Effectiveness of Non-pharmacological Interventions on Symptom Clusters in Cancer Patients: a Network Meta-analysis

Background The presence of symptom clusters is associated with poor treatment outcomes and decreased quality of life in patients with cancer, and holistic interventions for symptom clusters can improve the management efficiency. Numerous non-pharmacologic interventions are available for symptom clusters in patients with cancer, but there is disagreement as to which interventions is the most effective. Objective To explore and compare the effectiveness of different non-pharmacological interventions in reducing the severity of symptom clusters in cancer patients. Methods In September 2021, randomized controlled trials (RCTs) about non-pharmacological interventions in reducing the severity of symptom clusters in cancer patients were searched in SinoMed, CNKI, Wanfang Data, CQVIP, the Cochrane Library, PubMed, Web of Science and Wiley Online Library databases from inception to September 2021. Two researchers independently screened studies based on the inclusion and exclusion criteria, extracted data, and performed risk of bias assessment using the Cochrane handbook for systematic reviews of interventions (version 5.1.0) . RevMan 5.3 was adopted for heterogeneity test using a traditional method and publication bias analysis. Addis 16.6 was used to make a network meta-analysis. Results Twelve RCTs were finally included, involving 1 116 cases, and eight non-pharmacologic interventions: cognitive behavior intervention, mindfulness-based stress reduction, acupoint massage, multiple-modality exercise, exercise and health counseling, auricular point sticking therapy, narrative nursing, and attention control. Network meta-analysis results showed that, for reducing the severity of symptom clusters in cancer patients, acupoint massage was superior to interventions other than mindfulness-based stress reduction, mindfulness-based stress reduction was superior to usual care and narrative nursing, and cognitive behavioral intervention was superior to multiple-modality exercise, usual care and narrative nursing (Pmindfulness-based stress reduction>cognitive behavior intervention>auricular point sticking therapy/attention control>multiple-modality exercise>usual care>narrative nursing>exercise and health counseling. Conclusion Based on the results of network meta-analysis and probability ranking, acupoint massage was recommended as the clinical priority non-pharmacological intervention to alleviate the severity of symptom clusters in cancer patients, followed by mindfulness-based stress reduction. In the future, high-quality, large-sample, multicenter, double-blind RCTs are needed to further validate the effects of different non-pharmacological interventions on improving symptom clusters in cancer patients, and to provide more reliable evidence for supporting the development of interventions for symptom clusters in these patients.