Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Nov 24;11(11):CD008144.
doi: 10.1002/14651858.CD008144.pub2.

Educational interventions for the management of cancer-related fatigue in adults

Sally Bennett  1 , Amanda Pigott, Elaine M Beller, Terry Haines, Pamela Meredith, Christie Delaney
Affiliations
Meta-Analysis

Educational interventions for the management of cancer-related fatigue in adults

Sally Bennett et al. Cochrane Database Syst Rev. .

Abstract

Background: Cancer-related fatigue is reported as the most common and distressing symptom experienced by patients with cancer. It can exacerbate the experience of other symptoms, negatively affect mood, interfere with the ability to carry out everyday activities, and negatively impact on quality of life. Educational interventions may help people to manage this fatigue or to cope with this symptom, and reduce its overall burden. Despite the importance of education for managing cancer-related fatigue there are currently no systematic reviews examining this approach.

Objectives: To determine the effectiveness of educational interventions for managing cancer-related fatigue in adults.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, OTseeker and PEDro up to 1st November 2016. We also searched trials registries.

Selection criteria: We included randomised controlled trials (RCTs) of educational interventions focused on cancer-related fatigue where fatigue was a primary outcome. Studies must have aimed to evaluate the effect of educational interventions designed specifically to manage cancer-related fatigue, or to evaluate educational interventions targeting a constellation of physical symptoms or quality of life where fatigue was the primary focus. The studies could have compared educational interventions with no intervention or wait list controls, usual care or attention controls, or an alternative intervention for cancer-related fatigue in adults with any type of cancer.

Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. Trial authors were contacted for additional information. A third independent person checked the data extraction. The main outcome considered in this review was cancer-related fatigue. We assessed the evidence using GRADE and created a 'Summary of Findings' table.

Main results: We included 14 RCTs with 2213 participants across different cancer diagnoses. Four studies used only 'information-giving' educational strategies, whereas the remainder used mainly information-giving strategies coupled with some problem-solving, reinforcement, or support techniques. Interventions differed in delivery including: mode of delivery (face to face, web-based, audiotape, telephone); group or individual interventions; number of sessions provided (ranging from 2 to 12 sessions); and timing of intervention in relation to completion of cancer treatment (during or after completion). Most trials compared educational interventions to usual care and meta-analyses compared educational interventions to usual care or attention controls. Methodological issues that increased the risk of bias were evident including lack of blinding of outcome assessors, unclear allocation concealment in over half of the studies, and generally small sample sizes. Using the GRADE approach, we rated the quality of evidence as very low to moderate, downgraded mainly due to high risk of bias, unexplained heterogeneity, and imprecision.There was moderate quality evidence of a small reduction in fatigue intensity from a meta-analyses of eight studies (1524 participants; standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.52 to -0.04) comparing educational interventions with usual care or attention control. We found low quality evidence from twelve studies (1711 participants) that educational interventions had a small effect on general/overall fatigue (SMD -0.27, 95% CI -0.51 to -0.04) compared to usual care or attention control. There was low quality evidence from three studies (622 participants) of a moderate size effect of educational interventions for reducing fatigue distress (SMD -0.57, 95% CI -1.09 to -0.05) compared to usual care, and this could be considered clinically significant. Pooled data from four studies (439 participants) found a small reduction in fatigue interference with daily life (SMD -0.35, 95% CI -0.54 to -0.16; moderate quality evidence). No clear effects on fatigue were found related to type of cancer treatment or timing of intervention in relation to completion of cancer treatment, and there were insufficient data available to determine the effect of educational interventions on fatigue by stage of disease, tumour type or group versus individual intervention.Three studies (571 participants) provided low quality evidence for a reduction in anxiety in favour of the intervention group (mean difference (MD) -1.47, 95% CI -2.76 to -0.18) which, for some, would be considered clinically significant. Two additional studies not included in the meta-analysis also reported statistically significant improvements in anxiety in favour of the educational intervention, whereas a third study did not. Compared with usual care or attention control, educational interventions showed no significant reduction in depressive symptoms (four studies, 881 participants, SMD -0.12, 95% CI -0.47 to 0.23; very low quality evidence). Three additional trials not included in the meta-analysis found no between-group differences in the symptoms of depression. No between-group difference was evident in the capacity for activities of daily living or physical function when comparing educational interventions with usual care (4 studies, 773 participants, SMD 0.33, 95% CI -0.10 to 0.75) and the quality of evidence was low. Pooled evidence of low quality from two of three studies examining the effect of educational interventions compared to usual care found an improvement in global quality of life on a 0-100 scale (MD 11.47, 95% CI 1.29 to 21.65), which would be considered clinically significant for some.No adverse events were reported in any of the studies.

Authors' conclusions: Educational interventions may have a small effect on reducing fatigue intensity, fatigue's interference with daily life, and general fatigue, and could have a moderate effect on reducing fatigue distress. Educational interventions focused on fatigue may also help reduce anxiety and improve global quality of life, but it is unclear what effect they might have on capacity for activities of daily living or depressive symptoms. Additional studies undertaken in the future are likely to impact on our confidence in the conclusions.The incorporation of education for the management of fatigue as part of routine care appears reasonable. However, given the complex nature of this symptom, educational interventions on their own are unlikely to optimally reduce fatigue or help people manage its impact, and should be considered in conjunction with other interventions. Just how educational interventions are best delivered, and their content and timing to maximise outcomes, are issues that require further research.

PubMed Disclaimer

Conflict of interest statement

SB: none known; SB was an investigator in one of the studies in this review (Purcell 2011).

AP: none known; AP was an investigator in one of the studies in this review (Purcell 2011).

EB: none known.

TH: none known; TH was an investigator in one of the studies in this review (Purcell 2011).

PM: none known.

CD: none known.

SB, TH and AP did not extract data on trials they were involved in.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Educational interventions versus control (usual care or attention control), outcome: 1.1 General fatigue.
5
5
Forest plot of comparison: 1 Educational interventions versus control (usual care or attention control), outcome: 1.2 Fatigue intensity.
6
6
Forest plot of comparison: 1 Educational interventions versus control (usual care or attention control), outcome: 1.3 Fatigue distress.
7
7
Forest plot of comparison: 1 Educational interventions versus control (usual care or attention control), outcome: 1.4 Fatigue interference.
8
8
Forest plot of comparison: 1 Educational interventions versus control (usual care or attention control), outcome: 1.5 Use of fatigue management strategies.
9
9
Forest plot of comparison: 1 Educational interventions versus control (usual care or attention control), outcome: 1.4 Activities of daily living or physical functioning.
10
10
Forest plot of comparison: 1 Educational interventions versus control (usual care or attention control), outcome: 1.7 Anxiety.
11
11
Forest plot of comparison: 1 Educational interventions versus control (usual care or attention control), outcome: 1.8 Depression.
12
12
Forest plot of comparison: 1 Educational interventions versus control (usual care or attention control), outcome: 1.9 Global quality of life.
1.1
1.1. Analysis
Comparison 1 Educational interventions versus control (usual care or attention control), Outcome 1 General fatigue.
1.2
1.2. Analysis
Comparison 1 Educational interventions versus control (usual care or attention control), Outcome 2 Fatigue intensity.
1.3
1.3. Analysis
Comparison 1 Educational interventions versus control (usual care or attention control), Outcome 3 Fatigue distress.
1.4
1.4. Analysis
Comparison 1 Educational interventions versus control (usual care or attention control), Outcome 4 Fatigue interference.
1.5
1.5. Analysis
Comparison 1 Educational interventions versus control (usual care or attention control), Outcome 5 Use of fatigue management strategies.
1.6
1.6. Analysis
Comparison 1 Educational interventions versus control (usual care or attention control), Outcome 6 Activities of daily living or physical functioning.
1.7
1.7. Analysis
Comparison 1 Educational interventions versus control (usual care or attention control), Outcome 7 Anxiety.
1.8
1.8. Analysis
Comparison 1 Educational interventions versus control (usual care or attention control), Outcome 8 Depression.
1.9
1.9. Analysis
Comparison 1 Educational interventions versus control (usual care or attention control), Outcome 9 Global quality of life.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008144

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Barsevick 2004 {published data only}
    1. Barsevick AM, Dudley W, Beck S, Sweeney C, Whitmer K, Nail L. A randomized clinical trial of energy conservation for patients with cancer‐related fatigue. Cancer 2004;100(6):1302‐10. - PubMed
Barsevick 2010 {published data only}
    1. Barsevick A, Beck SL, Dudley WN, Wong B, Berger AM, Whitmer K, et al. Efficacy of an intervention for fatigue and sleep disturbance during cancer chemotherapy. Journal of Pain & Symptom Management 2010;40(2):200‐16. - PMC - PubMed
Foster 2015 {published and unpublished data}
    1. Foster C, Calman L, Grimmett C, Breckons M, Cotterell P, Yardley L, et al. Managing fatigue after cancer treatment: development of RESTORE, a web‐based resource to support self‐management. Psycho‐oncology 2015;24(8):940‐9. - PubMed
    1. Foster C, Grimmett C, May CM, Ewings S, Myall M, Hulme C, et al. A web‐based intervention (RESTORE) to support self‐management of cancer‐related fatigue following primary cancer treatment: a multi‐centre proof of concept randomised controlled trial. Support Care Cancer 2016;24(6):2445‐53. - PMC - PubMed
    1. Grimmett C, Armes J, Breckons M, Calman L, Corner J, Fenlon D, et al. RESTORE: an exploratory trial of an online intervention to enhance self‐efficacy to manage problems associated with cancer‐related fatigue following primary cancer treatment: study protocol for a randomized controlled trial. Trials 2013;14:184. - PMC - PubMed
    1. Grimmett C, Breckons M, Calman L, Corner J, Fenlon D, Richardson A, et al. Restore: A web‐based intervention to support self‐management of cancer‐related fatigue following primary cancer treatment. Psycho‐oncology 2013;22:10.
    1. Grimmett C, Breckons M, Calman L, Corner J, Fenlon D, Richardson A, et al. Restore: An online intervention to enhance self‐efficacy to self manage cancer related fatigue; an exploratory trial protocol. Supportive Care in Cancer. 2013; Vol. 21:S100. - PMC - PubMed
Godino 2006 {published data only}
    1. Godino C, Jodar L, Durán A, Martínez I, Schiaffino A. Nursing education as an intervention to decrease fatigue perception in oncology patients. European Journal of Oncology Nursing 2006;10(2):150‐5. - PubMed
Purcell 2011 {published data only}
    1. Purcell A, Fleming J, Burmeister B, Bennett S, Haines T. Is education an effective management strategy for reducing cancer‐related fatigue?. Support Care Cancer 2011;19(9):1429‐39. - PubMed
Ream 2006 {published data only}
    1. Ream E, Richardson A, Alexander‐Dann C. Supportive intervention for fatigue in patients undergoing chemotherapy: a randomized controlled trial. Journal of Pain & Symptom Management 2006;31(2):148‐61. - PubMed
Reif 2012 {published data only}
    1. Reif K, Vries U, Petermann F, Görres S. A patient education program is effective in reducing cancer‐related fatigue: a multi‐centre randomised two‐group waiting‐list controlled intervention trial. European Journal of Oncology Nursing 2013 Epub 2012;17(2):204‐13. - PubMed
Schjolberg 2014 {published data only}
    1. Schjolberg T, Dodd M, Henriksen N, Asplund K, Smastuen M, Rustoen K. Effects of an educational intervention for managing fatigue in women with early stage breast cancer. European Journal of Oncology Nursing 2014;18:286‐94. - PubMed
Wangnum 2013 {published data only}
    1. Wangnum K, Thanarojanawanich T, Chinwatanachai K, Jamprasert L, Maleehuan O, Janthakun V. Impact of the Multidisciplinary Education Program in Self‐Care on Fatigue in Lung Cancer Patients Receiving Chemotherapy. Journal of the Medical Association of Thailand 2013;96(12):1601‐8. - PubMed
Williams 2005 {published data only}
    1. Williams SA, Schreier AM. The role of education in managing fatigue, anxiety, and sleep disorders in women undergoing chemotherapy for breast cancer. Applied Nursing Research 2005;18(3):138‐47. - PubMed
    1. Williams SA, Schreier AM, Hodgson H. The effect of education in managing side effects in women receiving chemotherapy for treatment of breast cancer. Oncology Nursing Forum 2004;31(1):E16‐23. - PubMed
Wydra 2001 {published data only}
    1. Wydra EW. The effectiveness of a self‐care management interactive multimedia module. Oncology Nursing Forum 2001;28(9):1399‐407. - PubMed
Yates 2005 {published data only}
    1. Yates P, Aranda S, Hargraves M, Mirolo B, Clavarino A, McLachlan S, et al. Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early‐stage breast cancer. Journal of Clinical Oncology 2005;23(25):6027‐36. - PubMed
Yuen 2006 {published data only}
    1. Yuen HK, Mitcham M, Morgan L. Managing post‐therapy fatigue for cancer survivors using energy conservation training. Journal of Allied Health 2006;35(2):121E‐139E. - PubMed
Yun 2012 {published data only}
    1. Yun YH, Lee KS, Kim YW, Park SY, Lee ES, Noh DY, et al. Web‐based tailored education program for disease‐free cancer survivors with cancer‐related fatigue: a randomized controlled trial. Journal of Clinical Oncology 2012;30(12):1296‐303. - PubMed

References to studies excluded from this review

Allard 2006 {published data only}
    1. Allard N. Day surgery and recovery in women with a suspicious breast lesion: evaluation of a psychoeducational nursing intervention. Canadian Oncology Nursing Journal/Revue canadienne de soins infirmiers en oncologie 2006;16(3):137‐53. - PubMed
Allison 2004 {published data only}
    1. Allison PJ, Edgar L, Nicolau B, Archer J, Black M, Hier M. Results of a feasibility study for a psycho‐educational intervention in head and neck cancer. Psycho‐oncology 2004;13(7):482‐5. - PubMed
Armes 2007 {published data only}
    1. Armes J, Chalder T, Addington‐Hall J, Richardson A, Hotopf M. A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer‐related fatigue. Cancer 2007;110(6):1385‐95. - PubMed
Barsevick 2002 {published data only}
    1. Barsevick AM, Whitmer K, Sweeney C, Nail LM. A pilot study examining energy conservation for cancer treatment‐related fatigue. Cancer Nursing 2002;25(5):333‐41. - PubMed
Borthwick 2003 {published data only}
    1. Borthwick D, Knowles G, McNamara S. Assessing fatigue and self‐care strategies in patients receiving radiotherapy for non‐small cell lung cancer. European Journal of Oncology Nursing 2003;7(4):231‐41. - PubMed
Brown {published data only}
    1. Brown P, Clark MM, Atherton P, Huschka M, Sloan J A, Gamble G, et al. Will improvement in quality of life (QOL) impact fatigue in patients receiving radiation therapy for advanced cancer?. American Journal of Clinical Oncology 2006;29(1):52‐8. - PubMed
Chan {published data only}
    1. Chan CW, Richardson A, Richardson J. Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial. J Pain Symptom Management 2011;41(2):347‐57. - PubMed
Corbett 2016 {published data only}
    1. Corbett T, Walsh JC, Groarke A, Moss‐Morris R, McGuire BE. Protocol for a pilot randomised controlled trial of an online intervention for post‐treatment cancer survivors with persistent fatigue. BMJ Open 2016;6(6):e011485. - PMC - PubMed
Davidson 2001 {published data only}
    1. Davidson JR, Waisberg JL, Brundage MD, MacLean AW. Nonpharmacologic group treatment of insomnia: a preliminary study with cancer survivors. Psycho‐oncology 2001;10(5):389‐97. - PubMed
Dirksen 2008 {published data only}
    1. Dirksen SR, Epstein DR. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. Journal of Advanced Nursing 2008;61(2):664‐75. - PubMed
Evers {published data only}
    1. Evers G, Giesberts K, Claeys P, Bogaert W, Paridaens R. Effect of self‐care instruction on self‐care knowledge and behaviour related to fatigue after radiotherapy and chemotherapy. Acta Hospitalia 1998;38(2):51‐61.
Fawzy 1995 {published data only}
    1. Fawzy NW. A psychoeducational nursing intervention to enhance coping and affective state in newly diagnosed malignant melanoma patients. Cancer Nursing 1995;18(6):427‐38. - PubMed
Given 2002 {published data only}
    1. Given B, Given CW, McCorkle R, Kozachik S, Cimprich B, Rahbar MH, et al. Pain and Fatigue Management: Results of a Nursing Randomized Clinical Trial. Oncology Nursing Forum 2002;29(6):949‐56. - PubMed
Holley 2001 {published data only}
    1. Holley S, Borger D. Energy for living with cancer: preliminary findings of a cancer rehabilitation group intervention study. Oncology Nursing Forum 2001;28(9):1393‐6. - PubMed
Kim 2002 {published data only}
    1. Kim Y, Roscoe JA, Morrow GR. The effects of information and negative affect on severity of side effects from radiation therapy for prostate cancer. Supportive Care in Cancer 2002;10(5):416‐21. - PubMed
OBrien 2014 {published data only}
    1. O'Brien L, Loughnan A, Purcell A, Haines T. Education for cancer‐related fatigue: Could talking about it make people more likely to report it?. Supportive Care in Cancer 2014;22:209‐15. - PubMed
Ream 2002 {published data only}
    1. Ream E, Richardson A, Alexander‐Dann C. Facilitating patients' coping with fatigue during chemotherapy ‐ Pilot outcomes. Cancer Nursing 2002;25(4):300‐8. - PubMed
Ream 2005 {published data only}
    1. Ream E, Richardson A, Evison M. A feasibility study to evaluate a group intervention for people with cancer experiencing fatigue following treatment. Clinical Effectiveness in Nursing 2005;9(3‐4):178‐87.
Stanton 2005 {published data only}
    1. Stanton AL, Ganz PA, Kwan L, Meyerowitz BE, Bower JE, Krupnick JL, et al. Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. Journal of Clinical Oncology 2005;23(25):6009‐18. - PubMed
Wengstrom 1999 {published data only}
    1. Wengstrom Y, Haggmark C, Strander H, Forsberg C. Effects of a nursing intervention on subjective distress, side effects and quality of life of breast cancer patients receiving curative radiation therapy‐a randomized study. Acta Oncologica 1999;38(6):763‐70. - PubMed
Willems 2016 {published data only}
    1. Willems RA, Bolman CA, Mesters I, Kanera IM, Beaulen AA, Lechner L. Short‐term effectiveness of a web‐based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: Randomized controlled trial. Psycho‐oncology 2016;Online early. - PubMed
Yesilbalkan {published data only}
    1. Yesilbalkan OU, Karadakovan A, Göker E. The effectiveness of nursing education as an intervention to decrease fatigue in Turkish patients receiving chemotherapy. Oncology Nursing Forum 2009;36(4):E215‐22. - PubMed

References to studies awaiting assessment

Bigatao 2016 {published data only}
    1. Bigatao MR, Peria FM, Tirapelli DPC, Carlotti Junior CG. Educational program on fatigue for brain tumor patients: Possibility strategy?. Arquivos de neuro‐psiquiatria 2016;74(2):155‐60. - PubMed
Littlechild 2016 {published data only}
    1. Littlechild B. Managing fatigue: a trial of group and individual educational support for hospice outpatients. European Journal of Palliative Care 2016;23(4):166‐8.
Sandler 2015 {published data only}
    1. Sandler C, Goldstein D, Horsfield S, Bennett B, Friedlander M, Bastick P, et al. TOPS: A randomised controlled trial of a multidisciplinary intervention for post‐cancer fatigue. Journal of Clinical Oncology 2015;33(15):9571.
Velji 2006 {unpublished data only}
    1. Velji K. Effect of an individualized symptom education program on the symptom distress of women receiving radiation therapy for gynecological cancers. PhD thesis 2006.

Additional references

Aaronson 1993
    1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez N, et al. The European organization for research and treatment of cancer QLQ‐C30: a quality‐of‐life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute 1993;85(5):365‐76. - PubMed
Borneman 2007
    1. Borneman T, Piper B, Chih‐Yi Sun V, Koczywas M, Uman G, Ferrell B. Implementing the Fatigue Guidelines at One NCCN Member Institution: Process and Outcomes. Journal of the National Comprehensive Cancer Network 2007;5(10):1092‐101. - PMC - PubMed
Bower 2006
    1. Bower JE. Management of cancer‐related fatigue. Clinical Advances in Hematology & Oncology 2006;4(11):828‐9. - PubMed
Butt 2008
    1. Butt Z, Wagner LI, Beaumont JL, Paice J, Peterman A, Shevrin D, et al. Use of a single‐item screening tool to detect clinically significant fatigue, pain, distress, and anorexia in ambulatory cancer practice. Journal of Pain and Symptom Management 2008;35:20‐30. - PubMed
Chelf 2001
    1. Chelf JH, Agre P, Axelrod A, Cheney L, Cole DD, Conrad K, et al. Cancer‐related patient education: an overview of the last decade of evaluation and research. Oncology Nursing Forum 2001;28(7):1139‐47. - PubMed
Cohen 1988
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd Edition. New Jersey: Lawrence Erlbaum, 1988.
Cramp 2012
    1. Cramp F, Byron‐Daniel J. Exercise for the management of cancer‐related fatigue in adults. Cochrane Database of Systematic Reviews 2012, Issue 11. [DOI: 10.1002/14651858.CD006145.pub3] - DOI - PMC - PubMed
Deeks 2001
    1. Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta‐analysis. In: Egger M, Davey Smith G, Altman DG editor(s). Systematic Reviews in Health Care: Meta‐analysis in Context (2nd edition). London (UK): BMJ Publication Group, 2001.
Du 2015
    1. Du S, Hu L, Dong J, Xu G, Jin S, Zhang H, et al. Patient education programs for cancer‐related fatigue: A systematic review. Patient Education and Counseling 2015;98:1308‐19. - PubMed
Goedendorp 2009
    1. Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD006953.pub2] - DOI - PMC - PubMed
GRADEPro GDT 2015 [Computer program]
    1. McMaster University (developed by Evidence Prime, Inc.). GRADEpro Guideline Development Tool [Software]. McMaster University (developed by Evidence Prime, Inc.), 2015.
Hann 1998
    1. Hann DM, Jacobsen PB, Azzarello LM, Martin S, Curran S, Fields K, et al. Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory. Quality of Life Research 1998;7(4):301‐10. - PubMed
Higgins 2011
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins J, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org, 2011.
Hinds 1995
    1. Hinds C, Streater A, Mood M. Functions and preferred methods of receiving information related to radiotherapy. Cancer Nursing 1995;18:374‐84. - PubMed
Jacobsen 1999
    1. Jacobsen PB, Hann DM, Azzarello LM, Horton J, Balducci L, Lyman GH. Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. Journal of Pain and Symptom Management 1999;18(4):233‐42. - PubMed
Jacobsen 2007
    1. Jacobsen PB, Donovan KA, Vadaparampil ST, Small BJ. Systematic review and meta‐analysis of psychological and activity‐based interventions for cancer‐related fatigue. Health Psychology 2007;26(6):660‐7. - PMC - PubMed
Jameson 2016
    1. Jameson G, VonHoff D. Fatigue. In: Alberts D, Lluria M, Kha S, Weihs K editor(s). Supportive Cancer Care. Springer International Publishing, 2016:163‐81.
Kangas 2008
    1. Kangas M, Bovbjerg D, Montgomery G. Cancer‐related fatigue: A systematic and meta‐analytic review of non‐pharmacological therapies for cancer patients. Psychological Bulletin 2008;134(5):700‐41. - PubMed
Koornstra 2014
    1. Koornstraa R, Peters M, Donofrio S, Borne B, Jong F. Management of fatigue in patients with cancer – A practical overview. Cancer Treatment Review 2014;40(6):791–9. - PubMed
Kris 2004
    1. Kris A, Dodd M. Symptom experience of adult hospitalized medical‐surgical patients. Journal of Pain and Symptom Management 2004;28(5):451–9. - PubMed
Lawrence 2004
    1. Lawrence D, Kupelnick B, Miller K, Devine D, Lau J. Evidence report on the occurrence, assessment, and treatment of fatigue in cancer patients. Journal of the National Cancer Institute Monographs 2004;32:40‐50. - PubMed
Minton 2013
    1. Minton O, Richardson A, Sharpe M, Hotopf M, Stone P. Drug therapy for the management of cancer‐related fatigue. Cochrane Database of Systematic Reviews 2013, Issue 12. [DOI: 10.1002/14651858.CD006704.pub3] - DOI - PubMed
Mitchell 2006
    1. Mitchell SA, Berger AM. Cancer‐related fatigue: the evidence base for assessment and management. Cancer Journal 2006;12(5):374‐87. - PubMed
Mock 2005
    1. Mock V, Frangakis C, Davidson NE, Ropka ME, Pickett M, Poniatowski B, et al. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psychooncology 2005;14(6):464‐77. - PubMed
Morrow 2005
    1. Morrow GR, Shelke AR, Roscoe JA, Hickok JT, Mustian K. Management of cancer‐related fatigue. Cancer Investigation 2005;23(2):229‐39. - PubMed
NCCN 2016
    1. National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: cancer‐related fatigue. Available from: https://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf (Accessed June 2016) 2016.
Nuesche 2010
    1. Nüesch E, Trelle S, Reichenbach S, Rutjes AW, Tschannen B, Altman DG, et al. Small study effects in meta‐analyses of osteoarthritis trials: meta‐epidemiological study. BMJ 2010;341:c3515. - PMC - PubMed
Pildal 2007
    1. Pildal J, Hróbjartsson A, Jørgensen KJ, Hilden J, Altman DG, Gøtzsche PC. Impact of allocation concealment on conclusions drawn from meta‐analyses of randomized trials. Journal of Epidemiology 2007;36(4):847‐57. - PubMed
Piper 1998
    1. Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM. The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncology Nursing Forum 1998;25(4):677‐84. - PubMed
Portenoy 1994
    1. Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander‐Klar H, Kiyasu E, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. European Journal of Cancer 1994;30A(9):1326‐36. - PubMed
Purcell 2009
    1. Purcell A, Fleming J, Haines T, Bennett S. Cancer‐related fatigue: A review and a conceptual framework to guide therapists' understanding. British Journal of Occupational Therapy 2009;72(2):79‐86.
Ream 1996
    1. Ream E, Richardson A. The role of information inpatients' adaptation to chemotherapy and radiotherapy: a review of the literature. European Journal of Cancer Care 1996;5:132‐8. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Schulz 2010
    1. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c332. - PMC - PubMed
Smets 1996
    1. Smets EM, Garssen B, Cull A, Haes JC. Application of the multidimensional fatigue inventory (MFI‐20) in cancer patients receiving radiotherapy. British Journal of Cancer 1996;73(2):241‐5. - PMC - PubMed
Smets 1998a
    1. Smets EM, Visser MR, Willems‐Groot AF, Garssen B, Oldenburger F, Tienhoven G, et al. Fatigue and radiotherapy: (A) experience in patients undergoing treatment. British Journal of Cancer 1998;78(7):899‐906. - PMC - PubMed
Smets 1998b
    1. Smets EM, Visser MR, Willems‐Groot AF, Garssen B, Schuster‐Uitterhoeve AL, Haes JC. Fatigue and radiotherapy: (B) experience in patients 9 months following treatment. British Journal of Cancer 1998;78(7):907‐12. - PMC - PubMed
Smith 2007
    1. Smith G, Toonen T. Primary Care of the Patient with Cancer. American Family Physician 2007;75(8):1207‐14. - PubMed
Sood 2007
    1. Sood A, Barton DL, Bauer BA, Loprinzi CL. A critical review of complementary therapies for cancer‐related fatigue. Integrative Cancer Therapies 2007;6(1):8‐13. - PubMed
Stark 2012
    1. Stark L, Tofthagen C, Visovsky C, McMillan S. The Symptom Experience of Patients with Cancer. Journal of Hospice and Palliative Nursing 2012;14(1):61–70. - PMC - PubMed
Stone 2000
    1. Stone P, Richards M, A'Hern R, Hardy J. A study to investigate the prevalence, severity and correlates of fatigue among patients with cancer in comparison with a control group of volunteers without cancer. Annals of Oncology 2000;11:561‐7. - PubMed
Stricker 2004
    1. Stricker CT, Drake D, Hoyer KA, Mock V. Evidence‐based practice for fatigue management in adults with cancer: exercise as an intervention. Oncology Nursing Forum 2004;31(5):963‐76. - PubMed
van den Bourne 1998
    1. Bourne HW. The patient from receiver of information to informed decision‐maker. Patient Education and Counseling 1998;34(2):89‐102. - PubMed
Wanchai 2011
    1. Wanchai A, Armer JM, Stewart BR. Nonpharmacologic supportive strategies to promote quality of life in patients experiencing cancer‐related fatigue: a systematic review. Clinical Journal of Oncology Nursing 2011;15(2):203‐14. - PubMed
Woo 1998
    1. Woo B, Dibble SL, Piper BF, Keating SB, Weiss MC. Differences in fatigue by treatment methods in women with breast cancer. Oncology Nursing Forum 1998;25(5):915‐20. - PubMed
Yellen 1997
    1. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E. Measuring fatigue and other anemia‐related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. Journal of Pain and Symptom Management 1997;13(2):63‐74. - PubMed

Publication types

LinkOut - more resources