Moderators of the effect of psychosocial interventions on fatigue in women with breast cancer and men with prostate cancer: Individual patient data meta-analyses

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Harriët J G Abrahams 1, Hans Knoop 1, Maartje Schreurs 2, Neil K Aaronson 3, Paul B Jacobsen 4, Robert U Newton 5, Kerry S Courneya 6, Joanne F Aitken 7 8 9 10, Cecilia Arving 11, Yvonne Brandberg 12, Suzanne K Chambers 7 13 14 15, Marieke F M Gielissen 16, Bengt Glimelius 17, Martine M Goedendorp 18 19, Kristi D Graves 20, Sue P Heiney 21, Rob Horne 22, Myra S Hunter 23, Birgitta Johansson 17, Laurel L Northouse 24, Hester S A Oldenburg 25, Judith B Prins 26, Josée Savard 27, Marc van Beurden 28, Sanne W van den Berg 29, Irma M Verdonck-de Leeuw 30 31, Laurien M Buffart

Main idea: Our findings did not provide evidence that any selected demographic or clinical characteristic, or baseline levels of fatigue or pain, moderated effects of psychosocial interventions on fatigue. A specific focus on decreasing fatigue seems beneficial for patients with breast cancer with clinically relevant fatigue.

Abstract

Objective: Psychosocial interventions can reduce cancer-related fatigue effectively. However, it is still unclear if intervention effects differ across subgroups of patients. These meta-analyses aimed at evaluating moderator effects of (a) sociodemographic characteristics, (b) clinical characteristics, (c) baseline levels of fatigue and other symptoms, and (d) intervention-related characteristics on the effect of psychosocial interventions on cancer-related fatigue in patients with non-metastatic breast and prostate cancer.

Methods: Data were retrieved from the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium. Potential moderators were studied with meta-analyses of pooled individual patient data from 14 randomized controlled trials through linear mixed-effects models with interaction tests. The analyses were conducted separately in patients with breast (n = 1091) and prostate cancer (n = 1008).

Results: Statistically significant, small overall effects of psychosocial interventions on fatigue were found (breast cancer: β = -0.19 [95% confidence interval (95%CI) = -0.30; -0.08]; prostate cancer: β = -0.11 [95%CI = -0.21; -0.00]). In both patient groups, intervention effects did not differ significantly by sociodemographic or clinical characteristics, nor by baseline levels of fatigue or pain. For intervention-related moderators (only tested among women with breast cancer), statistically significant larger effects were found for cognitive behavioral therapy as intervention strategy (β = -0.27 [95%CI = -0.40; -0.15]), fatigue-specific interventions (β = -0.48 [95%CI = -0.79; -0.18]), and interventions that only targeted patients with clinically relevant fatigue (β = -0.85 [95%CI = -1.40; -0.30]).

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