Abstract
PurposeCancer-related fatigue remains one of the most prevalent and distressing symptoms experienced by cancer patients. Effective treatments for cancer-related fatigue are needed. The objective of this meta-analysis is to determine the impact of mistletoe extracts as a pharmacological treatment for the management of cancer-related fatigue.MethodsWe included randomized clinical trials (RCTs) and non-randomized studies of interventions (NRSIs) in cancer patients. Inclusion criteria were cancer-related fatigue severity or prevalence as an outcome and testing of mistletoe extracts compared to control groups. We searched Medline (EuropePMC), Embase, the Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and opengrey.org through October 2020. We assessed the risk of bias using the Cochrane risk of bias tools for RCTs and NRSIs and conducted a meta-analysis.ResultsWe performed one meta-analysis with 12 RCTs, including 1494 participants, and one meta-analysis with seven retrospective NRSIs, including 2668 participants. Heterogeneity between the studies was high in both meta-analyses. Most studies had a high risk of bias. A random-effects model showed for RCTs a standardized mean difference of –0.48 (95% confidence interval –0.82 to –0.14; p = 0.006) and for NRSIs an odds ratio of 0.36 (95% confidence interval 0.20 to 0.66; p = 0.0008).ConclusionTreatment with mistletoe extracts shows a moderate effect on cancer-related fatigue of similar size to physical activity. These results need to be confirmed by more placebo-controlled trials. Future trials should investigate different treatment durations and their effect on cancer-related fatigue in post-treatment cancer survivors.Trial registration.This meta-analysis has been registered under the PROSPERO registration number CRD42020191967 on October 7, 2020.
Highlights
Cancer-related fatigue (CRF) is a symptom experienced by cancer patients
Our results show a statistically significant but smaller effect size than the previous meta-analysis, which included 9 randomized clinical trials (RCTs) with 779 patients and calculated an standardized mean differences (SMDs) of –0.79
RCTs and non-randomized studies of interventions (NRSIs), lead to effect estimates that imply a significant symptom-reducing effect of mistletoe extracts against control regarding CRF. This result is relevant for healthcare providers seeking a pharmacological treatment for CRF, in oncological settings where physical activity is not possible or where complementary CRF treatment is sought
Summary
Cancer-related fatigue (CRF) is a symptom experienced by cancer patients. The most cited definition, provided by the National Comprehensive Cancer Network in the USA, describes CRF as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent physical activity and that interferes withA recent systematic review of 129 studies with 71,568 patients reported a 49% prevalence of CRF with significant heterogeneity among studies [5]. Cancer-related fatigue (CRF) is a symptom experienced by cancer patients. The most cited definition, provided by the National Comprehensive Cancer Network in the USA, describes CRF as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent physical activity and that interferes with. A recent systematic review of 129 studies with 71,568 patients reported a 49% prevalence of CRF with significant heterogeneity among studies [5]. The prevalence of CRF ranged from 11 to 99%. The variation of the prevalence can be attributed to the variety of scales, with differing cut-off values, and to the different probabilities of experiencing CRF depending on the cancer type and treatment stage [5]. Patients with gastrointestinal (50%), breast (49.7%), and lymphoma (43.3%) cancers reported a higher CRF prevalence than patients with gynecological (26.2%) and prostate (26.3%) cancers [5].
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