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Revisión sistemática

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Efficacy and safety of methylphenidate and ginseng in cancer-related fatigue: a network meta-analysis of randomized controlled trials

Autores Li H , Che K , Zhi Z , Xu W , Huang J , Wang X , Liang X , Zhao T , Hu J , Hou T , Sun S , He J
Revista Translational cancer research
Año 2023
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 14 Estudios primarios 13 Estudios primarios (14 referencias)

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BACKGROUND: Incidence of cancer-related fatigue (CRF), which can persist 5 to 10 years, is nearly 85% in cancer patients. It severely affects the quality of life and is strongly associated with poor prognosis. As clinical trial data on CRF treated with methylphenidate and ginseng, two potential medicines, has been accumulating, an updated meta-analysis was performed to evaluate and compare the efficacy and safety of the two medicines in CRF. METHODS: Randomized controlled trials that investigated methylphenidate or ginseng in the treatment of CRF were identified through a literature search. The primary outcome was CRF relief. Standardized mean difference (SMD) was used to analyze the effect. RESULTS: Eight studies on methylphenidate were included and the pooled SMD was 0.18 [95% confidence interval (95% CI): -0.00 to 0.35, P=0.05]. Five studies on ginseng were included and the SMD was 0.32 (95% CI: 0.17-0.46, P<0.0001). Results of network meta-analysis showed that the order was ginseng, methylphenidate, placebo from high efficacy to low and ginseng was significantly better than methylphenidate (SMD =0.23, 95% CI: 0.01-0.45). Incidences of insomnia and nausea caused by ginseng were significantly lower than those caused by methylphenidate (P<0.05). CONCLUSIONS: Both methylphenidate and ginseng can significantly ameliorate CRF. Ginseng may be superior to methylphenidate because ginseng may be more effective and might cause less adverse events. Head-to-head trials with fixed protocol are warranted to identify the optimal medical strategy.

Revisión sistemática

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Effectiveness of Cognitive Behavioral Therapy in Improving Functional Health in Cancer Survivors: A Systematic Review and Meta-analysis.

Revista Critical reviews in oncology/hematology
Año 2022
Enlaces Pubmed DOI

Este artículo incluye 95 Estudios primarios 95 Estudios primarios (95 referencias)

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BACKGROUND: Cancer survivors suffer from health deficits caused by their disease and treatment. This study conducted a systematic review and meta-analysis on how, and to what extent, cognitive-behavioral therapy (CBT) impacts functional health outcomes in cancer survivors. METHODS: We searched 7 electronic databases, 91 published review articles, and 4 professional websites for eligible randomized and non-randomized controlled trials focusing on cancer survivors. RESULTS: We included 95 studies published between 1986 and 2021. Risk of bias across studies was low overall. We identified an overall statistically significant treatment effect size across functional health categories, d=0.391, p<0.001, and significant moderators associated with CBT's treatment effect, i.e., treatment phase and type of comparison. CONCLUSIONS: CBT was effective at improving functional health outcomes of cancer survivors, regardless of therapy delivery modality or number of cancer diagnoses patients had, but not for newly diagnosed patients or those currently benefiting from an active comparator intervention.

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The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review.

Revista Journal of cancer survivorship : research and practice
Año 2022
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 68 Estudios primarios 68 Estudios primarios (68 referencias)

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PURPOSE: To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. METHODS: A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service's Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. RESULTS: Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. CONCLUSIONS: The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS: Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum.

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Systematic review and meta-analysis of cognitive-behavioural therapy for insomnia on subjective and actigraphy-measured sleep and comorbid symptoms in cancer survivors.

Revista Sleep medicine reviews
Año 2022
Enlaces Pubmed DOI

Este artículo incluye 22 Estudios primarios 21 Estudios primarios (22 referencias)

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This systematic review and meta-analysis assessed the efficacy of cognitive-behavioural therapy for insomnia (CBT-I) among cancer survivors and explored its effect on comorbid symptoms. Studies were included if they assessed the efficacy of CBT-I in adults diagnosed with cancer published prior to August 2020. The primary outcome was insomnia severity. The protocol was pre-registered on PROSPERO (CRD42020169986). Twenty-two studies met eligibility criteria. CBT-I significantly improved insomnia severity (g = 0.78) with durable benefits at 3- and 6-month follow-up. CBT-I produced significant small to large effects for diary-measured sleep efficiency, wake after sleep onset, total sleep time, sleep onset latency, sleep quality, anxiety, depression, fatigue, and overall quality of life. Subgroup analyses revealed no significant difference between in-person and self-help CBT-I. Overall, CBT-I is a robustly efficacious and durable treatment for insomnia among cancer survivors and can produce concomitant benefits on other symptoms. Implementation efforts are needed to ensure that people with cancer have access to CBT-I as the recommended first-line treatment for insomnia.

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Acupuncture Improves Multiple Treatment-Related Symptoms in Breast Cancer Survivors: A Systematic Review and Meta-Analysis

Revista Journal of alternative and complementary medicine (New York, N.Y.)
Año 2021
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 26 Estudios primarios 26 Estudios primarios (26 referencias)

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Introduction: Acupuncture has demonstrated effectiveness for symptom management among breast cancer survivors. This meta-analysis aims to evaluate the effect of acupuncture on treatment-related symptoms among breast cancer survivors. Methods: The authors searched PubMed, CINAHL, and EMBASE for relevant randomized clinical trials (RCTs) of acupuncture for managing treatment-related symptoms published in English through June 2021. They appraised the quality of each article using the Cochrane Collaboration Risk of Bias Criteria. The primary outcomes were pain, hot flashes, sleep disturbance, fatigue, depression, lymphedema, and neuropathy as individual symptoms. They also evaluated adverse events reported in acupuncture studies. Results: Of 26 selected trials (2055 patients), 20 (1709 patients) were included in the meta-analysis. Acupuncture was more effective than control groups in improving pain intensity [standardized mean difference (SMD) =-0.60, 95% confidence intervals (CI)-1.06 to-0.15], fatigue [SMD =-0.62, 95% CI-1.03 to-0.20], and hot flash severity [SMD =-0.52, 95% CI-0.82 to-0.22]. The subgroup analysis indicated that acupuncture showed trends but not significant effects on all the treatment-related symptoms compared with the sham acupuncture groups. Compared with waitlist control and usual care groups, the acupuncture groups showed significant reductions in pain intensity, fatigue, depression, hot flash severity, and neuropathy. No serious adverse events were reported related to acupuncture intervention. Mild adverse events (i.e., bruising, pain, swelling, skin infection, hematoma, headache, menstrual bleeding) were reported in 11 studies. Conclusion: This systematic review and meta-analysis suggest that acupuncture significantly reduces multiple treatment-related symptoms compared with the usual care or waitlist control group among breast cancer survivors. The safety of acupuncture was inadequately reported in the included studies. Based on the available data, acupuncture seems to be generally a safe treatment with some mild adverse events. These findings provide evidence-based recommendations for incorporating acupuncture into clinical breast cancer symptom management. Due to the high risk of bias and blinding issues in some RCTs, more rigorous trials are needed to confirm the efficacy of acupuncture in reducing multiple treatment-related symptoms among breast cancer survivors. © Copyright 2021, Mary Ann Liebert, Inc., publishers 2021.

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Non-specific effects of acupuncture and sham acupuncture in clinical trials from the patient's perspective: a systematic review of qualitative evidence.

Autores Ho RS , Wong CH , Wu JC , Wong SY , Chung VC
Revista Acupuncture in medicine : journal of the British Medical Acupuncture Society
Año 2021
Enlaces Pubmed DOI

Este artículo está incluido en 1 Síntesis amplia 20 Síntesis amplias (1 referencia)

Este artículo incluye 20 Estudios primarios 20 Estudios primarios (20 referencias)

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BACKGROUND: Previous clinical trials have demonstrated that both acupuncture and sham acupuncture exert significant, non-specific effects on treatment outcomes when compared to no-treatment controls. A recently developed framework (mechanisms in orthodox and complementary and alternative medicine-MOCAM) suggests that the non-specific effects of acupuncture originate from multiple domains (e.g. patient characteristics, acupuncturist skill/technique, the patient-acupuncturist relationship, and the acupuncture environment). However, it remains to be determined precisely how these domains influence the non-specific effects of treatment among patients receiving acupuncture and sham acupuncture in clinical trials. Therefore, we conducted a systematic review to synthesize existing qualitative evidence on how trial participants randomized to acupuncture and sham acupuncture groups experience non-specific effects, regardless of the types of medical condition investigated. METHODS: This systematic review included primary qualitative studies embedded in randomized controlled trials designed to investigate acupuncture or sham acupuncture interventions. Eligible studies published in English were derived from a search of five international databases. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) tool. Using a framework synthesis approach, the identified MOCAM framework was adapted based on the synthesis of the available qualitative evidence. RESULTS: A total of 20 studies of high methodological quality were included. Our proposed model indicated that the effects of acupuncture may be increased by maintaining a professional status, applying a holistic treatment approach, practicing empathy, and providing patients with an appropriate explanation of the theory behind acupuncture and sham acupuncture. From the patient's perspective, the efficacy of treatment can be increased by following the lifestyle modification advice provided by acupuncturists, maintaining a positive attitude toward treatment efficacy, actively engaging with acupuncturists during consultation, and making behavioral changes based on experience gained during the trial. CONCLUSION: The results of this study may provide a basis for improving and standardizing key components of non-specific effects in acupuncture treatment, and for improving the isolation of specific effects in future clinical trials involving acupuncture and sham acupuncture.

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Acupuncture for Breast Cancer: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes

Autores Zhang Y , Sun Y , Li D , Liu X , Fang C , Yang C , Luo T , Lu H , Li H , Zhang H , Liang Q , Wu J , Huang L , Xu R , Ren L , Chen Q
Revista Frontiers in oncology
Año 2021
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 33 Estudios primarios 33 Estudios primarios (33 referencias)

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Abstract: The present systematic review and meta-analysis was undertaken to evaluate the effects of acupuncture in women with breast cancer (BC), focusing on patient-reported outcomes (PROs). Methods: A comprehensive literature search was carried out for randomized controlled trials (RCTs) reporting PROs in BC patients with treatment-related symptoms after undergoing acupuncture for at least four weeks. Literature screening, data extraction, and risk bias assessment were independently carried out by two researchers. Results: Out of the 2, 524 identified studies, 29 studies representing 33 articles were included in this meta-analysis. At the end of treatment (EOT), the acupuncture patients’ quality of life (QoL) was measured by the QLQ-C30 QoL subscale, the Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES), the Functional Assessment of Cancer Therapy–General/Breast (FACT-G/B), and the Menopause-Specific Quality of Life Questionnaire (MENQOL), which depicted a significant improvement. The use of acupuncture in BC patients lead to a considerable reduction in the scores of all subscales of the Brief Pain Inventory-Short Form (BPI-SF) and Visual Analog Scale (VAS) measuring pain. Moreover, patients treated with acupuncture were more likely to experience improvements in hot flashes scores, fatigue, sleep disturbance, and anxiety compared to those in the control group, while the improvements in depression were comparable across both groups. Long-term follow-up results were similar to the EOT results. Conclusions: Current evidence suggests that acupuncture might improve BC treatment-related symptoms measured with PROs including QoL, pain, fatigue, hot flashes, sleep disturbance and anxiety. However, a number of included studies report limited amounts of certain subgroup settings, thus more rigorous, well-designed and larger RCTs are needed to confirm our results.

Revisión sistemática

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Pharmacological Interventions for the Management of Cancer-Related Fatigue Among Cancer Survivors: Systematic Review and Meta-Analysis.

Autores Sun X , Chen Y , Cheung WK , Wu IX , Xiao F , Chung VC
Revista Integrative cancer therapies
Año 2021
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 15 Estudios primarios 15 Estudios primarios (15 referencias)

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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.

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Placebo response in trials of drug treatments for cancer-related fatigue: A systematic review, meta-analysis and meta-regression

Autores Roji R , Stone P , Ricciardi F , Candy B
Revista BMJ supportive & palliative care
Año 2020
Enlaces Pubmed DOI PubMed Central Pubmed central

Este artículo incluye 30 Estudios primarios 30 Estudios primarios (30 referencias)

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Background Cancer-related fatigue (CRF) is one of the most distressing symptoms experienced by patients. There is no gold standard treatment, although multiple drugs have been tested with little evidence of efficacy. Randomised controlled trials (RCTs) of these drugs have commented on the existence or size of the placebo response (PR). The objective of this systematic review was to establish the magnitude of the PR in RCTs of drugs to relieve CRF and to identify contributing factors. Method RCTs were included in which the objective was to treat CRF. A meta-analysis was conducted using the standardised mean change (SMC) between baseline and final measurement in the placebo group. To explore factors that may be associated with the PR (eg, population or drug), a meta-regression was undertaken. Risk of bias was assessed using the revised Cochrane tool. Results From 3916 citations, 30 relevant RCTs were identified. All had limitations that increased their risk of bias. The pooled SMC in reduction in fatigue status in placebo groups was -0.23 (95% confidence intervals -0.42 to -0.04). None of the variables analysed in the meta-regression were statistically significant related to PR. Conclusion There is some evidence, based on trials with small samples, that the PR in trials testing drugs for CRF is non-trivial in size and statistically significant. We recommend that researchers planning drug studies in CRF should consider implementing alternative trial designs to better account for PR and decrease impact on the study results. ©

Revisión sistemática

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Psychostimulants for cancer-related cognitive impairment in adult cancer survivors: a systematic review and meta-analysis.

Revista Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Año 2019
Enlaces Pubmed DOI

Este artículo incluye 6 Estudios primarios 6 Estudios primarios (6 referencias)

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BACKGROUND: Cognitive impairment is recognized as a common symptom experienced by cancer survivors which impacts on quality of life (QoL) and day-to-day activities. One of the treatment options is the use of psychostimulants but the evidence supporting its use remains unclear. OBJECTIVES: To identify the level of evidence of psychostimulants' effect on the management of cognitive impairment in adult cancer survivors. METHODS: Electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL) and reference lists of relevant reviews were searched from inception to December 2017, with no language restrictions applied. Randomized controlled trials (RCTs), evaluating the effect of psychostimulants on cognitive impairment among cancer patients with no primary or secondary brain tumor or brain radiation, were included. The primary outcome was cognitive function changes, whereas secondary outcomes were adverse events (AEs) and QoL. RESULTS: Six RCTs were included: three studies investigating methylphenidate and three modafinil, with a total of 244 and 146 patients, respectively. Due to important differences in methodologies between studies, a meta-analysis was assumed inappropriate for the primary outcome. A narrative synthesis was performed. One study using methylphenidate and two using modafinil demonstrated improvements in some cognitive functions as measured by objective cognitive assessment tests. Psychostimulants did not improve QoL and were not associated with more AEs. CONCLUSION: To date, limited evidence is available to estimate the usefulness (or lack) of psychostimulants on cognitive function in this population.