The impact of non-pharmacological cancer-related fatigue interventions on activity performance and participation outcomes in adult cancer survivors: A systematic review.

Abstract

Introduction: Increased cancer survivorship means more people are living with cancer-related fatigue (CRF). CRF is the most distressing symptom survivors experience and is associated with activity performance limitations, restricted participation in meaningful life roles and reduced quality of life. Occupational therapists have skills relevant to fatigue management, however, the role of occupational therapy in CRF management is unclear. Synergies between the focus of occupational therapy on enabling participation in everyday life and challenges experienced by survivors living with CRF suggests opportunity for considerable occupational therapy involvement in CRF management. Thesis overview: This thesis contains two sections, a literature review and a systematic review study. The literature review examined and critiqued existing research exploring the experience of survivors living with CRF, current occupational therapy involvement within CRF management and identified an evidence gap pertaining to participation within CRF research. Subsequently, the systematic review study presented in section two of this thesis aimed to identify whether existing non-pharmacological interventions effective in minimising CRF also had an impact on everyday activity performance and participation outcomes for adult cancer survivors. Study methods: The study was a systematic review with narrative synthesis. Eight databases were searched (Medline, CINAHL, PsychINFO, EMBASE, Scopus, OT Seeker, CENTRAL, Cochrane SR database), from 1998-2018 and limited to randomised controlled trials (RCTs) published in English. Study results: A total of 29 studies met selection criteria and were included in the review. Four intervention categories were identified: physical activity, psychosocial, multi-modal and ‘hands on’ therapies. In 28 studies (97%) quality of life, not participation or activity performance, was investigated as a primary or secondary outcome. Correspondingly, instruments measuring quality of life were used in 28 studies (97%). Three studies (10%) used additional instruments to measure participation, however, outcomes were not always reported. No obvious pattern of impact was identified between intervention type and survivors’ quality of life subscale data. Conclusion: Findings of this review indicate there is insufficient evidence to determine whether survivors’ activity performance and participation is impacted by CRF interventions. Consideration of the sensitivity and precision of quality of life instruments to measure activity performance and participation should be incorporated into future CRF research designs.