Chang Chi-Wen, Mu Pei-Fan, Jou Shiann-Tarng, Wong Tai-Ting, Chen Yu-Chih
a Professor and Deputy Academic Dean b Assistant professor c Professor and Chief of NS Pediatrics d Director 1. School of Nursing, National Yang-Ming University and Instructor, School of Nursing, Chang Gung University, Taipei, Taiwan R. O.C. Taiwan. A collaborating centre of the Joanna Briggs Institute 2. School of Nursing, National Yang-Ming University, Taipei, Taiwan R. O.C. Taiwan Joanna Briggs Institute Collaborating Centre. 3. Visiting Staff, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan R. O.C. 4. Division of Paediatric Neurosurgery, Department of Neurosurgery, Neurological Institute, Veterans General Hospital, Taipei, Taiwan R. O.C. 5. Department of Nursing, Taipei Veterans General Hospital, & Adjunct Associate Professor, School of Nursing, National Taipei University of Nursing and Health Sciences; Taipei Medical University and National Defense Medical Center.
JBI Libr Syst Rev. 2012;10(10):574-614. doi: 10.11124/jbisrir-2012-60.
Fatigue is one of the most distressing and prevalent symptoms reported by paediatric oncology patients. With the increase in cancer survival rate, how to control children's cancer-related fatigue during treatments or the coexisting period with the disease to further increase their quality of life has become the focus of medical teams who provide care to children with cancer.
The objective of this systematic review was to synthesise the best available evidence concerning the effectiveness of non-pharmacological interventions on fatigue in children and adolescents with cancer.
The search strategy aimed to find studies published between 1960 and 2010, in either the English or Chinese languages. Reference lists of studies that met the inclusion criteria were also searched for additional studies.
This review included randomised controlled trials and quasi-experimental studies that examined the effectiveness of non-pharmacological interventions for fatigue in children and adolescents with cancer.
Children and adolescents aged between one to 18 years old, with cancer either during or after the chemotherapy. The types of cancer included were acute lymphoblastic leukaemia, acute myeloid leukaemia, lymphoma and solid tumours.
Non-pharmacological interventions for fatigue in children and adolescents with cancer including: activity enhancement (exercise, physical activity), psychosocial interventions, cognitive behavioural therapy, stress management, relaxation, nutrition consultation, massage and educational interventions. The intervention descriptions included the length, frequency, setting and intervention providers.
The outcome measures considered fatigue scores assessment.
The review considered studies conducted either in a hospital or a community setting.
The data were extracted and synthesised using the standardised data extraction tool and synthesis function offered by the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.
The review included six studies - five English-language papers and one Chinese-language paper. Meta-analysis did not show a statistically significant impact on the effectiveness of exercise interventions in reducing overall fatigue in children and adolescents with cancer. Exercise interventions did lead to a statistically significant improvement (p = 0.01) in general fatigue (i.e. tiredness, physical weakness) (effect size = -0.76; 95% Confidence Interval -1.35 to -0.17).
The results of this systematic review show that exercise interventions can effectively reduce the level of general fatigue of children aged six to 18 years. No strong conclusions can be made for the use of massage therapy or health education measures, as there was only one article for each of these interventions.
The review provides an evidenced-based guide to future priorities for clinical practice. Exercise intervention could reduce the level of general fatigue of children aged six to 18 years. In particular, exercise interventions for fatigue are feasible and safe.
There is still a lack of rigorous research on this specific topic. Further research requires more rigorous study design and reporting of methodological issues, such as randomised controlled trials using concealment of allocation. Other non-pharmacological interventions for this problem should also be examined, including cognitive behavioural therapy, stress management, relaxation, support groups and massage therapy.
疲劳是儿科肿瘤患者报告的最令人痛苦且普遍存在的症状之一。随着癌症生存率的提高，如何在治疗期间或与疾病共存期间控制儿童癌症相关疲劳，以进一步提高他们的生活质量，已成为为癌症患儿提供护理的医疗团队关注的焦点。
本系统评价的目的是综合关于非药物干预对癌症患儿和青少年疲劳有效性的最佳现有证据。
检索策略旨在查找1960年至2010年间以英文或中文发表的研究。还对符合纳入标准的研究的参考文献列表进行检索以寻找其他研究。
本评价纳入了随机对照试验和准实验研究，这些研究考察了非药物干预对癌症患儿和青少年疲劳的有效性。
年龄在1至18岁之间、在化疗期间或化疗后患有癌症的儿童和青少年。所包括的癌症类型有急性淋巴细胞白血病、急性髓细胞白血病、淋巴瘤和实体瘤。
针对癌症患儿和青少年疲劳的非药物干预包括：活动增强（运动、体育活动）、心理社会干预、认知行为疗法、压力管理、放松、营养咨询、按摩和教育干预。干预描述包括时长、频率、环境和干预提供者。
结局测量考虑疲劳评分评估。
本评价考虑在医院或社区环境中进行的研究。
使用乔安娜·布里格斯循证卫生保健中心统计学评估与评审工具的标准化数据提取工具和综合功能对数据进行提取和综合。
本评价纳入了6项研究——5篇英文论文和1篇中文论文。荟萃分析未显示运动干预对降低癌症患儿和青少年总体疲劳有效性有统计学显著影响。运动干预确实导致一般疲劳（即疲倦、身体虚弱）有统计学显著改善（p = 0.01）（效应量 = -0.76；95%置信区间 -1.35至 -0.17）。
本系统评价结果表明，运动干预可有效降低6至18岁儿童的一般疲劳水平。对于按摩疗法或健康教育措施的使用，由于每项干预仅有一篇文章，无法得出有力结论。
本评价为临床实践的未来重点提供了循证指南。运动干预可降低6至18岁儿童的一般疲劳水平。特别是，针对疲劳的运动干预是可行且安全的。
关于这个特定主题仍缺乏严谨的研究。进一步的研究需要更严谨的研究设计并报告方法学问题，如采用分配隐藏的随机对照试验。还应研究针对此问题的其他非药物干预，包括认知行为疗法、压力管理、放松、支持小组和按摩疗法。
