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Interventions for multidimensional aspects of breast cancer-related fatigue: a meta-analytic review

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Abstract

Purpose

This meta-analysis sought to determine whether exercise, psychological, or alternative forms of interventions differentially improve cognitive, physical, and general dimensions of cancer-related fatigue (CRF) in women with a history of breast cancer.

Methods

Databases (PubMed, PsychINFO, EMBASE, and Cochrane Library) were systematically reviewed from inception through March 2019, with data extracted from randomized controlled trials of fatigue interventions using multidimensional CRF outcome measures. Two authors independently assessed methodological quality using the Cochrane Collaboration’s risk of bias tool. Analyses were performed with Comprehensive Meta-Analysis (v.3).

Results

A total of 471 studies were assessed, of which 11 studies with 12 sets of data involving 1067 patients were included. Across intervention types, small to moderate improvements were observed for cognitive (g = − 0.38), physical (g = − 0.46), and general (g = − 0.45) CRF (p values < 0.01). Exercise produced moderate benefit for cognitive (g = − 0.44), physical (g = − 0.48), and general (g = − 0.49) CRF (p values < 0.01) whereas psychotherapy and disparate forms of alterative interventions were not effective (p values > 0.45). However, a large effect size was observed for a single trial of acupressure across all three CRF dimensions (p < 0.05).

Conclusions

Exercise improved both cognitive and physical aspects of CRF. Further studies should determine the most effective forms, duration, intensity, and methods of supporting exercise in breast cancer patients. Further investigation of acupressure as an intervention for CRF should also be considered.

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Data availability

The authors maintain full control of all primary data and agree to allow the journal to review the data upon request.

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Funding

The study was funded by the Under Armour Women's Health and Breast Cancer Innovation Grant, the Johns Hopkins Catalyst Award, and the Robert L. Sloan Fund for Cancer Research.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Tracy D. Vannorsdall, Ermiece Straub, Christina Saba, Mallory Blackwood, Jingyi Zhang & Keren Stearns

  2. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Tracy D. Vannorsdall

  3. Baltimore, USA

    Tracy D. Vannorsdall

  4. Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Karen Lisa Smith

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  1. Tracy D. Vannorsdall
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Tracy Vannorsdall and Karen Smith contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ermiece Straub, Christina Saba, Mallory Blackwood, and Jingyi Zhang. The first draft of the manuscript was written by Tracy Vannorsdall, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Tracy D. Vannorsdall.

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Dr. Smith holds stock in ABT Labs and Abbvie. Dr. Smith also receives institutional research support from CancerIncite and Pfizer. The remaining authors declare that they have no conflict of interest.

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Appendix. Search terms

Appendix. Search terms

Chalder Fatigue Questionnaire OR Cancer Fatigue Scale OR EORTC QLQ-C30 OR Fatigue Assessment Questionnaire OR Fatigue Impact Scale OR Fatigue Symptom Checklist OR Fatigue Symptom Inventory OR Linear Analogue Self-Assessment Scale OR Multidimensional Fatigue Inventory OR Multidimensional Fatigue Symptom Inventory OR Piper Fatigue Scale OR Schwartz Cancer Fatigue Scale AND Breast OR Cancer OR Carcinoma OR Neoplasm.

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Vannorsdall, T.D., Straub, E., Saba, C. et al. Interventions for multidimensional aspects of breast cancer-related fatigue: a meta-analytic review. Support Care Cancer 29, 1753–1764 (2021). https://doi.org/10.1007/s00520-020-05752-y

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