Researchers examined data from 113 previously published studies involving more than 11,500 cancer patients with fatigue. Patients were randomly assigned to treat their exhaustion with exercise or psychotherapy, or both, or with drugs.
Exercise and psychotherapy were associated with a 26 per cent to 30 per cent reduction in fatigue during and after cancer treatment, the study found. Drugs, however, were tied to only a 9 per cent decline in fatigue.
“Patients need to try exercise or psychotherapy before they reach for a pharmaceutical,” said lead study author Karen Mustian of the University of Rochester Medical Center in Rochester, New York.
Cancer-related fatigue is common and may be tied to the effects of tumors or treatments, researches note in JAMA Oncology. Unlike other types of exhaustion, just getting more sleep or giving aching muscles a break from strenuous activities can’t address fatigue associated with tumors.
Fatigue tied to cancer can persist for years and may be worsened by other cancer-related health problems like depression, anxiety, sleep disturbance and pain.
It’s not clear why exercise and psychotherapy may be more effective than drugs, Mustian said by email.
“We do not know for sure why exercise works, but some research is beginning to suggest it is due to anti-inflammatory effects and also improvements in physical function – cardiovascular, pulmonary and muscular,” Mustian added. “In terms of psychotherapy, the most beneficial form was group therapy that used a cognitive behavioral approach to educate patients, help them to change the way they think about fatigue and managing it, and adopting behaviors to help alleviate it.”
Most participants in the studies were female, and almost half of the studies involved women with breast cancer.
Age, gender, cancer type and forms of exercise didn’t appear to influence how effective exercise or psychotherapy was relative to medications, researchers found.
Overall, the analysis included 14 drug studies, mostly looking at stimulants or drugs designed to promote wakefulness.
Among the 69 evaluations of exercise, most looked at aerobic activity alone or in combination with other types of movement.
Of the 34 psychological interventions tested in the studies, most involved therapies focused on behavior and education.
One benefit of the current study is that researchers were able to pool the data from several individual research efforts that were, alone, too small to draw meaningful conclusions about the relative advantages of different treatments, the authors note.
Limitations include the varied designs in the studies, which made it difficult to assess how factors such as race, education, income or other demographic differences might have impacted the results, the researchers also point out.
Even so, the findings confirm previous research on interventions to ease cancer-related fatigue, Dr. Jens Ulrich Rueffer, head of the German Fatigue Society in Cologne, said by email.
“We already knew that exercise and/or psychological interventions were beneficial for treating cancer-related fatigue,” said Kerry Courneya, a researcher at the University of Alberta, in Edmonton, Canada.
“What we learned from this new meta-analysis is that exercise and psychological counseling are roughly equal in their benefits for cancer-related fatigue,” Courneya, who wasn’t involved in the study, added by email. “And both appear superior to current pharmaceutical treatments.”