Various interventions for cancer-related fatigue in patients with breast cancer: a systematic review and network meta-analysis

Purpose To investigate the effects of various intervention approaches on cancer-related fatigue (CRF) in patients with breast cancer. Method Computer searches were conducted on PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang databases from their establishment to June 2023. Selection was made using inclusion and exclusion criteria, and 77 articles were included to compare the effects of 12 interventions on patients with breast cancer. Results: Seventy-seven studies with 12 various interventions were examined. The network findings indicated that cognitive behavioral therapy (CBT) (SMD, -1.56; 95%CI, -3.08 similar to-0.04), Chinese traditional exercises (CTE) (SMD, -0.85; 95%CI, -1.34 similar to-0.36), aerobic exercise (AE) (SMD, -0.77; 95%CI, -1.09 similar to-0.45), multimodal exercise (ME) (SMD, -0.75; 95%CI, -1.26 similar to-0.25), music interventions (MI) (SMD, -0.74; 95%CI, -1.45 similar to-0.03), and yoga (YG) (SMD, -0.44; 95%CI, -0.83 to -0.06) can reduce CRF more than the control group (CG). For relaxation exercises (RE) (MD, -6.69; 95%CI, -9.81 similar to-3.57), MI (MD, -5.45; 95%CI, -7.98 similar to-2.92), AE (MD, -4.34; 95%CI, -5.90 similar to-2.78), ME (MD, -3.47; 95%CI, -4.95 similar to-1.99), YG (MD, -2.07; 95%CI, -3.56 similar to-0.57), and mindfulness training (MD, -1.68; 95%CI, -2.91 similar to-0.46), PSQI improvement was superior to CG. In addition, for CTE (MD, 11.39; 95%CI, 4.11-18.66), YG (MD, 11.28; 95%CI, 1.63-20.93), and AE (MD, 9.34; 95%CI, 0.26 similar to 18.42), Functional Assessment of Cancer Therapy-Breast improvement was superior to CG. Conclusion Cognitive behavioral therapy (CBT) is the most effective measure for alleviating CRF in patients with breast cancer and Relaxation exercises (RE) is the most effective measure for improving sleep quality. In addition, Chinese traditional exercises (CTE) is the best measure for enhancing quality of life. Additional randomized controlled trials (RCTs) are expected to further investigate the efficacy and mechanisms of these interventions.