1 August 2017

A meta-analysis recently published in JAMA Oncology evaluated studies that reported on therapies for cancer-related fatigue (CRF). CRF is very common, can persist for years after treatment, and is exacerbated by depression, anxiety, sleep disturbance and pain – which can also be long-term effects of cancer therapy. The authors focused on papers that reported the effects of pharmaceutical treatment, psychological therapy, and exercise.

In evaluating 113 randomized trials in adults with cancer, they found that exercise and psychological interventions as well as the combination of both reduce cancer-related fatigue during and after cancer treatment, and that these therapies were significantly better than pharmaceutical therapy. Age, cancer type (breast vs other cancers) or exercise mode (aerobic, resistance, or combined) were not associated with effectiveness of the intervention – patients of all ages, with all types of cancer equally experienced improvement in cancer-related fatigue.

As this was a meta-analysis, a review of multiple previously published studies, limitations include lack of detailed information on race, education level, socioeconomic status and other demographic factors in all studies – this can limit how the results may be applied to specific populations. The majority of studies evaluated were among breast cancer patients or survivors. Studies set different levels of fatigue as entry criteria, and in some studies it was not well defined. In addition, they found some studies had not been registered on ClinicalTrials.gov.

Despite the limitations, this study was important as it clearly demonstrated the benefit of exercise and psychological interventions to improve CRF. The authors recommend that these should be considered first-line therapy recommendations rather than pharmaceutical approaches.