Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

The use and effectiveness of non-pharmacological interventions to reduce fatigue in people with primary brain tumours: a systematic review (#515)

Thomas Carlick 1 , Shaun Kirsten 1 , Rachel Campbell 1 , Mona Faris 1 , Megan Jeon 1 , Dianne Legge 2 3 , Raymond Chan 4 , Mark Pinkham 5 , Eng-Siew Koh 6 7 , Georgia Halkett 3 , Brian Kelly 8 , Helen Heydon 9 10 , Ursula Sansom-Daly 11 , Meera Agar 12 , Kerryn Pike 13 14 , Katarzyna Lion 13 15 , Joanne Shaw 1 , Haryana Dhillon 1
  1. The University of Sydney, Faculty of Science, School of Psychology, The Psycho-oncology Co-operative Group (PoCoG), Sydney, NSW, Australia
  2. Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, Heidelberg, VIC, Australia
  3. Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
  4. Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
  5. Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
  6. Liverpool Cancer Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
  7. South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
  8. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
  9. The Centre for Online Health, The University of Queensland, St Lucia, QLD, Australia
  10. The Centre for Health Services Research, The University of Queensland, St Lucia, QLD, Australia
  11. Behavioural Sciences Unit, School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine & Health, University of New South Wales, Kensington, NSW, Australia
  12. Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
  13. School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
  14. Griffith Centre for Mental Health, Griffith University, Gold Coast, QLD, Australia
  15. The Hopkins Centre, Griffith University, QLD, Australia

Aim: People with primary brain tumour (PBT) report high levels of fatigue. This systematic review aimed to synthesise the evidence on use and effectiveness of non-pharmacological interventions for fatigue in people with PBT.

Methods: This review was prospectively registered with PROSPERO. PsycInfo, Medline, Scopus, CINAHL, and Web of Science databases were searched in August 2023 using terms related to fatigue, PBT, non-pharmacological approaches, and interventions/treatment. Randomised controlled trials (RCT) and non-randomised studies were included. A narrative synthesis approach was employed to analyse extracted information. The Cochrane Risk of Bias (RoB-2) and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tools were applied.

Results:  We identified 18 articles; 10 RCTs, 4 single-arm studies, 3 case studies, and 1 quasi-experimental study. Interventions included exercise-based interventions (n=10), cognitive rehabilitation (n=3), education/self-help (n=2), psychological (n=1), neuromuscular stimulation (n=1), and nursing (n=1). Eight were feasibility/pilot studies and 11 had small sample sizes (N<30). Six studies (3/10 RCTs) reported a statistically significant reduction in fatigue post-intervention. Studies, including those with positive results, commonly reported fatigue as a secondary outcome, had high attrition, and/or were uncontrolled. Regarding risk of bias for RCTs, 2 studies had a low risk of bias, 6 ‘some concerns’, and 2 a high risk. For non-randomised studies, 4 had a moderate risk, and 1 a high risk of bias.

Conclusions: Current evidence to suggest the effectiveness of non-pharmacological interventions for fatigue in people with PBT is limited and effective elements of these interventions were not identifiable. Mixed results, small sample sizes, and high attrition rates highlight the need for novel approaches when conducting non-pharmacological studies for fatigue in this population.  Inherent challenges associated with research in this population necessitates alternative methodologies. Innovative trial designs such as platform trials, n-of-1 studies, stated-preference studies, and tailored interventions, should be considered for future trials.