Efficacy of traditional Chinese medicine external therapy on cancer-related fatigue: a systematic review and network meta-analysis

Objectives: The purpose of this network meta-analysis was to compare and evaluate the effectiveness of several traditional Chinese medicine (TCM) external therapies in reducing cancer-related fatigue(CRF). Methods: A search of eight databases was conducted to obtain randomized controlled trials (RCTs) on different external therapies of traditional Chinese medicine for alleviating CRF. The Cochrane ROB 2.0 tool was used to assess the included studies' bias risk. Network meta-analysis and comparative effect ranking were conducted using STATA MP 17.0. The primary outcome was the CRF score. Standardized mean difference (SMD) and 95% confidence interval (95% CI) were used to calculate the effect size. The Confidence in Network Meta-Analysis (CINeMA) tool was used to assess the certainty of the evidence. Results: The systematic review included eighty-seven RCTs covering 13 different external therapies. Among the treatments studied, acupuncture, acupressure, traditional Chinese exercises, transcutaneous acupoint electrical stimulation, moxibustion, Chinese medicine foot bath, traditional Chinese medicine (TCM)emotional care, acupoint injection, acupoint application, warming needle were demonstrated to be effective in alleviating CRF in comparison to usual care. The surface under cumulative ranking curve (SUCRA) indicated that warming needle was most effective in relieving CRF, followed by Chinese medicine foot bath, TCM emotional care, acupoint injections, moxibustion, etc. Conclusions: This review indicated that warming needle might be the most effective traditional Chinese medicine external therapy for treating CRF. But, the low certainty of evidence (assessed via CINeMA) must be emphasized in this low confidence means the results should be interpreted with great caution. Further validation is required through additional clinical trials. These findings provide significant support for future research and clinical trials. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023479194.