Hilfiker R.1, Meichtry A.2, Eicher M.3, Nilsson Balfe L.4, Knols R.5, Verra M.L.6, Taeymans J.7
1HES-SO Valais-Wallis, School of Health Sciences, Leukerbad, Switzerland, 2Zurich University of Applied Sciences, Zürich, Switzerland, 3Institute of Physiotherapy, Zürich, Switzerland, 3Faculty of Biology and Medicine, University of Lausanne, Institute of Higher Education and Nursing Research, Lausanne, Switzerland, 4University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland, School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland, 5University Hospital Zurich, Zurich, Switzerland, Directory of Research and Education, Physiotherapy Occupational Therapy Research, Center, Zürich, Switzerland, 6Inselspital, Bern University Hospital, Berne, Switzerland., Department of Physiotherapy, Berne, Switzerland, 7Bern University of Applied Sciences, Health Department, Berne, Switzerland, Berne, Switzerland
Background: Cancer related fatigue is one of the most common and distressing symptoms of cancer and cancer treatment that can be prevalent before treatment onset and usually increases during therapy. There is a broad variety of non-pharmacological treatments against CRF. However, it is still unclear which of these anti CRF treatment modalities yield the largest treatment effect. In this paper we focused on exercise related non-pharmacological interventions, such as physical activity, aerobic and resistance training, and relaxation, while nutritional interventions were excluded.
Purpose: This indirect-comparisons meta-analysis aimed to assess the relative effects of different types of exercise and other non-pharmacological interventions on cancer-related fatigue in patients during and after cancer treatment.
Methods: Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses. Randomized studies published from inception to November 2015 evaluating different forms of exercise or other non-pharmacological interventions to reduce CRF in any cancer type during or after treatment. Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis.
Results: We included 215 studies. Comparing the treatments versus usual care during cancer treatment, relaxation exercise had the highest Standardized Mean Difference (SMD) -0.76 (95% Credible Interval (CrI) -1.06 to -0.46) while Yoga (SMD -0.65 (-1.02 to -0.28), cognitive behavioural therapy combined with physical activity (combined CBT, SMD -0.65 with 95% CrI -1.07 to -0.23) and resistance training (SMD -0.63 with 95% CrI -1.01 to -0.26) all had moderate to large SMDs. After cancer treatment, Yoga showed the highest effect (SMD -0.64 with 95% CrI -0.92 to -0.37). Combined aerobic and resistance training (SMD -0.49 with 95% CrI -0.68 to -0.31), CBT (SMD -0.48 with 95% CrI -0.69 to -0.27), combined CBT (SMD -0.46 with 95% CrI -0.74 to -0.19) and Tai-Chi (SMD -0.45 with 95% CrI -0.86 to -0.05) showed all moderate SMDs.
Conclusion(s): During cancer treatment: Relaxation, Yoga, Cognitive behavioural therapy (CBT) combined with physical activity, aerobic and resistance training (alone or combined) were able to reduce cancer-related fatigue, showing moderate to large effect sizes
After cancer treatment: Yoga showed a large effect size for the reduction of cancer-related fatigue, while combined aerobic and resistance training, cognitive behavioural therapy (CBT) alone or combined with physical activity, Tai-Chi as well as aerobic or resistance training alone all showed moderate effect size.
Implications: For clinical decision-making, our rankings of interventions to reduce CRF provide evidence-based choices and allow to target them to patients under treatment and patients having completed chemotherapies / radiotherapies. During cancer treatment, relaxation exercises and Yoga might be the first choice to manage cancer-related fatigue After cancer treatment, the clinician might encourage more physical activity enhancing interventions. Patient and health care professionals can now choose out of a variety of evidence based non-pharmaceutical interventions according to patients preference and abilities in order to tackle cancer related fatigue.
Funding acknowledgements: This study was funded by physioswiss (Swiss physiotherapy association) and the University of Applied Sciences and Arts Western Switzerland HES-SO.
Topic: Oncology, HIV & palliative care
Ethics approval: Ethical approval: not required.
All authors, affiliations and abstracts have been published as submitted.
