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

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.