Exercise and Psychological Interventions Most Effective for Cancer-Related Fatigue

A review of research on the effectiveness of several treatments for cancer-related fatigue (CRF) determined that exercise and psychological interventions resulted in more significant improvements than pharmaceutical regimens.

The review, published in JAMA Oncology, identified 113 randomized controlled trials (RCTs) for inclusion, almost half of which were focused solely on participants with breast cancer. The goal for all studies was to improve CRF, a devastating side effect of treatment that can last for years afterward. Due to its detrimental impact on patients’ quality of life and daily capabilities, the condition has been identified as a research priority.

Currently, the most commonly recommended treatments for CRF are variations in the pharmaceutical agent, exercise, or psychological interventions. For instance, psychological treatment plans can use a cognitive behavioral or a psychoeducational method, or exercise interventions can involve aerobic or nonaerobic activity. Pharmaceutical interventions may consist of a regimen of modafinil, paroxetine hydrochloride, or dexamphetamine, among several other drugs.

The authors calculated 127 effect sizes of interventions on CRF, based on the relevant literature, as some of the studies had multiple arms. Of these, 69 assessed exercise interventions, 34 assessed psychological interventions, 10 evaluated a combination of exercise and psychological interventions, and 14 evaluated pharmaceutical interventions.

After statistical analysis, the researchers found that all of the studies resulted in at least some improvement in CRF following intervention, as measured by different self-assessment scales. The largest overall effect was seen for the exercise interventions, which yielded significant moderate improvements. Shortly behind those were the studies using psychological interventions or the combination of exercise and psychological treatments. The effects of pharmaceutical interventions were significant but very slight.

Furthermore, the researchers determined that 8 variables were linked to intervention effectiveness, including cancer stage, treatment status at baseline, and delivery mode of treatment. For instance, group-based and in-person interventions were most successful, and early-stage patients experienced the greatest improvements. Cognitive behavioral therapy was the most effective of the psychological interventions. Age, sex, and cancer type did not significantly impact the effectiveness of the interventions. Improvement sizes were similar for anaerobic and aerobic exercise programs.

The study authors addressed the finding that a combination of exercise and psychological interventions was less effective than either of those interventions on their own by suggesting that patients may not have maintained adherence to these more complex, time-consuming regimens. They called for additional research on these combination interventions, as their review included just 10 studies that used this model.

Exercise and psychological interventions should be prescribed as the first line of treatment for CRF, at least until further research is completed, the authors concluded.

“Although the results of this meta-analysis are very informative, conducting more high-quality, phase 3 RCTs to test new treatment options and directly compare treatments with known efficacy for managing CRF is of critical importance,” they wrote.