Table 2.
Summary of findings: modified due to study types. Patients or population: patients with incurable cancer. Settings: outpatient. Intervention: multi-modal rehabilitation programmes comprising exercise and nutritional elements. Comparison: where available-standard care
| Patient- important outcomes | Studies | N = total participants* (breakdown per outcome measure) | Quality of the body of evidence (GRADE) | Comments |
|---|---|---|---|---|
| Quality of life | 3 [22, 23, 26] |
N = 214 129 (ESAS) 41 (EQ-VAS) 44 (EORTC C30) |
Low (C) | Two moderate quality studies with conflicting results, one low-quality study showing improvement, studies have limitations and inconsistencies in outcome variables. |
| Overall function | 2 [25, 28] |
N = 81 56 (ECOG PS) 25 (KPS) |
Very low (D) | Two studies with low and very low-quality examined changes in functional status scores, one finding significant and one non-significant improvements. Sparse data with limitations. |
| Fatigue | 4 [22, 24, 26, 28] |
N = 203 22 (BFI) 137 (MDFI) 44 (EORTC QLQ-C30) |
Low (C) | Two low, one very low-quality studies with limitations showing significant improvements in fatigue in spite of sparse data, and one high-quality (underpowered) study showing non-significant improvements in intervention group compared to control |
| Physical endurance/strength | 6 [22, 24–28] |
N = 342 6MWT (342) HGS (64 within two of the above studies) |
Moderate (B) | Six studies with quality overall low quality, with limitations: variable consistency in significance levels but overall magnitude of effect seen was improvement in spite of low statistical power of studies: GRADE of evidence increased (+2) |
| Depression | 6 [1, 23, 24, 26–28] |
N = 371 211 (ESAS) 124 (HADS) 36 (SCNS-LF59) |
Moderate (B) | Overall low-quality studies with limitations but GRADE of evidence increased (+2) due to studies all showing consistent significant improvements in depression/psychological subscales. |
| Nutrition/weight | 5 [24, 26, 28] |
N = 285 107 (PG-SGA) 178 (weight) |
Very low (D) | Five studies of overall low quality with serious limitations and indirectness (variable interventions). Two low-quality/very low–quality studies showed improved PG-SGA scores but the highest quality RCT showed only significant increases in protein intake. Evidence not strong enough to be upgraded. |
*Total participants include numbers actually analysed within studies for each outcome as opposed to Table 1 showing ‘N’ as numbers enrolled into each trial