Study Selection and Data Abstraction

Inclusion and exclusion criteria were defined a priori. Studies were included if participants were adults or children with cancer or recipients of hsct and if the study was a fully published primary randomized or quasi-randomized trial with a parallel-group design that evaluated a pharmacologic intervention for the management of fatigue.

Studies were excluded if fewer than 75% of the participants had cancer or were undergoing hsct, if fatigue was not an endpoint or was reported as an adverse effect, if the intervention was direct cancer treatment, and if fewer than 5 participants were randomized to any study arm. Inclusion was not restricted by language. For the purpose of the analysis, studies were limited to those using a systemically administered pharmacologic agent. Studies using non-systemically administered pharmacologic agents were excluded, as were studies in which only education or advice was provided.

Two reviewers (PDR and SO or LS) independently evaluated the titles and abstracts of publications identified by the search. Any publication considered potentially relevant by at least one reviewer was retrieved in full and assessed for eligibility. Inclusion of studies in this meta-analysis was determined by agreement of two reviewers (PDR and SO or LS). Discrepancies between the two reviewers were resolved by consensus and adjudication by a third reviewer if required (LLD or LS). The kappa statistic was used to evaluate agreement for study inclusion between the two reviewers. Strength of agreement was defined as slight (0.00–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80), or almost perfect (0.81–1.00) ²⁴.

Data were abstracted in duplicate by two reviewers (DT and PDR) and any discrepancies were resolved by consensus. We contacted authors of manuscripts when publications were missing data for the primary fatigue outcome.