Objective:

Current guidelines have different recommendations on applying pharmacological interventions for managing cancer-related fatigue (CRF) among cancer survivors. This systematic review aims to synthesize clinical evidence on pharmacological interventions for managing CRF.

Methods:

Five databases were searched for potential randomized controlled trials (RCTs) from their inception until October 2020. RCTs assessing the effect of pharmacological treatments for CRF among cancer survivors were considered eligible. Clinical significance was determined by comparing the estimated effect with that of minimal important difference (MID). The risk of bias of each included RCT was appraised using the Cochrane risk of bias tool for randomized trials 2. Data were synthesized using random-effect pairwise meta-analyses.

Results:

A total of 15 RCTs (1238 participants) were included. The majority presented some concerns of bias arising from the randomization process and selection of the reported results. Meta-analysis showed that psychostimulant and wakefulness agents had statistically significant while clinically insignificant effects on the treatment of CRF (pooled weighted mean difference [WMD]: 2.8, 95% confidence interval [CI]: 0.2-5.4, I²: 0%, 3 RCTs, MID: 3.0-6.0). Three natural products, including Renshen Yangrong Tang (mean difference [MD]: −16.1, 95% CI: −8.9 to −23.3, MID: −17.3 to −11.4), Tualang honey (MD: 11.2, 95% CI: 7.1-15.3, MID: 3.0-6.0), and Shenmai injection plus Peptisorb (MD: −1.6, 95% CI: −2.1 to −1.1, MID: −1.1 to −0.8) demonstrated statistically and clinically significant effect in reducing CRF.

Conclusions:

Existing evidence showed promising effects of 3 natural products in reducing CRF among cancer survivors. The results from this study need to be further confirmed with well-designed and adequately powered RCTs that use validated instruments for the measurement of CRF.

中文翻译：

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治疗癌症幸存者癌症相关疲劳的药理学干预措施：系统评价和荟萃分析

 客观的：

目前的指南对于应用药物干预措施来管理癌症幸存者的癌症相关疲劳（CRF）有不同的建议。本系统评价旨在综合治疗 CRF 的药物干预的临床证据。

 方法：

从开始到 2020 年 10 月，我们对五个数据库进行了潜在的随机对照试验 (RCT) 搜索。评估癌症幸存者 CRF 药物治疗效果的随机对照试验被认为是合格的。通过将估计效果与最小重要差异（MID）进行比较来确定临床意义。使用随机试验 2 的 Cochrane 偏倚风险工具评估每个纳入的 RCT 的偏倚风险。使用随机效应成对荟萃分析来合成数据。

 结果：

总共纳入 15 项随机对照试验（1238 名受试者）。大多数人对随机过程和报告结果的选择产生的偏差表示担忧。荟萃分析表明，精神兴奋剂和清醒剂对 CRF 的治疗具有统计学显着性但临床上不显着的影响（合并加权平均差 [WMD]：2.8，95% 置信区间 [CI]：0.2-5.4， I ² ：0%， 3 个 RCT，MID：3.0-6.0）。三种天然产品，包括人参养荣汤（平均差[MD]：-16.1，95% CI：-8.9至-23.3，MID：-17.3至-11.4）、Tualang蜂蜜（MD：11.2，95% CI：7.1-） 15.3，MID：3.0-6.0）和参麦注射液加Peptisorb（MD：-1.6，95％CI：-2.1至-1.1，MID：-1.1至-0.8）在降低CRF方面显示出统计学和临床​​上显着的效果。

 结论：

现有证据表明 3 种天然产品在降低癌症幸存者的 CRF 方面具有良好的效果。这项研究的结果需要通过精心设计、动力充足的随机对照试验来进一步证实，这些随机对照试验使用经过验证的仪器来测量 CRF。