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Physical rehabilitation for the management of cancer-related fatigue during cytotoxic treatment: a systematic review with meta-analysis

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Abstract

Objective

To assess the effect of physical therapy on cancer-related fatigue (CRF) during cytotoxic anticancer treatment.

Methods

Systematic review with meta-analysis of randomized clinical trials published from 2010 to 2021 (EMBASE, MEDLINE, PEDro; SciELO, and LILACS). Studies assessing the effect of supervised physical therapy (IG) for the management of CRF on adults undergoing anticancer treatment compared with a control group (CG) covering usual care or any uncontrolled practice, such as recommendations about exercise and health education, were included in this review.

Results

A total of 22 studies were included in the SR and 21 in the meta-analysis, resulting in 1.992 individuals (CG = 973 and IG = 1.019). There was a reduction in general fatigue [SMD =  − 0.69; 95%CI (− 1.15, − 0.22) p < 0.01; I2 = 87%; NNT = 3], with greater weight attributed to combined exercise (44%). Physical fatigue also reduced [SMD =  − 0.76; 95%CI (− 1.13, − 0.39) p < 0.01; I2 = 90%; NNT = 2], with greater weight for resistance exercise (50%) and greater effect with combined exercise [SMD =  − 1.90; 95%CI (− 3.04, − 0.76) p < 0.01; I 2 = 96%]. There was reduction in general fatigue with moderate intensity (74%) [SMD =  − 0.89; 95%CI (− 1.61, − 0.17) p < 0.02; I2 = 90%] and physical fatigue [SMD =  − 1.00; 95%CI (− 1.54, − 0.46) p < 0.01; I2 = 92%], while high intensity reduced only general fatigue [SMD =  − 0.35; 95%CI (− 0.51, − 0.20) p < 0.01; I2 = 0%]. The number of overall and weekly sessions has been shown to contribute to the reduction of CRF.

Conclusion

Physical rehabilitation with moderate intensity promoted greater relief of general and physical fatigue. Even after controlling for high heterogeneity, the quality of evidence, summarized in GRADE, was considered moderate for general fatigue and low for physical fatigue.

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Data availability

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Authors and Affiliations

  1. Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Sarmento Leite, 245, Porto Alegre, RS, Brazil

    Giana Berleze Penna & Anderson Sartor Pedroni

  2. Department of Physical Therapy, Federal University of Health Sciences of Porto Alegre, Sarmento Leite, 245, Porto Alegre, RS, Brazil

    Douglas Maquart Otto

  3. Postgraduate Program in Pneumological Sciences, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, Brazil

    Tassiana Costa da Silva

  4. Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, UFCSPA, Sarmento Leite, 245, Porto Alegre, RS, Brazil

    Fabricio Edler Macagnan

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Contributions

All authors planned the search strategy; Giana Penna, Tassiana da Silva, and Douglas Maquart Otto performed the searches and extracted the data into tables and endnote which were checked by Fabricio Macagnan. Anderson Pedroni synthesised the findings. Giana Penna, Douglas Maquart Otto, and Tassiana da Silva drafted the paper; Fabricio Macagnan and Anderson Pedroni critically revised the work. All authors contributed to the writing and editing of the final draft and have approved the submitted version.

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Correspondence to Giana Berleze Penna.

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Penna, G.B., Otto, D.M., da Silva, T.C. et al. Physical rehabilitation for the management of cancer-related fatigue during cytotoxic treatment: a systematic review with meta-analysis. Support Care Cancer 31, 129 (2023). https://doi.org/10.1007/s00520-022-07549-7

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