Finnegan-John, J., Molassiotis, A., Richardson, A., & Ream, E. (2013). A systematic review of complementary and alternative medicine interventions for the management of cancer-related fatigue. Integrative Cancer Therapies, 12, 276–290.

To appraise the evidence of the effectiveness of complementary and alternative medicine (CAM) interventions in reducing cancer-related fatigue (CRF).

Databases searched were Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, British Nursing Index, and Evidence-Based Medicine Reviews (EBMR).

The specific MEDLINE search strategy was provided.

Studies were included in the review if

• They were published in the English language
• They used a randomized, controlled trial or quasiexperimental design
• Patients were older than 18 years
• They tested at least one CAM as defined by the National Center for Complementary and Alternative Medicine (NCCAM)
• They measured fatigue and had CRF as primary or secondary outcome.

Studies were excluded from the review if they were psychosocial interventions.

In total, 2,398 references were retrieved. The Jadad scale was used to appraise study quality.

• The final number of studies included was 20. 
• The total sample included 1,560 patients (sample range 13–200).
• The majority of studies were performed in patients during treatment. 
• Most studies were performed in women with breast cancer.

Patients were undergoing multiple phases of care.

During treatment, the intervention that seemed to be the most effective was hypnosis (one study), whereas ginseng provided promising results (one study). Massage, multivitamins, herbs, yoga, relaxation therapy, and combined education and acupuncture were less effective. Sound and reliable conclusions could not be drawn due to the poor quality of the studies and varying interventions, timings, and dosages. Most studies did not describe processes to ensure intervention integrity, and the “dose” was often not well reported.

Evidence from the trials reviewed was not sufficient to support the use of the interventions examined.

• Studies were of low quality. 
• The appraisal method did not include consideration of factors such as sample size and power or difference between single and multisite studies.

Current evidence suggests a very limited role of CAM to contribute to improvement in fatigue among patients with cancer.