Educational interventions for the management of cancer-related fatigue in adults: A Cochrane Review (#176)
Introduction: Cancer-related fatigue (CRF) is reported as being the most common and distressing symptom experienced by patients with cancer. Education about fatigue is recommended for those commencing treatment and for those who find fatigue distressing. Despite the importance of education for managing CRF there are currently no systematic reviews examining this approach. Aim: To evaluate the effectiveness of educational interventions for managing cancer-related fatigue in adults. Methods: This was a systematic review of randomised controlled trials for the Cochrane Database of Systematic Reviews. Studies were included if they involved adults with any type of cancer; aimed to evaluate the effect of educational interventions designed to manage CRF; and listed fatigue or loss of energy as the primary outcome. Main outcomes considered were fatigue severity, fatigue interference and fatigue distress. Electronic searches of 12 databases and extensive hand searches were carried out. Two review authors independently screened the titles and abstracts for eligibility and assessed risk of bias using the Cochrane risk of bias tool. Review Manager software (RevMan 5) was used for all analyses. We pooled clinically and statistically homogeneous studies using the fixed-effect model. Results: 1284 articles of which 10 were confirmed as eligible. Meta-analysis of 10 studies found that educational interventions alone do not reduce the severity of fatigue. However careful inspection of 4 studies suggests that education may reduce fatigue interference. Two studies that had the largest effect for reducing fatigue interference included behavioural and supportive techniques in addition to education. Insufficient evidence exists for the effect of education on fatigue distress. Conclusions: This review suggests that educational interventions alone may not reduce the severity of fatigue. However, more rigorous research is required to determine the effects of education on reducing fatigue distress and its impact on daily life.