Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue.

CONTEXT: Fatigue is among the most common and distressing symptoms experienced by cancer patients. OBJECTIVE: This systematic review and meta-analysis evaluates the efficacy of psychological and activity-based interventions against cancer-related fatigue in cancer patients. DATA SOURCES: MEDLINE, PsycINFO, and CINAHL. STUDY SELECTION: Randomized controlled trials of psychological and activity-based interventions involving adult cancer patients in which fatigue was an outcome were reviewed. EXTRACTION: Forty-one trials were reviewed and 30 were included in a meta-analysis. DATA SYNTHESIS: Fifty percent of psychological trials and 44% of activity-based trials rated fair or better in quality yielded significant findings favoring the intervention condition. Meta-analysis yielded an overall effect size of 0.09 (95% CI = .02- .16) favoring nonpharmacological conditions. Further analysis indicated that effect sizes were significant for psychological interventions (d-sub(w) = .10, 95% CI = .02-.18) but not activity-based interventions (d-sub(w) = .05, 95% CI = -.08 - .19). CONCLUSIONS: Findings provide limited support for use of nonpharmacological interventions to manage cancer-related fatigue. The lack of research with heightened fatigue as an eligibility criterion is a notable weakness of the existing evidence base.