Effectiveness comparisons of various psychosocial therapies for cancer-related fatigue: A Bayesian network meta-analysis.

OBJECTIVES: The purpose of this network meta-analysis (NMA) is to compare the effect of several psychosocial therapies on CRF critically. METHODS: We applied systematic strategies based on eight databases, namely the Cochrane Central Register of Controlled Trials, PubMed, Embase, PsycINFO, China Biology Medicine (CBM), Wan Fang database, VIP, and China National Knowledge Infrastructure (CNKI) database to preliminary literature retrieval to identify relevant randomized controlled trials (RCTs). Studies, including adult patients (≥18 years) diagnosed with cancer, were eligible regardless of cancer stage and current treatment. We carried out an expression analysis for comparing the efficacy of various psychosocial therapies using Bayesian NMA. A battery of analyses and assessments, such as conventional meta-analysis and risk of bias, were performed concurrently. RESULTS: We identified 41 RCTs including six different psychosocial interventions (4422 participants), namely cognitive-behavioral therapy (CBT), mindfulness-based stress reduction therapy (MBSR), psychoeducational therapy (PE), stress management therapy (SMT), meditation therapy (MT) and comprehensive therapy (CT). Our NMA results showed that three psychosocial intervention therapies were effective for CRF in cancer patients. The most effective psychosocial intervention was MBSR (SMD = -1.23, CrI: -1.88, -0.59, SUCRA = 83.33%), followed by PE (SMD = -0.86, CrI: -1.53, -0.18, SUCRA = 58.51%) and CBT (SMD = -0.84, CrI: -1.31, -0.37, SUCRA = 57.67%). CONCLUSIONS: Our study showed that MBSR was most likely to be the best psychosocial intervention to relieve CRF in cancer patients. Medical staff should pay attention to applying MBSR to cancer patients in future clinical care.

Gut microbiota from patients with arteriosclerotic CSVD induces higher IL-17A production in neutrophils via activating RORγt.

The intestinal microbiota shape the host immune system and influence the outcomes of various neurological disorders. Arteriosclerotic cerebral small vessel disease (aCSVD) is highly prevalent among the elderly with its pathological mechanisms yet is incompletely understood. The current study investigated the ecology of gut microbiota in patients with aCSVD, particularly its impact on the host immune system. We reported that the altered composition of gut microbiota was associated with undesirable disease outcomes and exacerbated inflammaging status. When exposed to the fecal bacterial extracts from a patient with aCSVD, human and mouse neutrophils were activated, and capacity of interleukin-17A (IL-17A) production was increased. Mechanistically, RORγt signaling in neutrophils was activated by aCSVD-associated gut bacterial extracts to up-regulate IL-17A production. Our findings revealed a previously unrecognized implication of the gut-immune-brain axis in aCSVD pathophysiology, with therapeutic implications.

Mindfulness-based stress reduction can alleviate cancer- related fatigue: A meta-analysis.

OBJECTIVES: The purpose of this meta-analysis was to critically evaluate the effects of mindfulness-based stress reduction (MBSR) on cancer-related fatigue (CRF). METHODS: A systematic search of eight databases (Web of Science, Pubmed, Cochrane Library, Spring link, CNKI, Wanfang, VIP, CBM) was performed, to find randomized controlled trials (RCTs) from inception to January 2019. Using Cochrane Collaboration criteria, two reviewers critically and independently assessed the risk of bias and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. RESULTS: In all, fifteen RCTs were included in the systematic review, fourteen of which, consisting of 3008 patients (MBSR, 1502; control, 1506), were included in the meta-analysis. MBSR had a significant effect on fatigue in cancer patients, particularly among lung cancer patients. The meta-analysis also indicated that MBSR could significantly mitigate CRF compared with usual care or no intervention. 8 weeks of MBSR, supervised by experts, had a large effect on CRF. CONCLUSIONS: MBSR is effective for CRF management and can be recommended as a beneficial complementary therapy for CRF patients.

Yoga has a solid effect on cancer-related fatigue in patients with breast cancer: a meta-analysis.

PURPOSE: This study was designed to critically evaluate the effect of yoga on cancer-related fatigue in patients with breast cancer. METHODS: Eight databases (Cochrane Library, PubMed, Ovid-Medline, Web of Science, CBM, Wanfang, VIP, and CNKI) were systematically reviewed from inception to January 2019 for randomized controlled trials (RCTs). Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. RESULTS: A total of 17 qualified studies that included 2183 patients (yoga: 1112, control: 1071) were included in the meta-analysis. Yoga had a large effect on fatigue in post-treatment breast cancer patients and had a small effect on intra-treatment patients. The meta-analysis also indicated that supervised yoga class had a significant effect on CRF; the six-week program had a moderate beneficial effect while the 60/90 min/session supervised yoga class and the eight-week program demonstrated a large effect on fatigue in patients with breast cancer. Yoga could markedly mitigate the physical fatigue in breast cancer patients, had a medium impact on cognitive fatigue, and manifested a small effect on mental fatigue. Eight studies reported the adverse events, whereas ten studies did not. CONCLUSIONS: Yoga can be considered as an alternative therapy for relieving fatigue in breast cancer patients who have completed treatment or are undergoing anti-cancer treatment.