Assessing the efficacy and safety of traditional Chinese medicine for cancer-related fatigue in lung cancer patients: A comprehensive meta-analysis of randomized controlled trials

Cancer-related fatigue (CRF) is a persistent condition that significantly impacts the health of lung oncology patients. While the conventional and non-pharmacological therapy for CRF remain uncertain, traditional Chinese medicine (TCM) has become a trending option. This study aimed to assess the efficacy and safety of TCM for CRF in lung cancer from randomized controlled trials (RCTs). According to PRISMA guidelines, seven databases were searched up to 30 June 2024. Only TCM interventions were eligible in this review. Meta-analysis and network meta-analysis (NMA) were designed to pool outcomes results and compared various TCM interventions. The CONSORT-CHM and Risk of Bias tool were used to evaluate the quality and potential biases. This review included 41 RCTs. Compared with the routine treatment (RT), TCM + RT had significant improved efficacy rate (Risk Ratio (RR) = 1.333, 95 % Confidence Intervals (CI): 1.227 to 1.448, P < 0.01), Karnofsky Performance Status scores (KPS) (Mean Difference (MD) = 7.182, 95 % CI: 4.160 to 10.203, P < 0.01) and Quality of Life Questionnaires-C30 scores (QLQ-30) (MD = 9.186, 95 % CI: 6.707 to 11.665, P < 0.01). Also, TCM + RT showed significance in reducing Piper Fatigue Scale scores (PFS) (MD = -1.145, 95 % CI: -1.452 to -0.838, P < 0.01), Cancer-Fatigue Scale scores (MD = -6.411; 95 %CI: -8.837 to -3.985; P < 0.01) and Brief Fatigue Inventory scores (MD = -1.687; 95 %CI: -2.350 to -1.023; P < 0.01). From NMA results, Jianpi Yiqi Huatan Formula + RT was the best for improving efficacy rate, Kangai Injection + RT excelled in reducing PFS scores and enhancing QLQ-C30 scores, and Aidi Injection + RT was the most effective in elevating KPS scores. No serious adverse events were reported. However, poor RCTs quality and uncertain bias risk were common in this study. Our study showed that TCM was effective and safe for CRF in lung cancer. However, given the poor quality and uncertain risk of bias, the results should be interpreted cautiously. More standardized RCTs are needed in the future.