Fatigue

Mindfulness

Efficacy
Mindfulness-based stress reduction (MBSR): The available evidence suggests that MBSR is effective for fatigue. Six out of seven SRs (including 7 to 29 mixed-design studies) and two additional RCTs (n= 33, n=92) found that MBSR improves fatigue. 

Safety
Mindfulness-based approaches are generally considered safe in supportive cancer care. However, no rigorous assessment of the safety of mindfulness-based approaches in cancer patients is available.

Read the full version of the Mindfulness summary.

Music interventions

Efficacy
The evidence suggests music therapy and music medicine to be effective on fatigue. In an overview of five SRs (including 3 to 9 RCTs) assessing cancer-related fatigue, four SRs indicated that combining music-based interventions with usual or standard care could yield more benefits than control interventions; one SR reported no improvements.

Safety
Generally considered safe with no safety issues on record.
Caution is advised for acutely distressed and/or emotionally fragile patients, particularly in patients with serious and life-threatening cancers.

Read the full version of the Music intervention summary.

Tai chi

Efficacy
The available evidence suggests tai chi to be effective for fatigue. Two SRs (n=6 RCTs, n=26 mixed-design studies) concluded that fatigue positively affects short-term fatigue. An RCT (n=83) not included in the SRs also found positive effects on fatigue, the results need to be interpreted with caution as the study had many limitations. 

Safety
Generally considered safe when administered by a qualified practitioner. 
As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties.

Read the full version of the Tai chi summary.

Yoga

Efficacy
Breast cancer: The available evidence suggests yoga to be effective on fatigue short- and medium- term among cancer patients. The conclusion is reached from the results of six SRs (including 7 to 24 RCTs).

Safety
Generally considered safe when administered by a qualified practitioner. Few adverse events are reported in clinical trials, and serious adverse effects appear to be rare. Overall, injury rates are comparable to other exercise types.

Read the full version of the Yoga summary.

Acupuncture

Efficacy
The available evidence is contradictory on the effect of acupuncture on fatigue. The evidence derives from eleven SRs including seven to 20 RCTs, and a network meta-analysis. Five of the SRs found acupuncture improved fatigue. Another six SRs found inconclusive or non-significant results. Four RCTs were conducted after the SR, but they do not significantly add to the evidence of the systematic reviews. 

Safety
Generally safe when administered by a professional qualified practitioner.  Mild adverse effects, such as pain or bleeding at the acupuncture site, can be expected in 10% of all cases. Serious complications seem to be very rare. 

Read the full version of the Acupuncture for fatigue summary. 

Astralagus spp

Efficacy
The evidence is contradictory on the effect of Astralagus spp on fatigue. The results are based on three RCTs (n=17, n=84, n=310). All RCTs showed a trend of fatigue improvement; the only one (n=84) showing a significant difference conducted an open-label cycle, which limits the findings. 

Safety
Generally safe and only associated with minimal adverse effects when used in appropriate dilutions. 
Allergic reactions can occur with all oils. Should not be used undiluted.

Read the full version of the Astragalus spp summary. 

Biofeedback

Efficacy
The evidence for the effects of biofeedback on fatigue are of low methodological quality. A SR (n=6 mixed design study) found neurofeedback to be helpful in alleviating fatigue; however, no meta-analysis was conducted, and a summary of the effects was not provided.
 
Safety
Biofeedback is generally considered safe, and no adverse events have been reported in the included studies. Some concern for individuals with a history of psychiatric illness. 

Read the full version of the Biofeedback summary.

Ginseng spp

Efficacy
The evidence is contradictory on the effect of ginseng on fatigue. Ten RCTs have been conducted ranging from 20 - 346 participants. Four of the RCTs found significant results that showed ginseng helps lower fatigue. Six RCTs found no significant differences or were limited by poor study quality.  

Safety
Generally considered safe, with only minor adverse drug reactions reported. Mainly gastrointestinal intolerances, headaches, and sleep disorders have been reported. These are dose-dependent, infrequent, and transient. 

Read the full version of the Ginseng spp summary.

Homeopathy

Efficacy
Only few data are available. One RCT (n=200) found significantly lower levels of fatigue among patients receiving hypnotherapy and chemotherapy-based treatment. 

Safety
Generally considered safe when administered by qualified professionals. Contraindications include acute psychoses, severe personality disorders, and an inability to be hypnotized.

Read the full version of the Hypnotherapy summary. 

L-Carnitine

Efficacy
The evidence is contradictory on the effect of L-Carnitine on fatigue. Four RCTs (ranging from 29 to 409 participants) found no significant effect. However, three quasi-experimental studies (n=27, n=12, n=50) found that L-Carnitine decreases fatigue.  

Safety
Generally considered safe when administered by qualified professionals. Contraindications include acute psychoses, severe personality disorders, and an inability to be hypnotized.

Read the full version of the L-carnitine summary.

Massage (Classical/Swedish)

Efficacy
The evidence is contradictory on the effect of massage on fatigue. Five SRs have been conducted, ranging from five to 16 RCTs.  Two SRs (n= 5 RCTs, n= 5 RCTs) found that massage significantly reduced fatigue.  The three remaining SRs (n=7, n=8, n=16) found conflicting, non-significant, or insufficient evidence of the effects of massage on fatigue. 

Safety
Generally considered safe when administered by a qualified professional. Contraindications include strong, forceful massage in patients suffering from haemorrhagic disorders, low platelet counts, and blood thinning medication.

Read the full version of the Massage summary.

Mindfulness

Efficacy
Mindfulness-based cognitive therapy (MBCT): only few data are available for the effects of MBCT on fatigue. Three RCTs (n=40, n=74, n=100) have evaluated the effect of MBCT on fatigue; two found that MBCT reduces fatigue, the third RCT found no effect of MBCT. 

Safety
Mindfulness-based approaches are generally considered to be safe in supportive cancer care. However, no rigorous assessment of the safety of mindfulness-based approaches in cancer patients is available.

Read the full version of the Mindfulness summary.

Mistletoe

Efficacy
The evidence is inconclusive on the effect of mistletoe on cancer-related fatigue. Mistletoe has a moderate effect on CrF but risk of bias and heterogeneity were high in most studies. The evidence is based on the most recent and comprehensive SR, which included one meta-analysis of twelve RCTs and one of seven retrospective non-randomized studies.   

Safety
Mistletoe is generally considered safe with only transient and mild adverse effects. 
Common adverse events include soreness and inflammation at injection sites, headache, fever and chills.

Read the full version of the Mistletoe summary. 

Qigong

Efficacy
The evidence is inconclusive on the effect of qigong on fatigue. Three SRs (n=11 RCTs, n=15 RCTs, n=22 mixed-design studies) suggests qigong reduces fatigue, however one of the SRs had no distinction between qigong and tai-chi. Three further SRs (n=4 RCTs, n=11 RCTs, n=14 RCTs) also reported reduction on fatigue but were low-quality evidence. Lastly, one SR and one RCT One SR (22 CTs) concluded that qigong had no effect on fatigue.

Safety
Generally considered safe when administered by a qualified practitioner. 
As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties.

Read the full version of the Qigong summary.

Reflexology

Efficacy 
The evidence on the effects of reflexology on fatigue is limited by methodological shortcomings. One SR (n=6 mixed-design studies) found there is not enough high-level evidence to conclude effect. Six studies not included in the SR also evaluated the effect of reflexology on fatigue. Four RCTs (with 57-80 participants) found significant differences in reduced fatigue but two were of poor quality. Lastly, two studies had quasi experimental design (n=72, n=347 dyads) one found positive effect on fatigue and the other one found no effect.  

Safety
Generally considered safe when administered by a qualified practitioner. 

Read the full version of the Reflexology summary.

Therapeutic touch

Efficacy 
Only few trial data are available. TT may reduce fatigue, but the findings from one RCT (n=90) are limited by methodological shortcomings.

Safety
Generally considered safe when administered by a qualified practitioner, no serious safety concerns are known.

Read the full version of the Therapeutic touch summary.

Yoga

Efficacy
The evidence for effects of yoga on fatigue is contradictory. Three RCTs (n=68, n=97, n=358) found significant small/moderate effect, and three RCTs (n=39, n=52, n=70) found no significant effect of yoga on fatigue. 

Safety
Generally considered safe when administered by a qualified practitioner. Few adverse events are reported in clinical trials, and serious adverse effects appear to be rare. Overall, injury rates are comparable to other exercise types.

Read the full version of the Yoga summary.

Aromatherapy

Efficacy
The available evidence suggests aromatherapy is not effective for fatigue. The results are based on two SRs (n=19 mixed study design, n=43 mixed study design) and one additional RCT (n=57). 

Safety
Generally safe and only associated with minimal adverse effects when used in appropriate dilutions. 
Allergic reactions can occur with all oils. Should not be used undiluted.

Read the full version of the Aromatherapy summary. 

Coenzyme Q10

Efficacy
The evidence suggests coenzyme not to be effective for fatigue. In breast cancer patients (n=236), CoQ10 did not reduce fatigue compared with placebo. A further RCT of breast cancer patients (n=59) using a combination product including CoQ10 also reported no significant effect on average feeling of fatigue but significant reductions of the worst level of fatigue.

Safety
Generally well tolerated when taken in appropriate doses as a dietary supplement. One observational study reported a non-significantly increased hazard of breast cancer recurrence. 

Read the full version of the Coenzyme Q10 summary.

Progressive Muscle Relaxation

Efficacy
The evidence suggests progressive muscle relaxation not to be effective on fatigue. One SR (n=12 RCTs) and two RCTs (n=30, n=50) found no effect of on fatigue. Two RCTs (n=60, n=63) reported significant reduction on fatigue.  

Safety
Generally considered safe when administered by a qualified practitioner. 
Some concerns have been raised about the use of relaxation therapy interventions among individuals who have a history of psychiatric disorders.

Read the full version of the Progressive Muscle Relaxation summary.

Reiki

Efficacy
The available evidence of reiki on fatigue is of low methodological quality. One CCT (n=18) found a reductio in fatigue, but the study had poor methodological quality. A critical review (n=8 mixed-design studies) identified studies that reported reduced fatigue but concluded that they had poor methodological quality, and no conclusions could be made. 

Safety
Generally considered safe when administered by a qualified practitioner.  

Read the full version of the Reiki summary.