Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis

Roger Hilfiker; Andre Meichtry; Manuela Eicher; Lina Nilsson Balfe; Ruud H Knols; Martin L Verra; Jan Taeymans

doi:10.1136/bjsports-2016-096422

Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis

Br J Sports Med. 2018 May;52(10):651-658. doi: 10.1136/bjsports-2016-096422. Epub 2017 May 13.

Authors

Roger Hilfiker¹, Andre Meichtry², Manuela Eicher^{3

4}, Lina Nilsson Balfe¹, Ruud H Knols⁵, Martin L Verra⁶, Jan Taeymans^{7

8}

Affiliations

¹ School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland.
² Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland.
³ School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland.
⁴ Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
⁵ Directory of Research and Education, Physiotherapy Occupational Therapy Research, Center University Hospital Zurich, Zurich, Switzerland.
⁶ Department of Physiotherapy, Inselspital, Bern University Hospital, Berne, Switzerland.
⁷ Bern University of Applied Sciences Health, Berne, Switzerland.
⁸ Faculty of Sports Sciences and Exercise Rehabilitation, Vrije Universiteit Brussel, Brussels, Belgium.

Abstract

Aim: To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment.

Design: Systematic review and indirect-comparisons meta-analysis.

Data sources: Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses.

Eligibility criteria for selecting studies: Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment.

Study appraisal and synthesis: Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis.

Results: We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardisedmean difference (SMD) of -0.77 (95% Credible Interval (CrI) -1.22 to -0.31), while massage (-0.78; -1.55 to -0.01), cognitive-behavioural therapy combined with physical activity (combined CBT, -0.72; -1.34 to -0.09), combined aerobic and resistance training (-0.67; -1.01 to -0.34), resistance training (-0.53; -1.02 to -0.03), aerobic (-0.53; -0.80 to -0.26) and yoga (-0.51; -1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (-0.68; -0.93 to -0.43). Combined aerobic and resistance training (-0.50; -0.66 to -0.34), combined CBT (-0.45; -0.70 to -0.21), Tai-Chi (-0.45; -0.84 to -0.06), CBT (-0.42; -0.58 to -0.25), resistance training (-0.35; -0.62 to -0.08) and aerobic (-0.33; -0.51 to -0.16) showed all small-to-moderate SMDs.

Conclusions: Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF.

Keywords: cancer related fatigue; exercise; indirect comparison meta-analysis.; network meta-analysis; non-pharmaceutical interventions.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Cognitive Behavioral Therapy
Exercise Therapy*
Fatigue / etiology
Fatigue / therapy*
Massage
Neoplasms / complications*
Randomized Controlled Trials as Topic
Relaxation Therapy
Resistance Training
Tai Ji
Yoga