Introduction: Cancer-related fatigue (CRF) is the most common symptom associated with cancer and significantly impacts daily activities and quality of life. Mechanisms of CRF are multi-factorial, influenced by biological and psychosocial factors. A variety of interventions to address CRF have been explored, including exercise, psychosocial and pharmacological treatments. Existing systematic reviews of interventions, typically focused on one intervention type, report inconsistent findings. We aimed to compile evidence from systematic reviews to describe all interventions addressing CRF.
Method: We searched Medline, EMBASE, CINAHL, Cochrane and PsycInfo to June 2019. Systematic reviews of interventions where CRF was a specified outcome of the review were included. All titles and abstracts were independently assessed for inclusion. Relevant data related to study characteristics and intervention content, timelines and delivery mode were extracted. Risk of bias was evaluated using AMSTAR 2.
Results: We identified 35 reviews that met criteria, these predominantly included: adults (80%) of both sexes (63%) with mixed cancer types (63%) and stages (75%). Eight (23%) reviews focused on interventions during active treatment, four (11%) following treatment and 20 (57%) both phases. In most reviews (77%) exercise was part of the intervention: 15 (43%) exercise only and 6 (17%) combined exercise + psychosocial. Four (11%) reported pharmacological and three (9%) psychosocial only interventions. Assessment of fatigue was highly variable, measured using 59 different tools. Review quality varied, with 14% of high and 6% moderate quality.
Conclusion: Impact of exercise alone or in combination with other treatments has been most explored for addressing CRF. Reviews include mixed cancer types and stages, with a wide variety of tools to measure fatigue. This variability may distort intervention effects and contribute to inconsistent findings. Further research is needed to determine the most effective intervention for an individual with consideration of medical, treatment and psychosocial factors.