Various treatment interventions for the amelioration of cancer-related fatigue, a common and disabling adverse effect experienced by patients during and after cancer treatment, have shown promise in clinical trials. These therapies include exercise, psychological interventions, exercise and psychological interventions combined, and pharmaceutical options. To determine which intervention is most effective, researchers conducted a meta-analysis to compare the weighted effect sizes (WES) of these commonly used treatments. They searched electronic databases to identify randomized clinical trials of adults with cancer that measured the severity of cancer-related fatigue as an outcome. Exercise was defined as aerobic, anaerobic, or both, and psychological interventions were delineated as cognitive behavioral, psychoeducational, or eclectic.

A total of 113 studies comprising 11,525 patients (mean age, 54 years) were included in the analysis. Improvement in cancer-related fatigue was greatest among people participating in studies of exercise interventions (WES, 0.30). The researchers found similar improvements documented in studies in which psychological interventions (WES, 0.27) and exercise plus psychological interventions (WES, 0.26) were used. Pharmaceutical interventions, by contrast, yielded very small improvements (WES, 0.09).

The effectiveness of these interventions was associated with cancer stage, baseline treatment status, format (group or individual) and delivery mode of the experimental treatment, type of psychological intervention and control condition, use of intention-to-treat analysis, and fatigue measures. The results suggest that certain types of intervention may be more effective at different points in the cancer treatment trajectory; for example, exercise may be most effective in patients receiving primary treatment, and psychological treatment alone or exercise plus psychological treatment may be most effective in those who have ended primary treatment.-KR

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