Pharmacological interventions for the management of cancer-related fatigue among cancer survivors: systematic review and meta-analysis (Preprint)
BACKGROUND Background: Current guidelines have different recommendations on applying pharmacological interventions for managing cancer-related fatigue (CRF) among cancer survivors. OBJECTIVE Objective: This systematic review aims to synthesize clinical evidence on pharmacological interventions for managing CRF. METHODS Methods: Five databases were searched for potential Randomized controlled trials (RCTs) from their inception till October 2020. RCTs assessing the effect of pharmacological treatments for CRF among cancer survivors were considered eligible. Clinical significance was determined by comparing the estimated effect with that of minimal important difference (MID). The risk of bias of included RCTs were appraised using the Cochrane risk of bias tool for randomized trials 2. RESULTS Results: A total of 15 RCTs (1238 participants) were included. Majority presented some concerns of bias arising from the randomization process and selection of the reported result. Meta-analysis showed that psychostimulant and wakefulness agents had statistically significant while clinical insignificant effect on the treatment of CRF (pooled weighted mean difference (WMD): 2.8, 95% confidence interval (CI): 0.2 to 5.4, I2: 0%, 3 RCTs, MID: 3.0 to 6.0). Three natural products, including Renshen Yangrong Tang (mean difference (MD): -16.1, 95% CI: -8.9 to -23.3, MID: -17.3 to -11.4), Tualang honey (MD: 11.2, 95% CI: 7.1 to 15.3, MID: 3.0 to 6.0) and Shenmai injection plus Peptisorb (MD: -1.6, 95% CI: -2.1 to -1.1, MID: -1.1 to -0.8) demonstrated statistically and clinically significant effect in reducing CRF. CONCLUSIONS Conclusions: Existing evidence showed promising effects of three natural products in reducing CRF among cancer survivors. The results from this study need to be further confirmed with well-designed and adequate powered RCTs that use validated instruments for the measurement of CRF. CLINICALTRIAL The protocol of this systematic review has been registered in PROSPERO (registration number: CRD42018102347).