The effectiveness of non-pharmacological interventions on fatigue in children and adolescents with cancer: a systematic review.
BACKGROUND
Fatigue is one of the most distressing and prevalent symptoms reported by paediatric oncology patients. With the increase in cancer survival rate, how to control children's cancer-related fatigue during treatments or the coexisting period with the disease to further increase their quality of life has become the focus of medical teams who provide care to children with cancer.


OBJECTIVE
The objective of this systematic review was to synthesise the best available evidence concerning the effectiveness of non-pharmacological interventions on fatigue in children and adolescents with cancer.


METHODS
The search strategy aimed to find studies published between 1960 and 2010, in either the English or Chinese languages. Reference lists of studies that met the inclusion criteria were also searched for additional studies.
This review included randomised controlled trials and quasi-experimental studies that examined the effectiveness of non-pharmacological interventions for fatigue in children and adolescents with cancer.


METHODS
Children and adolescents aged between one to 18 years old, with cancer either during or after the chemotherapy. The types of cancer included were acute lymphoblastic leukaemia, acute myeloid leukaemia, lymphoma and solid tumours.
Non-pharmacological interventions for fatigue in children and adolescents with cancer including: activity enhancement (exercise, physical activity), psychosocial interventions, cognitive behavioural therapy, stress management, relaxation, nutrition consultation, massage and educational interventions. The intervention descriptions included the length, frequency, setting and intervention providers.


METHODS
The outcome measures considered fatigue scores assessment.
The review considered studies conducted either in a hospital or a community setting.


METHODS
The data were extracted and synthesised using the standardised data extraction tool and synthesis function offered by the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.


RESULTS
The review included six studies - five English-language papers and one Chinese-language paper. Meta-analysis did not show a statistically significant impact on the effectiveness of exercise interventions in reducing overall fatigue in children and adolescents with cancer. Exercise interventions did lead to a statistically significant improvement (p = 0.01) in general fatigue (i.e. tiredness, physical weakness) (effect size = -0.76; 95% Confidence Interval -1.35 to -0.17).


CONCLUSIONS
The results of this systematic review show that exercise interventions can effectively reduce the level of general fatigue of children aged six to 18 years. No strong conclusions can be made for the use of massage therapy or health education measures, as there was only one article for each of these interventions.


CONCLUSIONS
The review provides an evidenced-based guide to future priorities for clinical practice. Exercise intervention could reduce the level of general fatigue of children aged six to 18 years. In particular, exercise interventions for fatigue are feasible and safe.


CONCLUSIONS
There is still a lack of rigorous research on this specific topic. Further research requires more rigorous study design and reporting of methodological issues, such as randomised controlled trials using concealment of allocation. Other non-pharmacological interventions for this problem should also be examined, including cognitive behavioural therapy, stress management, relaxation, support groups and massage therapy.
a Professor and Deputy Academic Dean b Assistant professor c Professor and Chief of NS Pediatrics d Director 1. School of Nursing, National Yang-Ming University and Instructor, School of Nursing, Chang Gung University, Taipei, Taiwan R. O.C. Taiwan. A collaborating centre of the Joanna Briggs Institute 2. School of Nursing, National Yang-Ming University, Taipei, Taiwan R. O.C. Taiwan Joanna Briggs Institute Collaborating Centre. 3. Visiting Staff, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan R. O.C. 4. Division of Paediatric Neurosurgery, Department of Neurosurgery, Neurological Institute, Veterans General Hospital, Taipei, Taiwan R. O.C. 5. Department of Nursing, Taipei Veterans General Hospital, & Adjunct Associate Professor, School of Nursing, National Taipei University of Nursing and Health Sciences; Taipei Medical University and National Defense Medical Center.
Chi-Wen
CW
Chang
Pei-Fan
PF
Mu
Shiann-Tarng
ST
Jou
Tai-Ting
TT
Wong
Yu-Chih
YC
Chen