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Eur J Cancer Care (Engl). 2016 Nov;25(6):921-935. doi: 10.1111/ecc.12381. Epub 2015 Sep 16.

Non-pharmacological interventions to manage fatigue and psychological stress in children and adolescents with cancer: an integrative review.

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University of São Paulo at Ribeirão Preto College of Nursing - USP, WHO Collaborating Centre for the Development of Nursing Research, Ribeirão Preto, SP, Brazil.
University of Saskatchewan at College of Medicine - UOfS, Saskatoon, SK, Canada.
Department Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing - USP, Ribeirão Preto, SP, Brazil.
Rio de Janeiro State University, College of Nursing - UERJ, Rio de Janeiro, RJ, Brazil.


Cancer-related fatigue (CRF) is the most stressful and prevalent symptom in paediatric oncology patients. This integrative review aimed to identify, analyse and synthesise the evidence of non-pharmacological intervention studies to manage fatigue and psychological stress in a paediatric population with cancer. Eight electronic databases were used for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and the Cochrane Library. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts and the full articles, a final sample of nine articles was obtained. The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises. It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRF and psychological stress.


cancer-related fatigue; non-pharmacological intervention; paediatric oncology; psychological stress; symptom management

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