Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue
- Study type
- Meta-analysis
- Design
- Systematic review and meta-analysis of randomised clinical trials
- Sample size
- 113 unique studies with 11,525 unique participants
- Source
- JAMA Oncol · 2017
In plain words
Tiredness (fatigue) caused by cancer and its treatment is very common and distressing. This study pooled the results of 113 studies with more than 11 thousand patients. It found that exercise and psychological treatments (such as counselling) reduce fatigue and work better than the medicines currently available. Talk to your treating doctor before starting any exercise or treatment programme.
Key results
Treatment arms and regimens
Exercise intervention for cancer-related fatigue. Dosing details are in the full text.
Psychological intervention for cancer-related fatigue. Dosing details are in the full text.
Combined exercise and psychological intervention. Dosing details are in the full text.
Drug treatments for cancer-related fatigue. Dosing details are in the full text.
Source of the regimen details: Abstract of the paper
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Adults with cancer in randomised clinical trials that reported cancer-related fatigue (CRF) severity as an outcome and tested an exercise, psychological, combined exercise and psychological, or pharmaceutical intervention. In total, 11,525 unique participants (78% women; mean age 54 years, range 35 to 72 years) in studies published from 1 January 1999 to 31 May 2016 were included in the analysis.
Endpoints
Primary outcome: cancer-related fatigue (CRF) severity. Effect sizes (Cohen d) were calculated and weighted by the inverse of the standard error to give weighted mean effect sizes (WES). Study quality was assessed with a modified 12-item version of the Physiotherapy Evidence-Based Database scale (range 0 to 12; 12 indicating the highest quality).
Safety and side effects
The abstract gives no information on adverse effects of the interventions.
Clinical significance and place in guidelines
According to this meta-analysis, exercise and psychological interventions are effective in reducing cancer-related fatigue during and after treatment and are superior to the available pharmaceutical treatments. The authors recommend that clinicians prescribe exercise or psychological interventions as first-line treatment for cancer-related fatigue. The status of this recommendation in authoritative clinical guidelines should be checked separately.
Limitations
The abstract does not address limitations. According to the abstract, treatment effectiveness was associated with several variables (cancer stage, baseline treatment status, intervention format and mode of delivery, type of control condition and fatigue measures), and the range of WES was wide (−0.91 to 0.99). 78% of participants were women. The effect of pharmaceutical interventions was at the margin of significance (P=0.05).
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.