Non-pharmacologic intervention to prevent cancer-related fatigue among breast cancer patients: a systematic review and meta-analysis

Cancer-related fatigue (CRF) is a prevalent and debilitating condition among breast cancer patients, significantly impacting their quality of life. Non-pharmacologic interventions have gained attention as potential strategies for managing CRF, but evidence on their efficacy remains fragmented. This study aims to evaluate the effectiveness of non-pharmacologic interventions in preventing and reducing CRF among breast cancer patients through a systematic review and meta-analysis. A comprehensive search of PubMed, Web of Science, Scopus, Medline, Cochrane Library, and Google Scholar was conducted, yielding 741 records. After removing duplicates, 354 records underwent title and abstract screening. A total of 65 studies were assessed for eligibility, of which 12 studies were included in the meta-analysis. The pooled analysis included a total of 990 participants, comprising intervention and control groups. Interventions analyzed included acupuncture, yoga, resistance and aerobic exercises, mindfulness-based stress reduction, and cognitive-behavioral therapy (CBT). Outcomes were assessed using validated fatigue measurement tools. Random-effects models were used to estimate the standardized mean difference (SMD) and 95% confidence intervals (CIs). The pooled analysis demonstrated a significant reduction in CRF among participants receiving non-pharmacologic interventions compared to usual care, with an overall SMD of -1.45 (95% CI: -2.39, -0.51; p=0.003). High heterogeneity was observed (I²=97%). Subgroup analyses indicated that interventions such as acupuncture, resistance exercise, and mindfulness-based stress reduction yielded the most substantial reductions in fatigue levels. No significant publication bias was detected, as shown in the funnel plot analysis. In conclusion, non-pharmacologic interventions effectively reduce CRF in breast cancer patients, with certain modalities demonstrating superior efficacy. These findings support integrating these interventions into comprehensive cancer care plans to improve patient outcomes. Further research is warranted to address heterogeneity and explore long-term effects.