Dataset Information

Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data.

ABSTRACT:

Purpose

Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue.

Methods

We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test.

Results

Exercise interventions had statistically significant beneficial effects on fatigue (? = -0.17; 95% confidence interval [CI], -0.22 to -0.12). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (?difference = -0.18; 95% CI -0.28 to -0.08). Supervised interventions with a duration ?12 wk showed larger effects on fatigue (? = -0.29; 95% CI, -0.39 to -0.20) than supervised interventions with a longer duration.

Conclusions

In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration.

SUBMITTER: VAN Vulpen JK

PROVIDER: S-EPMC6962544 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data.

VAN Vulpen Jonna K JK Sweegers Maike G MG Peeters Petra H M PHM Courneya Kerry S KS Newton Robert U RU Aaronson Neil K NK Jacobsen Paul B PB Galvão Daniel A DA Chinapaw Mai J MJ Steindorf Karen K Irwin Melinda L ML Stuiver Martijn M MM Hayes Sandi S Griffith Kathleen A KA Mesters Ilse I Knoop Hans H Goedendorp Martine M MM Mutrie Nanette N Daley Amanda J AJ McConnachie Alex A Bohus Martin M Thorsen Lene L Schulz Karl-Heinz KH Short Camille E CE James Erica L EL Plotnikoff Ronald C RC Schmidt Martina E ME Ulrich Cornelia M CM VAN Beurden Marc M Oldenburg Hester S HS Sonke Gabe S GS VAN Harten Wim H WH Schmitz Kathryn H KH Winters-Stone Kerri M KM Velthuis Miranda J MJ Taaffe Dennis R DR VAN Mechelen Willem W Kersten Marie José MJ Nollet Frans F Wenzel Jennifer J Wiskemann Joachim J Verdonck-DE Leeuw Irma M IM Brug Johannes J May Anne M AM Buffart Laurien M LM

Medicine and science in sports and exercise 20200201 2

<h4>Purpose</h4>Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue.<h4>Methods</h4>We used individual patient data from 31 exercise RCT worldwide, representing 4366 patien ...[more]

PMID: 31524827

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Project description:Importance:Cancer-related fatigue (CRF) remains one of the most prevalent and troublesome adverse events experienced by patients with cancer during and after therapy. Objective:To perform a meta-analysis to establish and compare the mean weighted effect sizes (WESs) of the 4 most commonly recommended treatments for CRF-exercise, psychological, combined exercise and psychological, and pharmaceutical-and to identify independent variables associated with treatment effectiveness. Data Sources:PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane Library were searched from the inception of each database to May 31, 2016. Study Selection:Randomized clinical trials in adults with cancer were selected. Inclusion criteria consisted of CRF severity as an outcome and testing of exercise, psychological, exercise plus psychological, or pharmaceutical interventions. Data Extraction and Synthesis:Studies were independently reviewed by 12 raters in 3 groups using a systematic and blinded process for reconciling disagreement. Effect sizes (Cohen d) were calculated and inversely weighted by SE. Main Outcomes and Measures:Severity of CRF was the primary outcome. Study quality was assessed using a modified 12-item version of the Physiotherapy Evidence-Based Database scale (range, 0-12, with 12 indicating best quality). Results:From 17?033 references, 113 unique studies articles (11?525 unique participants; 78% female; mean age, 54 [range, 35-72] years) published from January 1, 1999, through May 31, 2016, had sufficient data. Studies were of good quality (mean Physiotherapy Evidence-Based Database scale score, 8.2; range, 5-12) with no evidence of publication bias. Exercise (WES,?0.30; 95% CI, 0.25-0.36; P?<?.001), psychological (WES,?0.27; 95% CI, 0.21-0.33; P?<?.001), and exercise plus psychological interventions (WES,?0.26; 95% CI, 0.13-0.38; P?<?.001) improved CRF during and after primary treatment, whereas pharmaceutical interventions did not (WES,?0.09; 95% CI, 0.00-0.19; P?=?.05). Results also suggest that CRF treatment effectiveness was associated with cancer stage, baseline treatment status, experimental treatment format, experimental treatment delivery mode, psychological mode, type of control condition, use of intention-to-treat analysis, and fatigue measures (WES range, -0.91 to 0.99). Results suggest that the effectiveness of behavioral interventions, specifically exercise and psychological interventions, is not attributable to time, attention, and education, and specific intervention modes may be more effective for treating CRF at different points in the cancer treatment trajectory (WES range, 0.09-0.22). Conclusions and Relevance:Exercise and psychological interventions are effective for reducing CRF during and after cancer treatment, and they are significantly better than the available pharmaceutical options. Clinicians should prescribe exercise or psychological interventions as first-line treatments for CRF.

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Dataset Information

Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data.

Purpose

Methods

Results

Conclusions

Publications

Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data.

Similar Datasets

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