Non-pharmacological interventions for cancer-related fatigue in terminal cancer patients: a systematic review and meta-analysis

Mai Hosokawa, Masami Ito, Ayumi Kyota, Kazue Hirai, Miyae Yamakawa, Mitsunori Miyashita

Research output: Contribution to journalArticlepeer-review


Background: Cancer-related fatigue (CRF) is a highly distressing symptom in patients with cancer. Although various interventions have been reported to reduce fatigue, few are available for use in terminally ill cancer patients, and it is unknown which interventions are effective. They are also often difficult to implement in terminally ill patients with cancer. We, therefore, assessed the recommended interventions to reduce CRF in terminally ill cancer patients. Methods: Four electronic databases were searched to identify studies published between January 2015 and March 2021. The inclusion criteria were terminally ill cancer patients; non-pharmacological interventions; studies in which usual care or control groups were compared, or comparisons were made prior to the post-intervention period; studies in which the primary outcome was fatigue scale or symptom scale (including those measuring fatigue on a subscale); and experimental study designs including randomised controlled trials (RCTs) and quasi-experimental studies. A summary of the data extracted from each study was created. We also conducted a meta-analysis of the RCTs. Results: A total of 1,954 publications were identified from the initial database, eight of which were included in this study. Three RCTs and five non-RCTs were included in the final evaluation. Most of the studies had a small number of participants. We conducted a meta-analysis of two of the three RCTs included in this study. There was insufficient evidence to determine the effects of the interventions compared to the controls [standard mean difference, −0.05; 95% confidence interval (CI): −0.48 to 0.37; two studies; 290 participants; I2=65%]. Conclusions: Few reports exist on non-pharmacological interventions for patients with terminal cancer and there was insufficient evidence to determine the effect of the interventions on fatigue. This highlights the lack of RCTs on non-pharmacological procedures and therapies for reducing fatigue.

Original languageEnglish
Pages (from-to)3382-3393
Number of pages12
JournalAnnals of palliative medicine
Issue number11
Publication statusPublished - 2022 Nov
Externally publishedYes


  • Cancer-related fatigue (CRF)
  • palliative care
  • terminally ill cancer patients

ASJC Scopus subject areas

  • Medicine(all)


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