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10-03-2017 | Oncology | News | Article

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Exercise, psychological interventions best option for cancer-related fatigue

medwireNews: Exercise and psychological interventions effectively improve cancer-related fatigue (CRF) during and after cancer treatment, with greater success than the available pharmaceutical options, study findings indicate.

According to the researchers, this means: “Clinicians should prescribe exercise and/or psychological interventions as first-line treatments for cancer-related fatigue.”

The meta-analysis of 113 randomized clinical trials involved 11,525 adults (mean age 54 years, 78% women) with a variety of cancer types, at various stages of disease and treatment, who received exercise, psychological, combined exercise and psychological, or pharmaceutical interventions to treat CRF.

Karen Mustian (University of Rochester Medical Center, New York, USA) and colleagues found that the greatest overall improvement in CRF occurred with exercise-based interventions (aerobic, anaerobic or strength, or both), with a moderate but significant weighted effect size (WES) of 0.30.

Significant moderate improvements also occurred with psychological interventions (cognitive behavioral, psychoeducational, or eclectic; WES=0.27), and with a combination of exercise plus psychological interventions (WES=0.26).

Furthermore, these three intervention types offered significantly greater improvements in CRF than those seen with pharmacological treatment with paroxetine hydrochloride, modafinil or armodafinil, methylphenidate hydrochloride or dexymethylphenidate, dexamphetamine, and methylprednisolone, where the WES was just 0.09.

The researchers also note in JAMA Oncology that “certain intervention modes may be more effective for treating CRF at different points in the cancer treatment trajectory.”

For example, patients with early-stage (nonmetastatic) disease and patients who had completed primary treatments (surgery, chemotherapy, or radiotherapy) reported the greatest benefit from the interventions overall.

And exercise-based interventions were most effective when given during primary treatment, whereas psychological interventions, either alone or alongside exercise, were most effective for survivors who had competed primary treatment.

Mustian and team also found that the overall effectiveness of interventions to improve CRF was not associated with age, gender, cancer type (breast vs others), exercise mode, allocation concealment, treatment fidelity protocol, or PEDro scale quality score.

They conclude that “exercise and psychological interventions are effective for improving CRF during and after primary treatment, whereas pharmaceutical interventions are not.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2017