancer patients: a systematic review and meta-analysis

Abstract

Background: Cancer-related fatigue (CRF) is a highly distressing symptom in patients with cancer. Although various interventions have been reported to reduce fatigue, few are available for use in terminally ill cancer patients, and it is unknown which interventions are effective. They are also often difficult to implement in terminally ill patients with cancer. We, therefore, assessed the recommended interventions to reduce CRF in terminally ill cancer patients. Methods: Four electronic databases were searched to identify studies published between January 2015 and March 2021. The inclusion criteria were terminally ill cancer patients; non-pharmacological interventions;studies in which usual care or control groups were compared, or comparisons were made prior to the postintervention period; studies in which the primary outcome was fatigue scale or symptom scale (including those measuring fatigue on a subscale); and experimental study designs including randomised controlled trials (RCTs) and quasi-experimental studies. A summary of the data extracted from each study was created.We also conducted a meta-analysis of the RCTs.Results: A total of 1,954 publications were identified from the initial database, eight of which were included in this study. Three RCTs and five non-RCTs were included in the final evaluation. Most of the studies had a small number of participants. We conducted a meta-analysis of two of the three RCTs included in this study. There was insufficient evidence to determine the effects of the interventions compared to the controls [standard mean difference, −0.05; 95% confidence interval (CI): −0.48 to 0.37; two studies; 290 participants; I 2 =65%].Discussion: Few reports exist on non-pharmacological interventions for patients with terminal cancer and there was insufficient evidence to determine the effect of the interventions on fatigue. This highlights the lack of RCTs on non-pharmacological procedures and therapies for reducing fatigue.

Non-pharmacological interventions in primary care to improve the quality of life of older patients with palliative care needs: a systematic review of randomised controlled trials

“…The decision to include only RCTs was taken both because it is most robust study designs for assessing the efficacy of an intervention and while evaluating other reviews on non-pharmacological interventions in palliative care, the challenge in providing accurate recommendations often stems from inadequate or poorly structured study designs 10 11 15…”

“…Some systematic reviews about non-pharmacological interventions in palliative care, mainly in patients with advanced cancer, refer interventions as music therapy, massage therapy, one-termed transcutaneous electric nerve stimulation, cognitive behavioural strategies, aromatherapy, but they are consistent referring that besides there are few adverse events reported, these interventions need to be tested using adequate samples and well-powered studies 10 11…”

Jian Pi Sheng Sui Gao (JPSSG) alleviation of skeletal myoblast cell apoptosis, oxidative stress, and mitochondrial dysfunction to improve cancer-related fatigue in an AMPK-SIRT1- and HIF-1-dependent manner

“…At present, various interventions have been developed for relieving CRF (such as exercise interventions, psychosomatic therapies, psychoeducation, etc. ), while there still lacks standardized treatment (11). Additionally, CRF is a leading reason why those with cancer abandon subsequent treatment, which greatly interferes with their prognosis (12).…”