| Author, year, & country | Cancer Type | Age | Total | Loss to Attrition | Treatment Received | Primary Outcome | Fatigue outcome | MCID (as reported) | Individual improvement |
|---|---|---|---|---|---|---|---|---|---|
| Abrahams et al. 2019; Netherlands | > 1 type | 45 | n=141 | 28% | Surgery, CT, RT, HT, TT | CIS–fatigue |
|
Reliable change index ≥1.96 | 51% in intervention & 46% in control improved |
| Bennett et al. 2007; New Zealand | > 1 type: Breast 77% | ≥18 | n=56 | 16% | NR | Self-reported physical activity | Schwartz Cancer Fatigue Scale | NR | NR |
| Bower et al. 2012; USA | Breast | 40-64 | n=31 | 6% | RT, CT, HT | Fatigue Symptom Inventory | SF-36 Vitality scale | Reliable change index 22.7 | NR: Mean improvement in SF-36 of 23.9 in intervention |
| Campo et al. 2013; USA | Prostate | ≥55 | n=40 | 28% | Surgery, RT, CT, ADT | FACIT-F |
|
3 | 69% in Qigong & 38 % in stretching improved; 12% & 30% deteriorated |
| Cantarero-Villanueva et al. 2013; Spain | Breast | 25-65 | n=68 | 10% | NR | Piper Fatigue Scale |
|
2.5 points | NR |
| Donnelly et al. 2011; UK | Gynaeco-logical | 18-75 | n=33 | 3% | Surgery + CT, RT | MFSI-SF & FACIT-F |
|
3 (FACIT-F) | NR: Mean score improved by >MCID |
| Galantino et al. 2003; USA | Breast | 40-59 | NR (n=11) | NR | CT or RT | Six-minute walk test & bodymass index | Brief Fatigue Inventory | NR | 75% of participants improved (both groups) |
| Heim et al. 2007; Germany | Breast | Range: 31-70 | n=90 | 30% | Surgery, CT or RT, or HT | NS | Multidimensional Fatigue Inventory | NR | NR |
| Kim et al. 2020; Korea | Breast | 20-69 | n=50 | 4% | Surgery, CT, RT, HT, TT | NS | Piper Fatigue Scale (revised) | NR | NR |
| Kröz et al. 2017; Germany | Breast | 18-75 | n=126* | 33% | Surgery, CT, RT, HT | Composite measure | Cancer Fatigue Scale (CFS-D) | NR | NR |
| Larkey et al. 2015; USA | Breast | 40-75 | n=101 | 14% | CT, RT | Fatigue Symptom Inventory |
|
3 | NR: Mean score improved by 2.5 points to 2.1 (<3 considered not fatigued) |
| Mayo et al. 2014; Canada | > 1 type | Adults | n=26 | 42% | NR | FACIT-F & Fatigue Symptom Inventory |
|
3-4 (FACIT-F) | 55% in intervention & 25% in control improved; 25% & 45% deteriorated |
| Pagola et al. 2020; Spain | Breast | 18-65 | n=23 | 0% | Surgery, CT, RT, HT | PERFORM questionnaire |
|
3.5 | NR: Mean change scores above the MCID in both groups |
| Payne et al. 2008; USA | Breast | ≥55 | n=20 | 10% | Postmenopausal women receiving HT | NS | Piper Revised Fatigue Scale | NR | NR |
| Prinsen et al. 2013; Netherlands | > 1 type: Breast 35%, Head & neck 24% | 18-65 | n=64 | 42% | Curative (surgery, CT, RT, IT, &/or HT) | NS | CIS–fatigue | NR | NR |
| Rogers et al. 2014; Canada | Breast | 30-70 | n=46 | 9% | Surgery, CT, RT, HT | NS | FSI & PROMIS fatigue | NR | 58% had worse fatigue intensity & 37% had worse fatigue interference (FSI), though only 16% deteriorated on the PROMIS |
| Sandler et al. 2017; Australia | > 1 type: Breast (89%) & Colon | ≥18 | n=46 | 15% | Surgery, CT, RT, HT, TT | Somatic fatigue subscale of SPHERE |
|
Improvement >1SD | 32% of intervention & 8% of control improved; n=2 in control deteriorated |
| Stan et al. 2016; USA | Breast | 20-75 | n=34 | 32% | Surgery, CT, RT, HT | Feasibility & MFSI-SF |
|
NR | NR |
| Yuen et al. 2007; USA | Breast | Range: 32-78 | n=29 | 24% | Surgery, CT, RT | NS | Piper Fatigue Scale | NR | n=2 had worse fatigue after intervention |
| a Loss to attrition was calculated for the first post-intervention time-point. CIS-fatigue, fatigue severity subscale of the Checklist Individual Strength; CT, chemotherapy; FACIT-F, Functional Assessment of Chronic Illness Therapy-Fatigue; HT, hormonal therapy; IT, immunotherapy MCID, minimal clinically important difference; MFSI-SF, Multidimensional Fatigue Syndrome Inventory-Short Form; NR, not reported; NS, not specified; PROMIS, Patient-Reported Outcomes Measurement Information System; RT, radiotherapy; TT, targeted therapy. *Total allocated. |
| Study | Time Since Treatment | Questionnaire | Cut-point used | Other details or descriptions |
|---|---|---|---|---|
| Abrahams et al. [61] | Minimal 1 year | CIS–fatigue [50] | ≥35 [51] | “severe fatigue” |
| Bennett et al. [46] | ≥6 months | NR | NR | “fatigued” |
| Bower et al. [38] | ≥6 months since local & adjuvant therapy (except HT) | SF-36 vitality scale [62] | ≤50 | “and self-report that fatigue was a consequence of cancer or cancer therapy”; The SF-36 consists of four items that assess how much of the time (from “none of the time” to “all of the time”) an individual “felt full of pep,” “had a lot of energy,” “felt worn out,” and “felt tired” during the past four weeks. |
| Campo et al. [36] | NS: Median of ~5 years since diagnosis#; Current HT: 48% | NCI CTCAE [53], or a 0-100 general fatigue grading | ≥1 or >20, respectively | “Significant fatigue”; limiting instrumental or self-care activities of daily living; - General fatigue grading: “fatigue currently and in the past week”" |
| Cantarero-Villanueva et al. [39] | Finished treatment in the previous 18 months (except HT) | Piper Fatigue Scale | > 3 | Responses to this scale are based on “the fatigue you are experiencing now”. |
| Donnelly et al. [37] | Undergoing treatment or post therapy & within 3 years of diagnosis (mean months = ~9±9 months) | 0-10 numerical rating scale | 10-Jan | “mild to severe fatigue” |
| Galantino et al. [40] | Had undergone adjuvant treatment in the past year | NR |
|
“suffering from self-reported fatigue” |
| Heim et al. [44] | > 6 weeks since surgery, RT or CT | 0-10 linear analogue scale | ≥4 |
|
| Kim et al. [33] | NS: Completed CT & RT ≥6 months and <5years from enrolment | “More than 4 out of 10” | ≥4 | “experienced greater than moderate fatigue” |
| Kröz et al. [27] | ≥36 months since surgery, CT or RT & <45 months since diagnosis | Fatigue Numerical Scale & Cancer Fatigue Scale (CFS-D) [58,59] | ≥4 & ≥24, respectively | “diagnosis of chronic CRF for >6 months”; CFS-D: Responses to this scale are based on “current state” |
| Larkey et al. [45] | 6 months to 5 years (since surgery, CT, RT) | SF-36 vitality scale [62] | ≤50 |
|
| Mayo et al. [35] | NR (during & after rehabilitation)# | 0-10 visual analogue scale | ≥4 | “moderate to severe fatigue” |
| Pagola et al. [32] | ≤5 years since treatment | Perform questionnaire [32] | <45 |
|
| Payne et al. [41] | NR | 0-10 scale | ≥3 | Participants were asked: How do you rate your usual rate of fatigue (0 = no fatigue & 10 =extreme fatigue)? How frequently do you feel that level of fatigue? To what extent does your fatigue interfere with usual activities of daily living? |
| Prinsen [47] | Completed curative treatment <1 year earlier | CIS–fatigue [50] | ≥35 [51] | “severe fatigue” |
| Rogers et al. [42] | ≥4 weeks after primary (except HT), >8 weeks after surgery | 0-10 Likert scale or 0–3 Likert scale | ≥3 or ≥1, respectively | 0-10: average fatigue over past week; 0-3: sleep dysfunction |
| Sandler et al. [7] | 3-12 months | Somatic fatigue subscale of SPHERE [48] | ≥3 | SPHERE asks about the prevalence of symptoms over the “past few weeks” and has a conservative scoring algorithm where “never” or “some of the time” are both designated as 0. A score of ≥3 has been validated to designate disabling/prolonged fatigue states [49]. |
| Stan et al. [43] | 4-12 months post-surgery, ≥2 months post RT/CT | 0-10 single numeric analogue scale | ≥4 |
|
| Yuen et al. [26] | Completion of RT &/or CT (range: 9 days to 35 months) | 0-10 numeric rating scale | ≥4 |
|
| a CIS-fatigue, fatigue severity subscale of the Checklist Individual Strength; CT, chemotherapy; NCI CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events; NR, not reported; NS, not specified; PSQI, Pittsburgh Sleep Quality Index; HT, hormonal therapy; RT, radiotherapy; SPHERE, Somatic and Psychological HEalth Report; #authors confirmed treatment completion. |
| Author | ACSM Category | Intervention | Duration (weeks) | Supervision | Frequency (per week) | Intensity | Time (min) | Progression | Comparator | Monitoring of fatigue |
|---|---|---|---|---|---|---|---|---|---|---|
| Abrahams et al. [61] | Aerobic | Graded exercise therapy (GET) | ~12 | Non-supervised PA, 6±2 GET sessions (a component of CBT) | 14 | Low | 3-120 min | Graded increases in duration by 1 min, up to 60 min twice daily | Other components of CBT | NS: likely discussed in sessions with therapists as part of GET |
| Bennett et al. [46] | Aerobic | Motivational interviewing for physical activity | 24 | Non-supervised, initial in-person session & 3 phone calls | Goal = most days | Moderate | Goal = 30 | NR | Usual care | NS: participants asked about adverse events or problems during each call |
| Bower et al. [38] | Neuromotor | Iyengar yoga classes | 12 | Supervised, groups of 4-6 | 2 | NR | 90 | Postures progressed from simpler to more challenging | Health educations classes | NR |
| Campo et al. [36] | Neuromotor | Qigong (eccentric focus) | 12 | Supervised classes & home-based (DVD) | 2 classes | Somewhat strong (RPE 0-10 of ~4) | 60 | Progression to more time performing standing movements | Non-aerobic stretching | NR |
| Cantarero-Villanueva et al. [39] | Aerobic | Deepwater aquatic exercise | 8 | Supervised, groups of 10-12 | 3 | Moderate | 60 | NR | Usual care | NS: discomfort or low-intensity pain/stiffness after an exercise session was reported |
| Donnelly et al. [37] | Aerobic & Resistance | Walking & strengthening exercises | 12 | Home-based, initial in-person consultation & weekly calls | Goal = at least 5 | Moderate | 30 | NS: Physical activity levels discussed weekly | Usual care | NR |
| Galantino et al. [40] | Aerobic | Walking (video & written instructions) | 6 | 3 supervised group sessions and home-based with weekly calls | Goal = at least 3 | Monitored (RPE & HR), NR | 60 | NR | Tai Chi | A weekly journal inquired about the nature of fatigue before & after exercise |
| Heim et al. [44] | Aerobic & Resistance | Strength exercises & walking (demonstrations & brochure) | NR | During an in-patient complex rehabilitation program | Aerobic: 2 and RT: 3 | NR | 30 | NR | Complex rehabilitation (usual care) | NR |
| Kim et al. [33] | Aerobic & Resistance | Exercise adherence program based on social capital | 12 | Supervised groups of 3-6 for 8 sessions & home-based | 1 (6 weeks) and 2 (6 weeks) | Low-High | NR | NR | Written information on exercise | NS: Exercise journal provided |
| Kröz et al. [27] | Aerobic | Aerobic training | 10 | 8 trainer-led sessions complemented by home-based training | 5-Mar | Monitored, NR | 30-45 | Performance adjustments based on HR | Multimodal therapy | NS: Subjective health complaints reported were recorded & graded |
| Larkey et al. [45] | Neuromotor | Qigong/Tai Chi Easy | 12 | Both supervised & home-based | Goal = 5 | Low | 30-60 | NR | Sham Qigong | NR |
| Mayo et al. [35] | Aerobic | Individualised walking program | 8 | Non-supervised (pedometer & weekly calls) | Daily (steps per day) | NR | NR (steps per day) | Based on rating of fatigue (10% weekly ↑ or ↓) | Usual care (rehabilitation program) | Weekly calls to ascertain level of fatigue |
| Pagola et al. [32] | Aerobic & Resistance | High-intensity aerobic & resistance exercise | 16 | Supervised | 2 | RPE 0-10, and Aerobic: 7-8 and RT: 6-7 | 75 | Aerobic: based on RPE 7-8/10 | RT & non-supervised moderate aerobic exercise | NS: Number of RT exercises depended on perceived fatigue |
| Payne et al. [41] | Aerobic | Walking exercise intervention | 14 | Non-supervised & home-based | 2 | Moderate | 20 | NR | Usual care | NR |
| Prinsen [47] | Aerobic | CBT including a physical activity (walking or cycling) | 24 | Home-based physical activity (in-person CBT) | 14 (2/day) | NR | 5-120 | From 5-10 min up to 90-120 min per day | Waitlist control | NR |
| Rogers et al. [42] | Aerobic & Resistance | Walking & strength training with behavioural support | 12 | Supervised (26 sessions) + home-based walking | Walking: 4 and Resistance: 2 | Moderate (48-52% HRR) | 40 | Walking: gradually advanced | Usual care | NS: Non-serious adverse events reported (e.g. modification of resistance exercise due to lymphedema) |
| Sandler et al. [7] | Aerobic | Combined GET/CBT | 12 | 5 consultations with an EP & 6-8 with a psychologist | Regular | Low | 30 | GET (graduated increases in duration to 30 min, then increase in frequency) | Education package (principles of CBT/GET) | GET & activity pacing (CBT) encourages participants to avoid exacerbations of fatigue |
| Stan et al. [43] | Resistance | Strengthening exercises | 12 | Home-based (DVD) | 5-Mar | NS: ‘Rapid Easy Strength Training’ | 20 | NR | Yoga | NS: Bi-monthly phone calls to assess & document side-effects |
| Yuen et al. [26] | Aerobic & Resistance | Aerobic & resistance exercise | 12 | Home-based | 3 | Aerobic: RPE 6-20 of 10-13 | 20-40 | Aerobic: NR and Resistance: Progress in no. of circuits (from 1-3) & resistive load | Usual care | Monthly calendars to record fatigue each day (0-10 NRS). Calendars collected at 12 wks |
| a ACSM, American College of Sports Medicine; EP, exercise physiologist; CBT, cognitive behavioural therapy; GET, graded exercise therapy, HR, heart rate; HRR, heart rate reserve; NR, not reported; NRS, numerical rating scale; NS, not specified; RPE, rating of perceived exertion. |