Exercise, Psychological Interventions Best for Reducing Cancer-Related Fatigue

A meta-analysis has found that exercise and psychological interventions were best at reducing cancer-related fatigue and were more effective than pharmaceutical options.

A new meta-analysis published in JAMA Oncology has found that exercise and psychological interventions were best at reducing cancer-related fatigue both during and after treatment, and that these types of interventions were more effective than available pharmaceutical options.

“More research is needed to better understand the effectiveness of interventions that combine exercise and psychological treatments for cancer-related fatigue,” wrote researcher Karen M. Mustian, PhD, MPH, of Wilmot Cancer Institute, University of Rochester Medical Center, New York, and colleagues. “Clinicians should prescribe exercise and psychological interventions as first-line therapy for patients experiencing cancer-related fatigue.”

Mustian and colleagues performed a meta-analysis to establish and compare the weighted effect size (WES) of four of the most commonly recommended treatments for cancer-related fatigue: exercise, psychological, exercise and psychological therapies combined, and pharmaceutical therapies. Relevant studies were independently reviewed by 12 raters. They identified 113 unique studies that included 11,525 adults with cancer published between 1999 and 2016 with sufficient data. Severity of cancer-related fatigue was the primary outcome of the analysis.

A review of the studies showed that interventions involving exercise (WES, 0.30; P < .001) were the most effective at reducing cancer-related fatigue, followed by psychological interventions (WES, 0.27; P < .001) and those  that combined exercise plus psychological interventions (WES, 0.26; P < .001). Pharmaceutical interventions did not improve cancer-related fatigue (WES, 0.09; P = .05).

The researchers also tested whether certain variables were associated with the effectiveness of these interventions. They found that the effectiveness of a given intervention was associated with cancer stage, treatment status at baseline, experimental treatment format (group or individual), primary delivery mode of experimental treatment, psychological mode, type of control condition, use of intention-to-treat analysis, and fatigue scale used.

“Although improvements in cancer-related fatigue were reported by all patients and survivors, patients with early-stage (ie, nonmetastatic) disease and patients who had completed primary treatments (ie, surgery, chemotherapy, or radiotherapy) reported the greatest benefit,” the researchers wrote.

In addition, Mustian and colleagues found that delivery of interventions in group format and in person were the most effective at reducing cancer-related fatigue.

“Although the results of this meta-analysis are very informative, conducting more high-quality, phase III randomized clinical trials to test new treatment options and directly compare treatments with known efficacy for managing cancer-related fatigue is of critical importance,” the researchers wrote.