Bennett, S., Pigott, A., Beller, E.M., Haines, T., Meredith, P., & Delaney, C. (2016). Educational interventions for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews, 11, CD008144. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the effectiveness of educational interventions for managing fatigue in adults with cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: CENTRAL, MEDLINE, ENBASE, CINAHL, ERIC, PEDro, PsycINFO, OT seeker, clinicaltrials.gov, and Australian New Zealand Clinical Trials Registry
 
INCLUSION CRITERIA: Randomized, controlled trials and adults with cancer. At least one study group received an educational intervention aimed at fatigue management.
 
EXCLUSION CRITERIA: Not specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 2,489
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Risk of Bias tool. All the studies had lack of blinding for outcome assessment, which was not included in the final determination of study quality. All studies had high or unclear risk of bias related to sample size. The GRADE approach was used for study quality.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 14 studies  
  • TOTAL PATIENTS INCLUDED IN REVIEW = 2,213
  • SAMPLE RANGE ACROSS STUDIES: 30–396
  • KEY SAMPLE CHARACTERISTICS: Multiple different types of cancer at various phases of care. Most had mild to moderate fatigue at baseline.

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Results

  • For general fatigue: SMD = –0.27 (95% confidence interval [CI] [–0.51, –0.04]), showing a positive effect of education. These studies were of low quality.
  • For fatigue intensity: SMD = –0.28 (95% CI [–0.51, –0.04]) effect of education. These studies were of moderate quality.
  • For fatigue interference: SMD = –0.35 (95% CI [–0.54, –0.16]), showing benefit of education. Studies were of moderate quality.
  • For anxiety (three studies): SMD = –1.37 (95% [CI –2.76, –0.18]). Studies were of low quality.
  • For depression (four studies of very low quality), no impact on depression was found.
  • Insufficient evidence existed to analyze the results according to stage of disease, phase of care, and method of education delivery. Education was delivered individually, face-to-face, in group settings, or with self-use of video or print material. Most interventions included counseling and patient training components.

Conclusions

Educational interventions appear to play some role in reducing overall fatigue, fatigue intensity, and fatigue interference, and might provide some benefit for anxiety. No effect on depression was found in this study, but baseline levels of depression were not generally clinically relevant.

Limitations

  • High heterogeneity

Nursing Implications

The incorporation of educational interventions as part of care to manage fatigue is reasonable but may not be sufficient to have a clinically meaningful impact.

Legacy ID

6278