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

摘要

To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment.Systematic review and indirect-comparisons meta-analysis.Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses.Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment.Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis.We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardisedmean difference (SMD) of ?0.77 (95% Credible Interval (CrI) ?1.22 to ?0.31), while massage (?0.78; ?1.55 to ?0.01), cognitive–behavioural therapy combined with physical activity (combined CBT, ?0.72; ?1.34 to ?0.09), combined aerobic and resistance training (?0.67; ?1.01 to ?0.34), resistance training (?0.53; ?1.02 to ?0.03), aerobic (?0.53; ?0.80 to ?0.26) and yoga (?0.51; ?1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (?0.68; ?0.93 to ?0.43). Combined aerobic and resistance training (?0.50; ?0.66 to ?0.34), combined CBT (?0.45; ?0.70 to ?0.21), Tai-Chi (?0.45; ?0.84 to ?0.06), CBT (?0.42; ?0.58 to ?0.25), resistance training (?0.35; ?0.62 to ?0.08) and aerobic (?0.33; ?0.51 to ?0.16) showed all small-to-moderate SMDs.Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF.