Fatigue with epidermal growth factor receptor tyrosine kinase inhibitors in cancer patients: A meta-analysis of randomized controlled trials

Coping Skills Interventions for Fatigue in Adults with Hematologic Malignancies: A Systematic Review

Background: Persons with hematologic malignancies have a high symptom burden throughout the illness journey. Coping skills interventions effectively reduce fatigue for other cancer patients. The purpose of this systematic review is to identify if coping interventions can reduce fatigue in patients with hematologic malignancies. Methods: A search of PubMed, Embase, CINAHL, APA Psych INFO, Scopus, Cochrane, and non-traditional publications was performed in June 2021 for studies introducing coping interventions for adults with hematological cancers within the past 20 years. The Transactional Model of Stress and Coping was used as a framework with fatigue as the primary outcome. The Johns Hopkins Nursing Evidence Based Practice Appraisal tool was used for quality appraisal. Results: Twelve interventional studies met criteria for inclusion. Four studies significantly reduced fatigue, with an additional 3 showing a reduction in fatigue. Interventions that utilized both problem and emotion-focused coping were more effective at reducing fatigue compared to interventions that only used emotion or problem-focused coping. Conclusion: This systematic review found moderate-strength evidence to support that coping interventions can reduce fatigue, with mixed, but mostly beneficial results. Clinicians caring for patients with hematologic malignancies should consider using coping interventions to reduce fatigue.

Risk of fatigue with PARP inhibitors in cancer patients: a systematic review and meta-analysis of 29 phase II/III randomized controlled trials

Fatigue was a frequently reported adverse event associated with the use of PARP inhibitors. We performed a systematic review and meta-analysis to fully investigate the fatigue of PARP inhibitors in cancer patients. Databases were searched for randomized controlled trials (RCTs) treated with PARP inhibitors till July 2020. Twenty-nine RCTs and 9479 patients were included. This meta-analysis suggests that the use of PARP inhibitors significantly increase the risk of developing all-grade (RR, 1.25; 95%CI, 1.20-1.31; p < 0.00001; I2 = 48%) and high-grade fatigue (RR, 1.92; 95%CI, 1.51-2.45; p < 0.00001; I2 = 11%). Veliparib was associated with a relatively lower risk of fatigue. Patients with ovarian cancer tend to be associated with a higher risk of fatigue than those with non-ovarian cancer. Longer duration of therapy was associated with a higher risk of all-grade fatigue. Patients receiving PARP inhibitor monotherapy tends to be associated with a higher risk of all-grade fatigue than those receiving combination treatment.

Toxicity profile of epidermal growth factor receptor tyrosine kinase inhibitors for patients with lung cancer: A systematic review and network meta-analysis

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are treatments commonly used for lung cancer. The toxicity profile including toxicity incidence, severity, and spectrum (involving various specific adverse events) of each EGFR-TKI are of particular clinical interest and importance. Data from phase II and III randomized controlled trials comparing treatments among EGFR-TKIs (osimertinib, dacomitinib, afatinib, erlotinib, gefitinib, and icotinib) and chemotherapy for lung cancer were synthesized with Bayesian network meta-analysis. The primary outcome was systemic all-grade and grade ≥3 adverse events. The secondary outcome was specific all-grade adverse events including those of the skin, gastrointestinal tract, lung, etc. 40 trials randomizing 13,352 patients were included. Generally greater toxicity for dacomitinib and afatinib, and safety for icotinib were suggested. Furthermore, we found individual EGFR-TKIs had different toxicity spectrums. These findings provide a compelling safety reference for the individualized use of EGFR-TKIs for patients with lung cancer.

Prevalence and severity of long-term physical, emotional, and cognitive fatigue across 15 different cancer entities

Background

Fatigue prevalence and severity have been assessed in a variety of studies, yet, not in a standardized way, and predominantly in breast cancer patients. Systematic, comparative investigations across a broad range of cancer entities are lacking.

Methods

The FiX study systematically enrolled 2244 cancer patients across 15 entities approximately 2 years after diagnosis. Fatigue was assessed with the multidimensional EORTC QLQ‐FA12 questionnaire. Physical, emotional, cognitive, and total fatigue were compared across entities and with normative values of the general population. Differences in patients' characteristics and cancer therapy between entities were taken into account using analyses of covariance models.

Results

Across all entities, mean physical fatigue levels were significantly higher than age‐ and sex‐matched means of the general population for all cancer entities (all Bonferroni‐Holm adjusted P < .01). For most entities also emotional and cognitive fatigue levels were significantly higher than normative values. Age‐ and sex‐standardized physical fatigue prevalence ranged from 31.8% among prostate to 51.7% among liver cancer patients. Differences between entities could not be fully explained by sex, age, BMI, or cancer therapy. Adjusted for these factors, mean physical fatigue was higher for stomach (P = .0004), lung (P = .034), kidney (P = .0011), pancreas (P = .081), and endometrium (P = .022) compared to breast cancer patients. Adjusted means of emotional fatigue were also lowest in breast cancer patients and significantly higher in stomach (P = .0047), bladder (P = .0036), and rectal (P = .0020) cancer patients.

Conclusions

Physical, emotional, and cognitive fatigue is prevalent in all 15 investigated cancer entities even 2 years after diagnosis. Fatigue in breast cancer patients, the so‐far most studied group, is in the lowest range among all entities, suggesting that the extent of fatigue is still insufficiently determined. Entity‐specific problems might need to be considered in the treatment of fatigue.