A systematic review of randomized controlled trials for management of persistent post-treatment fatigue in thyroid cancer survivors.
BACKGROUND
Fatigue that persists post-treatment is commonly reported by thyroid cancer (TC) survivors.


METHODS
A systematic review of published English language randomized controlled trials (RCTs) on interventions for management of persistent post-treatment fatigue in TC was conducted. This review excluded studies on short-term interventions used in preparation for radioactive iodine diagnostic scans or treatment. An electronic search was executed in six databases and supplemented by a hand search. Two reviewers independently reviewed all citations from the electronic search and relevant full-text studies. Two abstractors independently critically appraised included studies and abstracted the data. The data were qualitatively summarized.


RESULTS
A total of 1086 unique citations and 25 full-text studies were reviewed. Four studies summarizing the results of three RCTs were included. The interventions included: combination triiodothyronine with levothyroxine (L-T4) therapy compared to L-T4 alone (one RCT), reduction in degree of thyrotropin (TSH) suppression using L-T4 compared to maintenance of TSH suppression (one RCT), and supervised exercise compared to inactivity (two RCTs examining different fatigue outcomes in same population). Trial duration ranged from 10 weeks to six months. All trials had limitations, and the number of TC survivors included in respective RCTs ranged from 15 to 36. Hormonal treatment RCTs had mixed fatigue outcome results within respective trials. However, multiple measures suggesting improvement in fatigue were reported following the exercise intervention.


CONCLUSIONS
There is paucity of RCTs to guide evidence-based management of persistent post-treatment fatigue in TC survivors. RCTs of interventions for prevention or treatment of fatigue in TC survivors are needed.
1 Department of Psychology, University of Waterloo , Waterloo, Canada .
Joshua
J
To
Alyse S
AS
Goldberg
Jennifer
J
Jones
Junhui
J
Zhang
Julia
J
Lowe
Shereen
S
Ezzat
Jeremy
J
Gilbert
Afshan
A
Zahedi
Phillip
P
Segal
Anna M
AM
Sawka
D015444:Exercise; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D017741:Survivors; D013963:Thyroid Hormones / Q000627:therapeutic use*; D013964:Thyroid Neoplasms / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome
D013963:Thyroid Hormones