Efficacy of different non-pharmacological therapies on cancer-related fatigue in breast cancer patients: a network meta-analysis.

Cancer-related fatigue (CRF) is a highly prevalent and debilitating symptom among breast cancer patients, yet optimal non-pharmacological management strategies remain uncertain. We aimed to compare the relative efficacy of various non-pharmacological interventions for alleviating CRF in this population through a systematic review and network meta-analysis (NMA). We systematically searched PubMed, EMBASE, Web of Science, CINAHL, and CENTRAL from inception to June 2025 for randomized controlled trials (RCTs). Studies were included if they evaluated any non-pharmacological intervention for CRF in adult women with breast cancer. A frequentist random-effects NMA was conducted, and interventions were ranked using the Surface Under the Cumulative Ranking Curve (SUCRA). The primary outcome was CRF severity measured by validated scales. Twenty-six RCTs involving 2,811 patients were included, evaluating 21 distinct interventions. The network demonstrated good connectivity and no significant inconsistency (P > 0.05 for both global and local tests). Tai Chi Chih (TCC) was ranked as the most effective intervention (SUCRA = 99.1%), followed by cognitive behavioral therapy (CBT; SUCRA = 92.0%) and massage therapy (MT; SUCRA = 90.6%). Compared with usual care, all three showed large and statistically significant reductions in fatigue: TCC (SMD = -4.61, 95% CI: -6.20 to -3.02), CBT (SMD = -3.63, 95% CI: -4.87 to -2.40), and MT (SMD = -3.43, 95% CI: -4.66 to -2.20). Health education ranked lowest among active interventions (SUCRA = 19.4%). The funnel plot indicated no significant publication bias. This comprehensive NMA identifies Tai Chi Chih, cognitive behavioral therapy, and massage therapy as the most effective non-pharmacological strategies for reducing cancer-related fatigue in breast cancer patients. These findings provide robust evidence to prioritize these mind-body, psychological, and somatic approaches in clinical practice and supportive care guidelines. The study was registered at PROSPERO on 5 February 2025 (CRD42025642351).