Psychosocial interventions for fatigue during cancer treatment with palliative intent

Hanneke Poort; Marlies Peters; Gijs Bleijenberg; Marieke FM Gielissen; Martine Margaretha Goedendorp; Paul Jacobsen; Stans Verhagen; Hans Knoop

doi:10.1002/14651858.CD012030.pub2

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Figure 1

Study flow diagram.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

Forest plot of comparison: 1 Fatigue, outcome: 1.1 Post intervention.

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Figure 5

Forest plot of comparison: 1 Fatigue, outcome: 1.2 First follow‐up.

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Figure 6

Forest plot of comparison: 1 Fatigue, outcome: 1.3 Second follow‐up.

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Analysis 1.1

Comparison 1 Fatigue, Outcome 1 Post intervention.

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Analysis 1.2

Comparison 1 Fatigue, Outcome 2 First follow‐up.

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Analysis 1.3

Comparison 1 Fatigue, Outcome 3 Second follow‐up.

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Analysis 2.1

Comparison 2 Physical functioning, Outcome 1 Post intervention.

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Analysis 2.2

Comparison 2 Physical functioning, Outcome 2 First follow‐up.

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Analysis 3.1

Comparison 3 Social functioning, Outcome 1 Post intervention.

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Analysis 4.1

Comparison 4 Role functioning, Outcome 1 Post intervention.

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Analysis 5.1

Comparison 5 Emotional functioning, Outcome 1 Post intervention.

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Analysis 6.1

Comparison 6 Cognitive functioning, Outcome 1 Post intervention.

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Analysis 7.1

Comparison 7 Subgroup analyses, Outcome 1 Fatigue post intervention.

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Analysis 7.2

Comparison 7 Subgroup analyses, Outcome 2 Fatigue post intervention.

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Analysis 7.3

Comparison 7 Subgroup analyses, Outcome 3 Fatigue post intervention.

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Analysis 7.4

Comparison 7 Subgroup analyses, Outcome 4 Fatigue post intervention.

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Analysis 7.5

Comparison 7 Subgroup analyses, Outcome 5 Fatigue first follow‐up.

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Analysis 7.6

Comparison 7 Subgroup analyses, Outcome 6 Fatigue second follow‐up.

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Analysis 8.1

Comparison 8 Sensitivity analyses, Outcome 1 Fatigue post intervention.

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Analysis 8.2

Comparison 8 Sensitivity analyses, Outcome 2 Fatigue first follow‐up.

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Analysis 8.3

Comparison 8 Sensitivity analyses, Outcome 3 Fatigue second follow‐up.

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Psychosocial interventions compared with control intervention for fatigue during cancer treatment with palliative intent
Patient or population: patients with incurable cancer receiving cancer treatment with palliative intent Settings: university‐affiliated hospitals, cancer centres, public hospitals Intervention: psychosocial intervention Comparison: usual care or control condition (not a psychosocial intervention)
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
Outcomes	Assumed risk	Corresponding risk	Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
Fatigue	Not known	Not known	Fatigue in the psychosocial interventions group was lower than in the control group (SMD ‐0.25, 95% CI ‐0.50 to 0.00)	535 (12)	⊕⊝⊝⊝ very low^a,b
Physical functioning	Not known	Not known	Physical functioning in the psychosocial interventions group was higher (SMD 0.32, 95% CI 0.01 to 0.63)	307 (7)	⊕⊝⊝⊝ very low^a,b	An SMD of 0.32 represents a small effect size, with the upper end of the CI suggesting this may be clinically significant for some people.
Social functioning	Not known	Not known	Social functioning in the psychosocial interventions group was higher (MD 4.16, 95% CI ‐11.20 to 19.53)	141 (4)	⊕⊝⊝⊝ very low^a,b
Role functioning	Not known	Not known	Role functioning in the psychosocial interventions group was higher (MD 3.49, 95% CI ‐12.78 to 19.76)	143 (4)	⊕⊝⊝⊝ very low^a,b
Emotional functioning	Not known	Not known	Emotional functioning in the psychosocial interventions group was lower (SMD ‐0.11, 95% CI ‐0.56 to 0.35)	115 (3)	⊕⊝⊝⊝ very low^a,b
Cognitive functioning	Not known	Not known	Cognitive functioning in the psychosocial interventions group was lower (MD ‐2.23, 95% CI ‐12.52 to 8.06)	86 (2)	⊕⊝⊝⊝ very low^a,b
Adverse events	See comment	See comment	Not estimable			No data available for meta‐analysis.
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; SMD: standardised mean difference.
GRADE Working Group grades of evidence. High quality: We are very confident that the true effect lies close to the estimate of effect. Moderate quality: We are moderately confident in the effect estimate; the true effect is likely to be close the estimate of effect but may be substantially different. Low quality: Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of effect. Very low quality: We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^aDowngraded once: unclear risk of selection bias. ^bDowngraded twice: imprecision due to very sparse data.

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Comparison 1. Fatigue

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Post intervention Show forest plot	12	535	Std. Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.50, 0.00]

2 First follow‐up Show forest plot	4	147	Std. Mean Difference (IV, Random, 95% CI)	‐0.66 [1.00, ‐0.32]

3 Second follow‐up Show forest plot	2	91	Std. Mean Difference (IV, Random, 95% CI)	‐0.41 [‐1.12, 0.30]

Comparison 1. Fatigue

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Comparison 2. Physical functioning

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Post intervention Show forest plot	7	307	Std. Mean Difference (IV, Random, 95% CI)	0.32 [0.01, 0.63]

2 First follow‐up Show forest plot	2	122	Std. Mean Difference (IV, Random, 95% CI)	0.37 [‐0.20, 0.94]

Comparison 2. Physical functioning

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Comparison 3. Social functioning

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Post intervention Show forest plot	4	141	Mean Difference (IV, Random, 95% CI)	4.16 [‐11.20, 19.53]

Comparison 3. Social functioning

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Comparison 4. Role functioning

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Post intervention Show forest plot	4	143	Mean Difference (IV, Random, 95% CI)	3.49 [‐12.78, 19.76]

Comparison 4. Role functioning

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Comparison 5. Emotional functioning

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Post intervention Show forest plot	3	115	Std. Mean Difference (IV, Random, 95% CI)	‐0.11 [‐0.56, 0.35]

Comparison 5. Emotional functioning

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Comparison 6. Cognitive functioning

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Post intervention Show forest plot	2	86	Mean Difference (IV, Random, 95% CI)	‐2.23 [‐12.52, 8.06]

Comparison 6. Cognitive functioning

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Comparison 7. Subgroup analyses

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Fatigue post intervention Show forest plot	12	535	Std. Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.50, 0.00]

1.1 Short intervention duration	3	163	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.72, 0.48]
1.2 Intermediate‐long intervention duration	9	372	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐0.57, 0.02]
2 Fatigue post intervention Show forest plot	11	507	Std. Mean Difference (IV, Random, 95% CI)	‐0.27 [‐0.53, ‐0.00]

2.1 Group intervention delivery	3	195	Std. Mean Difference (IV, Random, 95% CI)	‐0.33 [‐0.78, 0.11]
2.2 Individual intervention delivery	8	312	Std. Mean Difference (IV, Random, 95% CI)	‐0.22 [‐0.58, 0.14]
3 Fatigue post intervention Show forest plot	12	535	Std. Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.50, 0.00]

3.1 Monodisciplinary intervention type	9	452	Std. Mean Difference (IV, Random, 95% CI)	‐0.20 [‐0.44, 0.04]
3.2 Multi‐disciplinary intervention type	3	83	Std. Mean Difference (IV, Random, 95% CI)	‐0.41 [‐1.30, 0.47]
4 Fatigue post intervention Show forest plot	12	535	Std. Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.50, 0.00]

4.1 Fatigue‐specific intervention aim	5	232	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.48, 0.31]
4.2 Other intervention aim	7	303	Std. Mean Difference (IV, Random, 95% CI)	‐0.37 [‐0.72, ‐0.02]
5 Fatigue first follow‐up Show forest plot	7	270	Std. Mean Difference (IV, Random, 95% CI)	‐0.53 [‐0.78, ‐0.28]

5.1 No additional sessions	4	147	Std. Mean Difference (IV, Random, 95% CI)	‐0.66 [1.00, ‐0.32]
5.2 Additional sessions	3	123	Std. Mean Difference (IV, Random, 95% CI)	‐0.43 [‐0.90, 0.04]
6 Fatigue second follow‐up Show forest plot	5	202	Std. Mean Difference (IV, Random, 95% CI)	‐0.26 [‐0.58, 0.07]

6.1 No additional sessions	2	91	Std. Mean Difference (IV, Random, 95% CI)	‐0.41 [‐1.12, 0.30]
6.2 Additional sessions	3	111	Std. Mean Difference (IV, Random, 95% CI)	‐0.22 [‐0.74, 0.30]

Comparison 7. Subgroup analyses

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Comparison 8. Sensitivity analyses

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Fatigue post intervention Show forest plot	9	476	Std. Mean Difference (IV, Random, 95% CI)	‐0.30 [‐0.59, 0.00]

2 Fatigue first follow‐up Show forest plot	1	103	Std. Mean Difference (IV, Random, 95% CI)	‐0.70 [‐1.10, ‐0.30]

3 Fatigue second follow‐up Show forest plot	1	81	Std. Mean Difference (IV, Random, 95% CI)	‐0.23 [‐0.67, 0.22]

Comparison 8. Sensitivity analyses

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