Non-pharmacological interventions for management of fatigue among children with cancer

Systematic review of existing practices and their effectiveness | BMJ Supportive & Palliative Care

Objectives: Fatigue is common among children living with cancer, particularly in advance stages. Little is known about the effectiveness of non-pharmacological approaches to manage this complex and distressing symptom among children. Thus, the present paper aim to critically examine the effectiveness and setting for non-pharmacological interventions to manage fatigue among children with cancer.

Methods: Six electronic databases were screened first in February 2013 and at second instance in March 2015. They include PsycINFO, Medline, EMBASE, CINAHL, Scopus and Cochrane library. All databases were systematically searched for literature on fatigue and cancer, limited to children (as age group) and English language.

Results: 1498 articles were identified, of which six were reviewed. Three types of interventions for managing fatigue were identified including (1) complementary and alternative medicine (healing touch/massage therapy), (2) exercise-based interventions and (3) nursing-based interventions. Most interventions were delivered during active treatment and in hospital settings where parents were involved to optimise participation. Despite fatigue scores being lower among intervention groups, no study findings were observed as being statistically significant.

Conclusion: Fatigue is common among children treated for and living with cancer. The most appropriate setting to deliver non-pharmacological interventions to manage fatigue appears to be in hospital. However, in absence of any strong evidence, professionals need to be cautious about existing non-pharmacological interventions. Future research must adopt more rigorous research designs that are adequately powered using validated measures to identify potential benefits. In addition, researchers may wish to test psychosocial interventions shown to be of benefit in adults.

Full reference: Bhardwaj, T. & Koffman, J. (2017) Non-pharmacological interventions for management of fatigue among children with cancer: systematic review of existing practices and their effectiveness. BMJ Supportive & Palliative Care. Published Online First: 31 July 2017

Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue

Mustian, K.M. et al. JAMA Oncology | Published online: 2 March 2017


Question: Which of the 4 most commonly recommended treatments for cancer-related-fatigue—exercise, psychological, the combination of exercise and psychological, and pharmaceutical—is the most effective?

Findings: This meta-analysis of 113 unique studies (11 525 unique participants) found that exercise and psychological interventions and the combination of both reduce cancer-related fatigue during and after cancer treatment. Reduction was not due to time, attention, or education. In contrast, pharmaceutical interventions do not improve cancer-related fatigue to the same magnitude.

Meaning: Clinicians should prescribe exercise and/or psychological interventions as first-line treatments for cancer-related fatigue.

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Cancer-related fatigue in post-treatment survivors

Corbett, T. et al. BMC Cancer. Published online: 25 November 2016


Background: Cancer-related fatigue (CrF) is a common and disruptive symptom that may be experienced during and after cancer. Research into the subjective experience of fatigue in this group is required. The common sense model of self-regulation of health and illness (SRM) addresses personal beliefs or mental representations—whether medically sound or unsubstantiated— that a person holds about a health issue. The current study assesses if the SRM could be used as a theoretical framework for organizing the experiences of people with CrF, with a view to identifying methods to address fatigue in cancer survivors.


Conclusion: This study explored the subjective experience of fatigue after cancer using the SRM. CrF should be approached as a complex psychosocial issue and considered from the patient perspective to facilitate better understanding and management of symptoms. The SRM is an applicable framework for identifying modifiable factors that could lead to improved coping with CrF in post-treatment cancer survivors.

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Appreciating the autonomy of cancer patients on deciding whether they want to be informed about interventional studies for fatigue

Poort, H. et al. (2016) Palliative Medicine. 30(9) pp. 897-898

Background: Fatigue is a prevalent and burdensome symptom for patients with advanced cancer. The long-term use of pharmacological interventions for fatigue is not supported by evidence, although non pharmacological and behavioral interventions are promising approaches to reducing fatigue based on their effectiveness in early-stage cancer patients. Behavioral factors, like sleeping problems and being less physically active, can also contribute to fatigue in advanced cancer patients. Interventional studies for the management of fatigue in advanced cancer patients are needed.

However, it is a notorious challenge to identify patients for interventional studies aimed at fatigue or symptom control while patients are undergoing cancer treatment with palliative intent. One of the barriers to successful identification of these patients is professional gatekeeping, due to the care professionals’ perception that study participation might be too burdensome for the patient. Although gatekeeping is done in order to prevent additional burden for patients who are seriously ill, it also limits access for patients to potentially effective interventions for fatigue and makes it difficult to develop evidence-based interventions for fatigue in advanced cancer patients.

Read the extract here