Exercise, Psychological Interventions Beat Pharma Options For Cancer-Related Fatigue

Meta-analysis points to a strategy of exercise and psychological therapy rather than pharmaceutical treatment for patients with cancer-related fatigue

  • Date: 07 Mar 2017
  • Author: By Lynda Williams, Senior medwireNews Reporter
  • Topic: Supportive Measures

medwireNews: Clinicians should treat cancer-related fatigue (CRF) with exercise-based and/or psychological interventions, indicates a meta-analysis published in JAMA Oncology.

The data from 11,525 participants of 113 studies showed that these options had a stronger impact on CRF than did pharmaceutical agents, such as paroxetine hydrochloride or modafinil, say Karen Mustian, from the University of Rochester Medical Center in New York, USA, and co-authors.

The randomised controlled studies included in the meta-analysis were judged to be of good quality and to have sufficient data on fatigue to allow determination of a mean weighted effect size (WES) for CRF severity, the researchers explain.

Almost half (46.9%) of the studies were conducted in breast cancer patients and the remainder in those with other tumour types, with 44.2% including participants with nonmetastatic cancer, 9.7% only those with metastases and 29.2% with both populations.

Both exercise interventions and psychological interventions, and combined exercise and psychological interventions, impacted on CRF during and after cancer treatment, with significant moderate effects of 0.30, 0.27 and 0.26, respectively. By contrast, pharmacological interventions had a “significant but very small” WES of 0.09.

The authors believe their study is the first to indicate that the efficacy of CRF treatment is linked to eight different factors, with WES ranging from –0.91 to 0.99.

Specifically, CRF reductions were greatest in patients with early-stage cancer, those who had completed their primary treatment, and in participants given cognitive behavioural therapy types of psychological intervention. CRF interventions that were given to groups of patients and in person were also particularly effective, as were those measured using the Piper Fatigue Scale and where the control condition was standard care.

“However, exercise and psychological interventions produced significant improvements in CRF, even when a rigorous specific-component (behavioural placebo) control comparison was used”, the researchers say.

Likewise, the team suggests that their study has shown for the first time that CRF efficacy is not related to patient age, cancer type or whether the exercise recommended was aerobic, anaerobic resistance or a combination, but might be influenced by the timing of CRF intervention.

“For example, exercise may be the most effective treatment for patients receiving primary treatment, whereas psychological and exercise plus psychological interventions may be most effective for survivors who have completed primary treatment”, write Karen Mustian et al.

While recommending more phase III research into the use of exercise-based and psychological interventions, the researchers conclude: “Clinicians should prescribe exercise and psychological interventions as first-line therapy for patients experiencing CRF.”


Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological and exercise treatments for cancer-related fatigue. A meta-analysis. JAMA Oncol; Advance online publication 2 March 2017. doi:10.1001/jamaoncol.2016.6914

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