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

Harriët J G Abrahams; Hans Knoop; Maartje Schreurs; Neil K Aaronson; Paul B Jacobsen; Robert U Newton; Kerry S Courneya; Joanne F Aitken; Cecilia Arving; Yvonne Brandberg; Suzanne K Chambers; Marieke F M Gielissen; Bengt Glimelius; Martine M Goedendorp; Kristi D Graves; Sue P Heiney; Rob Horne; Myra S Hunter; Birgitta Johansson; Laurel L Northouse; Hester S A Oldenburg; Judith B Prins; Josée Savard; Marc van Beurden; Sanne W van den Berg; Irma M Verdonck-de Leeuw; Laurien M Buffart

doi:10.1002/pon.5522

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

Psychooncology. 2020 Nov;29(11):1772-1785. doi: 10.1002/pon.5522. Epub 2020 Sep 3.

Authors

Harriët J G Abrahams¹, Hans Knoop¹, Maartje Schreurs², Neil K Aaronson³, Paul B Jacobsen⁴, Robert U Newton⁵, Kerry S Courneya⁶, Joanne F Aitken^{7

8

9

10}, Cecilia Arving¹¹, Yvonne Brandberg¹², Suzanne K Chambers^{7

13

14

15}, Marieke F M Gielissen¹⁶, Bengt Glimelius¹⁷, Martine M Goedendorp^{18

19}, Kristi D Graves²⁰, Sue P Heiney²¹, Rob Horne²², Myra S Hunter²³, Birgitta Johansson¹⁷, Laurel L Northouse²⁴, Hester S A Oldenburg²⁵, Judith B Prins²⁶, Josée Savard²⁷, Marc van Beurden²⁸, Sanne W van den Berg²⁹, Irma M Verdonck-de Leeuw^{30

31}, Laurien M Buffart^{2

5

32

33}

Affiliations

¹ Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
² Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
³ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁴ Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, USA.
⁵ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.
⁶ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
⁷ Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.
⁸ Cancer Council Queensland, Brisbane, Queensland, Australia.
⁹ Institute for Resilient Regions, University of Southern Queensland, Brisbane, Queensland, Australia.
¹⁰ School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
¹¹ Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
¹² Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
¹³ Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
¹⁴ Institute for Resilient Regions, University of Southern Queensland, Springfield, Queensland, Australia.
¹⁵ Health and Wellness Institute, Edith Cowan University, Perth, Western Australia, Australia.
¹⁶ Academy Het Dorp/Siza, Arnhem, The Netherlands.
¹⁷ Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
¹⁸ Department of Health Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹⁹ Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²⁰ Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
²¹ College of Nursing, University of South Carolina, Columbia, South Carolina, USA.
²² UCL School of Pharmacy, University College London, London, UK.
²³ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
²⁴ University of Michigan School of Nursing, Ann Arbor, MI, USA.
²⁵ Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van, Leeuwenhoek Hospital, Amsterdam, The Netherlands.
²⁶ Department of Medical Psychology, Radboud University Medical Center, Radboud, Institute for Health Sciences, Nijmegen, The Netherlands.
²⁷ School of Psychology, Université Laval and Laval University Cancer Research Center, Quebec City, Québec, Canada.
²⁸ Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
²⁹ Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands.
³⁰ Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
³¹ Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
³² Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
³³ Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.

PMID: 33448521
DOI: 10.1002/pon.5522

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]).

Conclusions: 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.

Keywords: breast cancer; cancer; fatigue; individual patient data meta‐analysis; moderators; oncology; prostate cancer; psychosocial interventions; psycho‐oncology.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Breast Neoplasms / psychology*
Breast Neoplasms / therapy*
Fatigue / etiology
Fatigue / psychology
Fatigue / therapy*
Female
Humans
Male
Prostatic Neoplasms / psychology*
Prostatic Neoplasms / therapy*
Psychosocial Intervention / methods*
Quality of Life / psychology
Social Support