Fatigue is one of the most common adverse effects of lung cancer, and the efficacy of nonpharmacological interventions on fatigue in lung cancer patients is still unclear. We aimed to assess the effectiveness of nonpharmacological interventions on lung cancer-induced fatigue. A systematic review and meta-analysis were performed on studies retrieved from the PubMed, Embase Ovid, Cochrane Central Register of Controlled Trials, and Web of Science databases from inception to June 2020. A total of 18 of randomized controlled trials with three intervention categories were identified, comprising 1,446 patients. We observed that fatigue was significantly affected by physical therapies (standard mean difference [SMD] = –1.26, 95% confidence intervals [CI]: –2.05 to –0.47, p = .002), but not by exercise interventions (SMD = –0.52, 95% CI: –1.46 to 0.43, p = .29) or education and psychological interventions (SMD = –0.39, 95% CI: –0.92 to 0.14, p = .15). More research with robust methodology is needed to justify these findings.
BowerJ. E. (2014). Cancer-related fatigue—mechanisms, risk factors, and treatments. Nature Reviews Clinical Oncology, 11(10), 597–609. https://doi.org/10.1038/nrclinonc.2014.127
2.
BrayF.FerlayJ.SoerjomataramI.SiegelR. L.TorreL. A.JemalA. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68(6), 394–424. https://doi.org/10.3322/caac.21492
3.
CarnioS.Di StefanoR. F.NovelloS. (2016). Fatigue in lung cancer patients: Symptom burden and management of challenges. Lung Cancer, 7, 73–82. https://doi.org/10.2147/lctt.S85334
4.
CavalheriV.JenkinsS.CecinsN.GainK.PhillipsM. J.SandersL. H.HillK. (2017). Exercise training for people following curative intent treatment for non-small cell lung cancer: A randomized controlled trial. Brazilian Journal of Physical Therapy, 21(1), 58–68. https://doi.org/10.1016/j.bjpt.2016.12.005
5.
ChanC. W.RichardsonA.RichardsonJ. (2011). Managing symptoms in patients with advanced lung cancer during radiotherapy: Results of a psychoeducational randomized controlled trial. Journal of Pain and Symptom Management, 41(2), 347–357. https://doi.org/10.1016/j.jpainsymman.2010.04.024
6.
ChangC. W.MuP. F.JouS. T.WongT. T.ChenY. C. (2013). Systematic review and meta-analysis of nonpharmacological interventions for fatigue in children and adolescents with cancer. Worldviews on Evidence-based Nursing, 10(4), 208–217. https://doi.org/10.1111/wvn.12007
7.
ChangW. P.LinC. C. (2017). Relationships of salivary cortisol and melatonin rhythms to sleep quality, emotion, and fatigue levels in patients with newly diagnosed lung cancer. European Journal of Oncology Nursing, 29, 79–84. https://doi.org/10.1016/j.ejon.2017.05.008
8.
ChengC. S.ChenL. Y.NingZ. Y.ZhangC. Y.ChenH.ChenZ.ZhuX. Y.XieJ. (2017). Acupuncture for cancer-related fatigue in lung cancer patients: A randomized, double blind, placebo-controlled pilot trial. Support Care in Cancer, 25(12), 3807–3814. https://doi.org/10.1007/s00520-017-3812-7
9.
CohenJ. (1962). The statistical power of abnormal-social psychological research: A review. Journal of Abnormal and Social Psychology, 65, 145–153. https://doi.org/10.1037/h0045186
10.
DhillonH. M.BellM. L.van der PloegH. P.TurnerJ. D.KabourakisM.SpencerL.LewisC.HuiR.BlinmanP.ClarkeS. J.BoyerM. J.VardyJ. L. (2017). Impact of physical activity on fatigue and quality of life in people with advanced lung cancer: A randomized controlled trial. Annals of Oncology, 28(8), 1889–1897. https://doi.org/10.1093/annonc/mdx205
11.
DuS.HuL.DongJ.XuG.JinS.ZhangH.YinH. (2015). Patient education programs for cancer-related fatigue: A systematic review. Patient Education and Counseling, 98(11), 1308–1319. https://doi.org/10.1016/j.pec.2015.05.003
12.
EggerM.SmithG. D.SchneiderM.MinderC. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629
13.
GerberL. H. (2017). Cancer-related fatigue: Persistent, pervasive, and problematic. Physical Medicine and Rehabilitation Clinics of North America, 28(1), 65–88. https://doi.org/10.1016/j.pmr.2016.08.004
14.
GrantS. J.SmithC. A.de SilvaN.SuC. (2015). Defining the quality of acupuncture: The case of acupuncture for cancer-related fatigue. Integrative Cancer Therapies, 14(3), 258–270. https://doi.org/10.1177/1534735415572879
HigginsJ. P.ThompsonS. G.DeeksJ. J.AltmanD. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327(7414), 557–560. https://doi.org/10.1136/bmj.327.7414.557
17.
HilfikerR.MeichtryA.EicherM.Nilsson BalfeL.KnolsR. H.VerraM. L.TaeymansJ. (2018). Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: A systematic review incorporating an indirect-comparisons meta-analysis. British Journal of Sports Medicine, 52(10), 651–658. https://doi.org/10.1136/bjsports-2016-096422
18.
HoffmanA. J.BrintnallR. A.GivenB. A.Von EyeA.JonesL. W.BrownJ. K. (2017). Using perceived self-efficacy to improve fatigue and fatigability in postsurgical lung cancer patients: A pilot randomized controlled trial. Cancer Nursing, 40(1), 1–12. https://doi.org/10.1097/ncc.0000000000000378
19.
HouL.ZhouC.WuY.YuY.HuY. (2017). Transcutaneous electrical acupoint stimulation (TEAS) relieved cancer-related fatigue in non-small cell lung cancer (NSCLC) patients after chemotherapy. Journal of Thoracic Disease, 9(7), 1959–1966. https://doi.org/10.21037/jtd.2017.06.05
20.
HugoyT.LerdalA.RustoenT.OksholmT. (2019). Predicting postoperative fatigue in surgically treated lung cancer patients in Norway: A longitudinal 5-month follow-up study. BMJ Open, 9(9), e028192. https://doi.org/10.1136/bmjopen-2018-028192
21.
HwangC. L.YuC. J.ShihJ. Y.YangP. C.WuY. T. (2012). Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy. Support Care in Cancer, 20(12), 3169–3177. https://doi.org/10.1007/s00520-012-1452-5
22.
JonesL. W.EvesN. D.PeddleC. J.CourneyaK. S.HaykowskyM.KumarV.WintonT. W.ReimanT. (2009). Effects of presurgical exercise training on systemic inflammatory markers among patients with malignant lung lesions. Applied Physiology Nutrition and Metabolism, 34(2), 197–202. https://doi.org/10.1139/h08-104
23.
JungJ. Y.LeeJ. M.KimM. S.ShimY. M.ZoJ. I.YunY. H. (2018). Comparison of fatigue, depression, and anxiety as factors affecting posttreatment health-related quality of life in lung cancer survivors. Psycho-Oncology, 27(2), 465–470. https://doi.org/10.1002/pon.4513
24.
KissN.IsenringE.GoughK.WheelerG.WirthA.CampbellB. A.KrishnasamyM. (2016). Early and intensive dietary counseling in lung cancer patients receiving (chemo)radiotherapy-A pilot randomized controlled trial. Nutrition and Cancer, 68(6), 958-967. https://doi.org/10.1080/01635581.2016.1188972
25.
LiberatiA.AltmanD. G.TetzlaffJ.MulrowC.GøtzscheP. C.IoannidisJ. P. A.ClarkeM.DevereauxP. J.KleijnenJ.MoherD. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. British Medical Journal, 339, b2700. https://doi.org/10.1136/bmj.b2700
26.
LinL.ZhangY.QianH. Y.XuJ. L.XieC. Y.DongB.TianL. (2019). Auricular acupressure for cancer-related fatigue during lung cancer chemotherapy: A randomised trial. BMJ Supportive & Palliative Care. https://doi.org/10.1136/bmjspcare-2019-001937
27.
LongN. H.ThanasilpS.ThatoR. (2016). A causal model for fatigue in lung cancer patients receiving chemotherapy. European Journal of Oncology Nursing, 21, 242–247. https://doi.org/10.1016/j.ejon.2015.10.010
28.
MaddocksM.HallidayV.ChauhanA.TaylorV.NelsonA.SampsonC.ByrneA.GriffithsG.WilcockA. (2013). Neuromuscular electrical stimulation of the quadriceps in patients with non-small cell lung cancer receiving palliative chemotherapy: A randomized phase II study. PLOS ONE, 8(12), e86059. https://doi.org/10.1371/journal.pone.0086059
29.
MediaA. S.PerssonM.TajhiziN.WeinreichU. M. (2019). Chronic obstructive pulmonary disease and comorbidities’ influence on mortality in non-small cell lung cancer patients. Acta Oncologica, 58(8), 1102–1106. https://doi.org/10.1080/0284186x.2019.1612942
30.
MendozaT. R.KehlK. L.BamideleO.WilliamsL. A.ShiQ.CleelandC. S.SimonG. (2019). Assessment of baseline symptom burden in treatment-naïve patients with lung cancer: An observational study. Support Care in Cancer, 27(9), 3439–3447. https://doi.org/10.1007/s00520-018-4632-0
31.
MorrisonE. J.NovotnyP. J.SloanJ. A.YangP.PattenC. A.RuddyK. J.ClarkM. M. (2017). Emotional problems, quality of Life, and symptom burden in patients with lung cancer. Clinical Lung Cancer, 18(5), 497–503. https://doi.org/10.1016/j.cllc.2017.02.008
32.
MosherC. E.SecintiE.HirshA. T.HannaN.EinhornL. H.JalalS. I.DurmG.ChampionV. L.JohnsS. A. (2019). Acceptance and commitment therapy for symptom interference in advanced lung cancer and caregiver distress: A pilot randomized trial. Journal of Pain and Symptom Management, 58(4), 632–644. https://doi.org/10.1016/j.jpainsymman.2019.06.021
33.
MosherC. E.WingerJ. G.HannaN.JalalS. I.EinhornL. H.BirdasT. J.CeppaD. P.KeslerK. A.SchmittJ.KashyD. A.ChampionV. L. (2016). Randomized pilot trial of a telephone symptom management intervention for symptomatic lung cancer patients and their family caregivers. Journal of Pain and Symptom Management, 52(4), 469–482. https://doi.org/10.1016/j.jpainsymman.2016.04.006
34.
MustianK. M.AlfanoC. M.HecklerC.KlecknerA. S.KlecknerI. R.LeachC. R.MohrD.PaleshO. G.PepponeL. J.PiperB. F.ScarpatoJ.SmithT.SprodL. K.MillerS. M. (2017). Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: A meta-analysis. JAMA Oncology, 3(7), 961–968. https://doi.org/10.1001/jamaoncol.2016.6914
35.
National Comprehensive Cancer Network. (2020). NCCN clinical practice guldelines in oncology cancer-related fatigue (version 2.2020). http://www.nccn.org
36.
NowickiA.PiekarskaJ.FarbickaE. (2017). The assessment of cancer-related fatigue syndrome in patients with lung cancer during palliative chemotherapy. Advances in Respiratory Medicine, 85(2), 69–76. https://doi.org/10.5603/arm.2017.0013
37.
PengW.ZhangH.LiZ. (2019). Responses of lung cancer survivors undergoing gamma knife surgery to supportive group psychotherapy. Medicine, 98(9), e14693. https://doi.org/10.1097/md.0000000000014693
38.
PoortH.PetersM.BleijenbergG.GielissenM. F.GoedendorpM. M.JacobsenP.VerhagenS.KnoopH. (2017). Psychosocial interventions for fatigue during cancer treatment with palliative intent. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD012030.pub2
39.
PouwelsS.FiddelaersJ.TeijinkJ. A.WoorstJ. F.SiebengaJ.SmeenkF. W. (2015). Preoperative exercise therapy in lung surgery patients: A systematic review. Respiratory Medicine, 109(12), 1495–1504. https://doi.org/10.1016/j.rmed.2015.08.009
40.
RipamontiC. I.AntonuzzoA.BossiP.CavalieriS.RoilaF.FatigoniS. (2018). Fatigue, a major still underestimated issue. Current Opinion in Oncology, 30(4), 219–225. https://doi.org/10.1097/cco.0000000000000451
41.
SaliganL. N.OlsonK.FillerK.LarkinD.CrampF.YennurajalingamS.EscalanteC. P.del GiglioA.KoberK. M.KamathJ.PaleshO.MustianK. (2015). The biology of cancer-related fatigue: A review of the literature. Support Care in Cancer, 23(8), 2461-2478. https://doi.org/10.1007/s00520-015-2763-0
42.
SchardtC.AdamsM. B.OwensT.KeitzS.FonteloP. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Medical Informatics and Decision Making, 7, 16. https://doi.org/10.1186/1472-6947-7-16
43.
SongS.YuJ.RuanY.LiuX.XiuL.YueX. (2018). Ameliorative effects of tai chi on cancer-related fatigue: A meta-analysis of randomized controlled trials. Support Care in Cancer, 26(7), 2091–2102. https://doi.org/10.1007/s00520-018-4136-y
44.
SungM. R.PatelM. V.DjalalovS.LeL. W.ShepherdF. A.BurkesR. L.FeldR.LinS.TudorR.LeighlN. B. (2017). Evolution of symptom burden of advanced lung cancer over a decade. Clinical Lung Cancer, 18(3), 274–280.e276. https://doi.org/10.1016/j.cllc.2016.12.010
45.
TanX.XiongH.GuiS.WanY.YanW.WangD.TongL.ZengG. (2019). Effects of cognitive education on the perceived control and symptom distress of lung cancer patients receiving chemotherapy: A randomised controlled trial. European Journal of Cancer Care, 28(5), e13120. https://doi.org/10.1111/ecc.13120
46.
TangW. R.ChenW. J.YuC. T.ChangY. C.ChenC. M.WangC. H.YangS. H. (2014). Effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy: An experimental pilot study. Complementary Therapies in Medicine, 22(4), 581–591. https://doi.org/10.1016/j.ctim.2014.05.006
47.
ThongM. S. Y.van NoordenC. J. F.SteindorfK.ArndtV. (2020). Cancer-related fatigue: Causes and current treatment options. Current Treatment Options in Oncology, 21(2), 17. https://doi.org/10.1007/s11864-020-0707-5
48.
TuQ.YangZ.GanJ.ZhangJ.QueB.SongQ.WangY. (2018). Transcutaneous electrical acupoint stimulation improves immunological function during the perioperative period in patients with non-small cell lung cancer undergoing video-assisted thoracic surgical lobectomy. Technology in Cancer Research & Treatment, 17, https://doi.org/10.1177/1533033818806477
49.
WangnumK.ThanarojanawanichT.ChinwatanachaiK.JamprasertL.MaleehuanO.JanthakunV. (2013). Impact of the multidisciplinary education program in self-care on fatigue in lung cancer patients receiving chemotherapy. Journal of the Medical Association of Thailand, 96(12), 1601–1608.
50.
WuC.ZhengY.DuanY.LaiX.CuiS.XuN.TangC.LuL. (2019). Nonpharmacological interventions for cancer-related fatigue: A systematic review and bayesian network meta-Analysis. Worldviews on Evidence-based Nursing, 16(2), 102–110. https://doi.org/10.1111/wvn.12352
51.
YorkeJ.Lloyd-WilliamsM.SmithJ.BlackhallF.HarleA.WardenJ.EllisJ.PillingM.HainesJ.LukerK.MolassiotisA. (2015). Management of the respiratory distress symptom cluster in lung cancer: A randomised controlled feasibility trial. Support Care in Cancer, 23(11), 3373–3384. https://doi.org/10.1007/s00520-015-2810-x
52.
ZhangL. L.WangS. Z.ChenH. L.YuanA. Z. (2016). Tai chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: A randomized controlled trial. Journal of Pain and Symptom Management, 51(3), 504–511. https://doi.org/10.1016/j.jpainsymman.2015.11.020
53.
ZhangY.LinL.LiH.HuY.TianL. (2018). Effects of acupuncture on cancer-related fatigue: A meta-analysis. Support Care in Cancer, 26(2), 415–425. https://doi.org/10.1007/s00520-017-3955-6
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