4 Interventions to Reduce Cancer-Related Fatigue: RANKED

In 2017, a team of researchers evaluated the four most commonly recommended treatments for cancer-related fatigue: 1) Exercise interventions, 2) Psychological interventions, 3) Combination of both exercise and psychological interventions, and 4) Pharmaceutical interventions. These researchers analyzed 113 scientific studies with a total of 11,535 participants to determine which type of intervention is most effective in reducing cancer-related fatigue. 

Their results are presented below, in order from most to least effective. The rankings were ordered by the weighted effect size (WES) presented in the study, which represents the total effect (improvement) on cancer-related fatigue. The higher the WES, the greater the improvement in cancer-related fatigue. For those who are interested, 95% confidence intervals (CIs) and significance values (p-values) are also provided.

1. Exercise interventions (WES: 0.30; 95% CI: 0.25-0.36; p<.001)

These interventions included aerobic (n=36), anaerobic (n=13), and combined aerobic/anaerobic exercise (n=20). Exercise interventions had the largest effect on cancer-related fatigue, although this effect was only statistically different from pharmaceutical interventions, not psychological or psychological/exercise combined interventions. Similar to psychological interventions, exercise interventions are most effective when implemented during primary treatment. 

2. Psychological interventions (WES: 0.27; 95% CI: 0.21-0.33; p<.001)

A total of 34 studies in the meta-analysis evaluated psychological interventions, which included cognitive behavioral, psychoeducational, and eclectic methods. As a whole, these psychological interventions had a significant effect on cancer-related fatigue. Among the different types of psychological interventions, the cognitive behavioral approach was most effective in reducing cancer-related fatigue, especially when prescribed to patients currently receiving primary treatment.

3. Combination of BOTH exercise and psychological interventions (WES: 0.26; 95% CI: 0.13-0.38; p<.001)

Although there were only 10 studies that used both exercise and psychological interventions, the results of these studies showed potential for combined exercise/psychological interventions, especially compared to pharmaceutical interventions. The researchers discussed the possibility that combined interventions could either work synergistically or be counterproductive. The researches also noted that combined exercise/psychological interventions appeared to be most helpful for patients who had already completed primary treatment. However, more research is needed to determine the true effect of combined exercise and psychological interventions due to the small sample size in this meta-analysis.

4. Pharmaceutical interventions (WES: 0.09; 95% CI: 0.00-0.19; p=0.05)

Pharmaceutical interventions tested various types of medications including paroxetine hydrochloride, dexamphetamine, and methylprednisolone. Although pharmaceutical interventions had a statistically significant effect on cancer-related fatigue, the effect was small in magnitude. Compared to exercise and/or psychological interventions, interventions that solely relied on pharmaceuticals were not as effective in reducing cancer-related fatigue. The difference between pharmaceutical interventions and psychological and/or exercise interventions was statistically significant. 

References

Mustian, K. M., Alfano, C. M., Heckler, C., Kleckner, A. S., Kleckner, I. R., Leach, C. R., . . . Miller, S. M. (2017). Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue. JAMA Oncology,3(7), 961. doi:10.1001/jamaoncol.2016.6914