Abstract
Cancer-related fatigue is a common and distressing symptom among patients undergoing radiotherapy, affecting physical function, psychological well-being, treatment adherence, and quality of life. Nursing teams are well positioned to deliver and reinforce nonpharmacological strategies, including exercise, self-management education, cognitive-behavioral support, mind-body approaches, and rehabilitation. This systematic review and meta-analysis evaluated the effectiveness of nursing-led or nursing-implementable nonpharmacological interventions in reducing fatigue among adult cancer patients receiving radiotherapy or adjuvant treatment including radiotherapy. A PRISMA-guided review was conducted using a PICOS framework. Searches were designed for PubMed/MEDLINE, Embase, Cochrane CENTRAL, ProQuest, and Scopus. Eligible studies were randomized or controlled clinical trials involving adult cancer patients, validated fatigue outcomes, relevant nonpharmacological interventions, and usual-care or attention-control comparators. Standardized mean differences (SMDs) with 95% confidence intervals were synthesized using random-effects models. Twelve trials were included in qualitative synthesis, and six trials with extractable multidimensional fatigue data were included in meta-analysis. At 3 months, interventions significantly reduced overall multidimensional fatigue (SMD -0.30, 95% CI -0.44 to -0.17), general fatigue (SMD -0.33, 95% CI -0.58 to -0.07), and physical fatigue (SMD -0.31, 95% CI -0.51 to -0.10). At 6 months, the overall effect remained significant (SMD -0.29, 95% CI -0.45 to -0.12), with additional benefits for general, affective, and cognitive fatigue. Nursing-implementable interventions, particularly supervised, tailored, and education-reinforced exercise or rehabilitation programs, appear effective in reducing radiotherapy-associated fatigue. However, evidence certainty is limited by heterogeneity, risk of bias, and the scarcity of radiotherapy-specific nurse-led trials.
