Changes in fatigue in rectal cancer patients before and after therapy: a systematic review and meta-analysis

Purpose: Fatigue is a common problem among rectal cancer patients and can affect their quality of life. This study conducted a systematic review to better understand changes in fatigue severity in rectal cancer patients before, during, and after they undergo therapy. Methods: We used preset keywords to search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and ProQuest databases for relevant studies published between 2000 and 2018, and data analysis was performed using Comprehensive Meta-Analysis (CMA) software (version 2.2.048) and SPSS software (version 19.0). In total, nine articles with complete data were included in our meta-analysis. Results: Fatigue conditions were compared before the start of therapy (baseline) and at 1 month (time 1), 3 months (time 2), 6 months (time 3), and 12 months (time 4) after the start of therapy. The standardized mean differences (SMDs) of the pooling effects size were 1.013 (95% confidence interval (CI) 0.217–1.810), − 0.551 (95% CI − 0.647 to − 0.456), − 0.330 (95% CI − 0.427 to − 0.233), and − 0.149 (95% CI − 0.221 to − 0.078), respectively. Subsequent analysis with a linear mixed effect model revealed that the estimate of the time variable was − 0.226 (p = 0.047), which indicates that the severity of fatigue varies over time and over the course of treatment. The results reveal that fatigue affects rectal cancer patients even before they start therapy. Conclusion: Although fatigue worsened during the first month after cancer therapy, it gradually improved thereafter.