Nonpharmacological interventions for cancer-related fatigue: A literature review

Non-pharmacological treatment options for fatigue: A systematic review of RCTs in adults

OBJECTIVE

Fatigue is a significant contributor to the burden experienced by patients with chronic disorders. The development of standardized treatments is challenging due to the lack of consensus concerning the etiology of fatigue. The aim of this systematic review is to provide an overview of non-pharmacological interventions for fatigue. The efficacy and differences in fatigue treatment across conditions will be explored.

METHODS

A systematic literature search was conducted using the databases PubMed, Web of Science, PsycInfo and CINAHL. Trials were eligible when (1) adult patients (≥ 18 years old) with disorders causing fatigue were included, (2) non-pharmacological interventions performed, (3) treatment was compared to standard care, placebo or active control group, (4) fatigue was the only primary outcome assessed with a multidimensional tool, and (5) a randomized controlled trial (RCT) design was applied.

RESULTS

7592 papers were screened. 91 RCTs were eligible, with data reported in 95 papers. Specific fatigue interventions were present for a broad range of conditions. Findings demonstrated promising evidence for physical activity, CBT, online programs and multidimensional modules. Additional types of interventions were effective, but evidence was limited due to risk of bias and small sample sizes. Due to high heterogeneity concerning methodology, a meta-analysis was not possible.

CONCLUSION

Several non-pharmacological treatment options for fatigue are promising. No clear evidence was found that fatigue should be treated differently depending on the underlying condition. However, further research is necessary with a focus on a transdiagnostic approach to fatigue, high study quality and long-term follow-ups.

The role of disease duration in the use of complementary and integrative medicine for cancer-related fatigue: a cross-sectional study

PURPOSE

This study aimed to assess the use of complementary and integrative medicine among cancer patients in Turkey for managing fatigue and to examine the moderating effect of disease duration on the relationship between fatigue levels and patients' attitudes toward complementary and integrative medicine.

METHODS

A cross-sectional study was conducted with 231 cancer patients recruited from a chemotherapy center in western Turkey. Participants completed sociodemographic forms, the Holistic Complementary and Alternative Medicine Questionnaire, and the Visual Analog Scale for Fatigue. Data were analyzed using linear regression and moderation analysis.

RESULTS

Among the participants, 38.5% reported using complementary and integrative medicine to manage fatigue, with biologically based treatments such as vitamin supplements and herbal tea being the most common. Regression analysis showed that younger age (p < 0.05), longer disease duration (p = 0.005), absence of complementary and integrative medicine-related complications (p < 0.001), and higher fatigue levels (p < 0.001) were significant predictors of positive attitudes toward complementary and integrative medicine. Additionally, disease duration moderated the relationship between fatigue levels and attitudes toward complementary and integrative medicine, with longer disease duration strengthening the association (B =  - 0.269, SE = 0.078, p = 0.001).

CONCLUSION

The findings suggest that fatigue and prolonged disease duration significantly influence cancer patients' attitudes toward complementary and integrative medicine. Given the increasing use of complementary and integrative medicine, healthcare professionals should provide evidence-based guidance to ensure its safe and effective use. Future research should explore the long-term effects of complementary and integrative medicine on cancer-related fatigue.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the importance of addressing cancer-related fatigue and recognizing the growing use of complementary and integrative medicine among cancer patients.

PATIENT OR PUBLIC CONTRIBUTION

Patients were invited to complete questionnaires. Investigators explained the study's objectives and content and addressed any concerns raised during data collection.

Fatigue in hematological cancer changes across chemotherapy trajectory within the context of IL-6, not hemoglobin level: evidence from growth curve modeling

PURPOSE

The present study aimed to examine (a) how fatigue severity changes during the course of chemotherapy in patients with hematologic cancer and (b) whether cytokines (IL-1 alpha, IL-1 beta, IL-6) are associated with fatigue change after controlling for demographic and clinical factors (e.g., hemoglobin/hematocrit, medications, comorbid conditions).

METHODS

This observational cohort study used data from 148 hematological cancer patients four times: prior to chemotherapy, on the last day of chemotherapy, 1 week after the chemotherapy completion, and 1 month after baseline assessment. Latent growth curve modeling was used to examine the longitudinal association of fatigue severity with cytokines and hemoglobin.

RESULTS

A quadratic growth curve model fit the data well, indicating model tenability, and explained a large amount of variance in fatigue across measurement time points. Fatigue slightly increased toward the end of chemotherapy and decreased with time after chemotherapy completion. The influence of IL-6 on fatigue was significant at all time points except at the last assessment occasion (i.e., 1 month after the baseline assessment). The influence of IL-6 on fatigue was independent (unique) from the impact of hemoglobin level. Age and chemotherapy given for the first line of treatment significantly influenced the rate of fatigue change over time. Age also influenced the change pattern's shape.

CONCLUSIONS

Fatigue severity changes across the course of chemotherapy within the context of IL-6 activity, not the hemoglobin level. The influence of IL-6 may be limited during and shortly after chemotherapy. These findings inform the development of new symptom management strategies.

The effect of hand massage on fatigue in women with cancer receiving brachytherapy: randomized clinical trial

PURPOSE

This randomized controlled study was conducted to analyze the effect of hand massage on the fatigue level of the women receiving brachytherapy.

METHODS

It was determined that 12 patients were included in each group (control and hand massage group), so 24 women with gynecologic cancer were included in the study. The application was performed on each hand for 5 min, a total of 10 min in hand massage group. Hand massage was applied before each brachytherapy (at the first, second, and third sessions, a total of three times) every other day for 1 week in the hand massage group. No intervention was performed to the control group during the study. The data were collected using the Patient Information Form and Brief Fatigue Inventory (BFI).

RESULTS

At the end of the brachytherapy, the fatigue severity score and impact of fatigue on activities of daily living scores of the group that applied hand massage were determined to be lower than the control group (p < 0.05).

CONCLUSION

It was determined that hand massage effectively controlled fatigue and the impact of fatigue on activities of daily living. Hand massage is a safe and economical method that can be performed by certified nurses.

TRIAL REGISTRATION

This clinical trial is registered at ClinicalTrials.gov (NCT06056713-09/21/2023).

Empowering mind-body wellness: effect of bundling seated exercises and psychoeducational rehabilitation using the teach-back approach on fatigue and coping of women postmastectomy

BACKGROUND

Being diagnosed with Breast Cancer (BC) is a crisis that throws the patient's life out of balance. Cancer-related fatigue is a debilitating sign experienced by women during and after BC treatment. Regular physical exercise may help mitigate patients' fatigue, enhance coping abilities, improve their quality of life, and overall well-being. In parallel, psychological interventions are geared toward normalizing the lived painful experiences among oncology patients.

OBJECTIVE

to examine the effect of bundling seated exercises and psychoeducational rehabilitation using the teach-back approach on fatigue and coping of women postmastectomy.

METHODS

A quasi-experimental study was conducted in the Oncology Surgical Department and chemotherapy unit at the Alexandria Main University Hospital, Egypt. A total of 60 women were randomly allocated to either to the study or the control groups. Women in the study group practiced seated exercises and psychological rehabilitation interventions, including mindfulness breathing, problem-solving training, cognitive reframing technique, and thought stopping while the control group received the routine care.

RESULTS

The study revealed a significant decline in the fatigue mean scores among participants in the intervention group from 136.10 ± 27.76 to 98.43 ± 25.99 (p < 0.001). Similarly, there was a significant decrease in the patients' mean scores of maladaptive coping, helplessness/ hopelessness (p = 0.014), and anxious preoccupation (p = 0.008). In contrast, there is a noticeable increment in the scores of adaptive coping, such as fighting spirit (p = 0.012), cognitive avoidance (p = 0.002), and fatalism (p = 0.009).

CONCLUSION

Bundling seated exercises and psychological rehabilitation interventions using the teach-back approach have been proven to be simple and inexpensive non-pharmacological methods of reducing cancer-related fatigue and improving coping skills among women post-mastectomy.

TRIAL REGISTRATION NUMBER

NCT06360276, ClinicalTrails.gov, Retrospectively registered (April 8th, 2024), URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT06360276 .

Effects of broadband music and audible band music on relaxation states and cognitive function in young adults: a randomized controlled trial

BACKGROUND

Although broadband music with inaudible high-frequency components may benefit human well-being, this research area is largely unexplored and lacks sufficient studies on the topic. This study aimed to investigate and compare the effects of broadband and audible band music on relaxation states and cognitive function in young adults.

METHODS

A single-blind randomized controlled trial was conducted in a professional soundproof laboratory from December 22, 2022, to January 18, 2023 with 32 participants randomly assigned to two groups, "Day 1 broadband + Day 2 audible band" (n = 16) and "Day 1 audible band + Day 2 broadband" (n = 16), listening to either broadband or audible band music (the same music piece played on the piano and harp) for two sessions of 15 min each on two consecutive days. Cognitive function was measured using CNS Vital Signs at pre-listening, after the 1st session, and after the 2nd session, while heart rate was monitored throughout the experiment. Visual Analog Scale was also administered for self-reported arousal, stress, thinking ability, and attention following each listening session.

RESULTS

No significant differences were found in heart rate, cognitive flexibility, and executive function between the broadband listening group and the audible band-listening group (p > 0.05). However, the broadband group exhibited significant differences in mean heart rate at several time points, as well as a significant improvement in VAS stress level during the 2nd listening session compared to the 1st (p < 0.05). On the other hand, significant improvements in cognitive flexibility and executive function were observed in the audible band group across different time points (p < 0.05).

CONCLUSION

Comparative analysis showed that broadband and audible band music influenced cognitive function differently. Short-term audible band music listening significantly improved cognitive flexibility and executive function, while short-term broadband music listening significantly reduced reaction time in cognitive tests. Additionally, broadband music consistently resulted in lower mean heart rates compared to audible band music at all time points, suggesting that it may be more effective in promoting relaxation and reducing stress, although these differences were not statistically significant. Since the cognitive enhancing effects of broadband music may be counteracted by the drowsy effect of the selected relaxing music, using different types of music may be necessary to confirm its effects in future studies.

Microbiome-Modifiers for Cancer-Related Fatigue Management: A Systematic Review

OBJECTIVES

This study systematically investigates the evidence regarding the use of probiotics in managing cancer-related fatigue (CRF).

STUDY DESIGN

We conducted a systematic review of randomized controlled trials.

DATA SOURCES

The systematic search encompassed six databases: PubMed, CINHAL, Cochrane Database of Systematic Reviews, Web of Science, Scopus, and EMBASE, covering the period from inception to December 2023. The assessment of risk of bias employed the Cochrane risk of bias tool (RoB 2). A narrative synthesis and an exploratory meta-analysis were conducted to summarize the evidence.

RESULTS

Among 460 records, three studies met the eligibility criteria and were included in the review. These studies involved a total of 284 participants with colorectal and breast cancer. One study demonstrated a marginal improvement in CRF postchemotherapy in colorectal cancer patients using probiotics. Another study, also using probiotics, reported a significant reduction in CRF among colorectal cancer patients undergoing chemotherapy. Additionally, a study employing synbiotics showed a substantial decrease in CRF severity in breast cancer patients receiving chemotherapy.

CONCLUSION

The study presents initial but varied evidence suggesting the potential of probiotics and synbiotics as adjunctive therapies in managing CRF alongside anticancer treatments.

IMPLICATIONS FOR NURSING PRACTICE

In nursing practice, large-scale clinical trials are urgently needed to evaluate the effectiveness of probiotics in treating cancer-related fatigue during cancer therapy. Insights from this review could guide nurses in selecting appropriate probiotic strains and integrating microbiome modifiers into comprehensive care plans, potentially enhancing the quality of life for cancer patients.

The Effectiveness of Immersive Virtual Reality as A Complementary Approach and a New Direction in Cancer Related Fatigue Management

Background: Recent advancements in the field of medical technology have illuminated that the implementation of virtual reality interventions can be highly effective in managing cancer-related fatigue. Moreover, this innovative intervention has demonstrated a substantial improvement in patients' overall well-being and daily functioning. Thus, it represents a promising alternative to traditional pharmacological treatments by effectively addressing symptoms and enhancing quality of life. Therefore, the integration of this approach signifies a significant advancement in patient care. Nevertheless, despite the ongoing efforts to diversify non-pharmacological treatments, pharmacological interventions are still the predominant method for managing cancer-related fatigue. Aim: This systematic review aimed to evaluate the effectiveness of immersive virtual reality in cancer-related fatigue management, and to explore the main side effects of immersive virtual reality. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Several online databases were used to find eligible studies in peer-reviewed journals relevant to the study keywords. Specifically, the included studies were systematic reviews and clinical trials that used immersive virtual reality-based intervention among adult patients with cancer and suffering from cancer-related fatigue. As well as were published in the English language from 2014 to 2024. As well as, three researchers independently contributed to study selections, data extraction, and study evaluations from different aspects: including quality assessment, risk of bias, and study synthesis. Results: After an extensive and comprehensive search, a total of ten published studies were included in this review study; 6 articles were quantitative clinical trial studies, and the other 4 were systematic review and meta-analysis studies. The quality of 6 included clinical trials was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for quantitative studies, the overall result showed that 33.3% of studies rated with moderate quality, no study was rated with low quality, and (66.7%) studies rated as high-quality studies. As well, the quality assessment of all review studies showed that all included systematic reviews and meta-analyses with a low risk of bias and high to moderate power of evidence. The result of this extensive and comprehensive review showed that immersive virtual reality has a significant effect in reducing cancer-related fatigue, however, still, there is a significant variation in the employment of immersive Virtual Reality protocols for cancer symptom management worldwide. Conclusion: Immersive virtual reality is an effective non-pharmacological intervention in reducing and controlling cancer-related fatigue among patients with various types of cancer, as well as being an affordable, cost-effective approach. Nevertheless, there remains a notable gap in the existing literature concerning virtual reality protocols, associated side effects, and the underlying mechanisms by which immersive virtual reality alleviates fatigue. Therefore, further research studies are warranted to address these gaps and advance our understanding in these areas.