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Non-pharmacological interventions for management of fatigue among children with cancer: systematic review of existing practices and their effectiveness
  1. Tushti Bhardwaj1 and
  2. Jonathan Koffman2
  1. 1 Department of Social Work, Dr B R Ambedkar College, University of Delhi, Yamuna Vihar, Delhi, India
  2. 2 Department of Palliative Care, Policy & Rehabilitation, King’s College London, Cicely Saunders Institute, London, UK
  1. Correspondence to Dr Tushti Bhardwaj, Asst Professor, Department of Social Work, Dr B R Ambedkar College, University of Delhi, Yamuna Vihar, Delhi-110094; tushti.p{at}


Objectives Fatigue is common among children living with cancer, particularly in advance stages. Little is known about the effectiveness of non-pharmacological approaches to manage this complex and distressing symptom among children. Thus, the present paper aim to critically examine the effectiveness and setting for non-pharmacological interventions to manage fatigue among children with cancer.

Methods Six electronic databases were screened first in February 2013 and at second instance in March 2015. They include PsycINFO, Medline, EMBASE, CINAHL, Scopus and Cochrane library. All databases were systematically searched for literature on fatigue and cancer, limited to children (as age group) and English language.

Results 1498 articles were identified, of which six were reviewed. Three types of interventions for managing fatigue were identified including (1) complementary and alternative medicine (healing touch/massage therapy), (2) exercise-based interventions and (3) nursing-based interventions. Most interventions were delivered during active treatment and in hospital settings where parents were involved to optimise participation. Despite fatigue scores being lower among intervention groups, no study findings were observed as being statistically significant.

Conclusion Fatigue is common among children treated for and living with cancer. The most appropriate setting to deliver non-pharmacological interventions to manage fatigue appears to be in hospital. However, in absence of any strong evidence, professionals need to be cautious about existing non-pharmacological interventions. Future research must adopt more rigorous research designs that are adequately powered using validated measures to identify potential benefits. In addition, researchers may wish to test psychosocial interventions shown to be of benefit in adults.

  • cancer
  • fatigue
  • children
  • non-pharmacological
  • complementary therapy

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  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared

  • Patient consent Not required, no human subjects involved as it is a systematic review of literature.

  • Ethics approval No study approval was obtained since the study does not involve human subjects.

  • Provenance and peer review Not commissioned; externally peer reviewed.