Artikel Jurnal

Non-pharmacological palliative interventions for cancer-related pain and fatigue: A network meta-analysis

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Cancer remains a major global health challenge, with an estimated 19.3 million new cases diagnosed in 2023 and projections indicating that 28.4 million people will be living with cancer by 2040 [1,2]. Among the most distressing and functionally limiting sequelae of cancer and its treatment are pain and fatigue, which are frequently interrelated rather than independent symptoms. Pain affects up to 90 % of patients with advanced cancer, whereas cancer-related fatigue (CRF) affects more than 70 % during active therapy and may persist for years after treatment completion [3,4]. These two symptoms frequently co-occur, form part of a shared symptom cluster, and together exert a synergistic impact on functional capacity, emotional well-being, and quality of life.
Mounting biological and clinical evidence demonstrates that pain and fatigue share overlapping mechanisms and often reinforce each other. Dysregulation of inflammatory and neuroendocrine pathways plays a central role in the onset and persistence of both symptoms. Activation of pro-inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha (TNF-α), heightens nociceptive sensitivity while simultaneously inducing metabolic and sleep disturbances that contribute to fatigue [5,6]. These pathways interact with hypothalamic–pituitary–adrenal (HPA) axis dysfunction, resulting in abnormal cortisol rhythms and impaired stress recovery, which further exacerbate pain perception and energy depletion [7]. Moreover, neuroinflammation and central sensitization mechanisms have been identified as key biological links between chronic pain and fatigue in both cancer and non-cancer populations [8]. Collectively, these findings provide a strong theoretical and empirical foundation for examining pain and fatigue within a unified analytic framework.
Clinically, the two symptoms are closely interconnected and frequently co-managed. Observational and cohort studies have reported moderate to strong correlations between pain and fatigue across cancer types and treatment stages [9]. Patients experiencing both report poorer functional status, higher psychological distress, and diminished quality of life compared with those experiencing either symptom alone [7,10]. Consequently, palliative and supportive care teams often employ multimodal strategies such as exercise, acupuncture, relaxation, or mindfulness-based approaches to alleviate both pain and fatigue simultaneously by targeting shared inflammatory, autonomic, and psychological mechanisms [11,12].
Despite this interconnection, current management strategies remain fragmented. Pharmacological treatments such as opioids remain the cornerstone of cancer pain control but are limited by sedation, nausea, and dependency, whereas pharmacologic options for CRF (e.g., psychostimulants or corticosteroids) show inconsistent efficacy and potential side effects. These limitations underscore the need for safe, non-pharmacological palliative interventions that can simultaneously address the physiological and psychosocial mechanisms underlying both symptoms. Such interventions encompass a wide range of modalities, including electrotherapy-based approaches (e.g., TENS, scrambler therapy [13,14]), acupuncture or acupressure derived from Traditional East Asian Medicine [15], biofield therapies such as Reiki and Healing Touch [16], mind–body movement practices such as yoga, tai chi, and qigong [17], sensory modulation therapies including massage, music therapy, and aromatherapy [18], structured physical exercise programs [19], social-support interventions [20], and psychological therapies such as cognitive behavioral therapy or psychoeducation [21]. For analytical consistency, these modalities were classified a priori into conceptually coherent categories based on theoretical mechanisms and delivery formats (e.g., sensory, energetic, mind–body movement, psychological), reducing heterogeneity and supporting the transitivity assumption in subsequent network modeling.
However, the evidence base for these non-pharmacological interventions remains highly fragmented. Previous systematic reviews have typically examined single modalities such as exercise, acupuncture, or mindfulness, or have focused on isolated outcomes, either pain or fatigue, without addressing their co-occurrence within a shared biological or clinical context. The heterogeneity of interventions, inconsistent outcome definitions, and small pooled samples across these reviews have limited the ability to draw integrated conclusions or establish comparative hierarchies of effectiveness [11,17,22]. To our knowledge, no previous quantitative synthesis has concurrently evaluated and ranked the full spectrum of non-pharmacological palliative interventions for both cancer-related pain and fatigue within a unified analytic framework. By integrating direct and indirect evidence across multiple modalities and applying CINeMA-based certainty grading, the present network meta-analysis provides the first comparative hierarchy of effectiveness for simultaneous symptom relief, contributing clinically interpretable evidence to guide holistic and multimodal palliative care.

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Detail Information

Series Title

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Call Number

616.99 YAN n

Publisher

Semarang : Journal of Psychosomatic Research., 2025

Collation

-

Language

English

ISBN/ISSN

0022-3999

Classification

616.99

Content Type

text

Media Type

-

Carrier Type

-

Edition

-

Subject(s)

Fatigue
Pain Management
Neoplasms

Specific Detail Info

https://doi.org/10.1016/j.jpsychores.2025.112501

Statement of Responsibility

Yan Adi Wibawa

Viewer

5

Other Information

Tanggal Pelaksanaan - Dari

2025-12-17

Tanggal Pelaksanaan - Sampai

2025-12-17

Akreditasi

Tidak

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