Advances in assessment systems and non-pharmacological intervention strategies for cancer-related fatigue following transarterial chemoembolization in hepatocellular carcinoma: a narrative review.
5 affiliations
- 1Department of Nursing, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. [email protected].
- 2Department of Nursing, Changhai Hospital, First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
- 3Shanghai Songjiang Sijing Hospital, Shanghai, 201601, China.
- 4Department of Nursing, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- 5Department of Nursing, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. [email protected].
Abstract
Purpose
Transarterial chemoembolization (TACE) is a primary treatment for intermediate to advanced hepatocellular carcinoma (HCC); however, cancer-related fatigue (CRF) is a prevalent and distressing symptom following TACE that significantly impairs patients' recovery and health-related quality of life. This review aimed to systematically summarize the current evidence on CRF screening, assessment, and non-pharmacological interventions specifically tailored to the post-TACE HCC population, and to propose an integrated, nurse-led clinical management framework.Methods
A narrative review was conducted by systematically searching PubMed, Web of Science, and CNKI for literature published up to April 2026. The search encompassed peer-reviewed original research articles (including randomized controlled trials, cohort studies, cross-sectional studies, and meta-analyses), clinical practice guidelines, and expert consensus reports. The level of evidence for each intervention category was evaluated using the Oxford Centre for Evidence-Based Medicine (OCEBM) grading system. The literature search focused on CRF epidemiology, pathophysiology, validated assessment tools, non-pharmacological interventions (including exercise, psychosocial support, nutritional management, and traditional Chinese medicine therapies), and nursing management models in HCC patients following TACE.Results
CRF following TACE is a multifactorial symptom driven by treatment-induced inflammation, hepatic dysfunction, and psychological distress. Validated screening tools, including the Brief Fatigue Inventory (BFI), Cancer Fatigue Scale (CFS), and EORTC QLQ-C30 fatigue subscale, are recommended for routine use, though to the best of our knowledge, no CRF assessment tool developed specifically for the post-TACE HCC population has been validated to date. A structured screening pathway encompassing baseline assessment, perioperative monitoring, and long-term follow-up was identified as essential for early detection. Among non-pharmacological interventions, individualized exercise prescriptions (aerobic and resistance training) have been most consistently supported across randomised trials and meta-analyses for alleviating CRF, followed by cognitive behavioral therapy, mindfulness-based stress reduction, and nutritional support. Traditional Chinese medicine approaches, including acupoint massage, auricular acupressure, and moxibustion, showed preliminary potential but require further high-quality validation. A nurse-led multidisciplinary care model integrating assessment, individualized intervention planning, and continuous coordination has been proposed as a promising operational framework for CRF management, endorsed by international CRF practice frameworks.Conclusions
Effective management of CRF after TACE requires a comprehensive, evidence-based approach spanning standardized screening, multimodal non-pharmacological interventions, and a nurse-coordinated multidisciplinary care model. Integrating routine CRF assessment into standard TACE clinical pathways and developing TACE-specific assessment tools are priorities for future research and clinical practice.
Related
- Case Report: Rapidly fatal hepatic portal venous gas following transarterial chemoembolization for hepatocellular carcinoma
- Enhanced Efficacy of Thalidomide‐Based Cocktail With Transarterial Chemoembolization in the Management of Unresectable Hepatocellular Carcinoma: A Multi‐Center Cohort Study
- Lesion selection and external evaluation of clinical-imaging survival models after transarterial chemoembolization for hepatocellular carcinoma
- Transarterial Radioembolization Versus Chemoembolization for Unresectable Large Single Hepatocellular Carcinoma.
- Efficacy and safety of sintilimab plus bevacizumab with or without transarterial chemoembolization for unresectable hepatocellular carcinoma: a propensity score-matched retrospective cohort study
BibTeX
@article{yang2026advances,
title = {{Advances in assessment systems and non-pharmacological intervention strategies for cancer-related fatigue following transarterial chemoembolization in hepatocellular carcinoma: a narrative review.}},
author = {Shiying Yang and Xuelei Yao and Yali Ren and Teng Ding and Jiamin Gao and Lin Shentu},
journal = {Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer},
year = {2026},
month = oct,
doi = {10.1007/s00520-026-11380-9},
url = {https://europepmc.org/article/MED/42909630},
note = {CC BY},
}
RIS
TY - JOUR
TI - Advances in assessment systems and non-pharmacological intervention strategies for cancer-related fatigue following transarterial chemoembolization in hepatocellular carcinoma: a narrative review.
AU - Shiying Yang
AU - Xuelei Yao
AU - Yali Ren
AU - Teng Ding
AU - Jiamin Gao
AU - Lin Shentu
PY - 2026
DA - 2026/10/23
JO - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
DO - 10.1007/s00520-026-11380-9
UR - https://europepmc.org/article/MED/42909630
AB - Purpose Transarterial chemoembolization (TACE) is a primary treatment for intermediate to advanced hepatocellular carcinoma (HCC); however, cancer-related fatigue (CRF) is a prevalent and distressing symptom following TACE that significantly impairs patients' recovery and health-related quality of life. This review aimed to systematically summarize the current evidence on CRF screening, assessment, and non-pharmacological interventions specifically tailored to the post-TACE HCC population, and to propose an integrated, nurse-led clinical management framework.Methods A narrative review was conducted by systematically searching PubMed, Web of Science, and CNKI for literature published up to April 2026. The search encompassed peer-reviewed original research articles (including randomized controlled trials, cohort studies, cross-sectional studies, and meta-analyses), clinical practice guidelines, and expert consensus reports. The level of evidence for each intervention category was evaluated using the Oxford Centre for Evidence-Based Medicine (OCEBM) grading system. The literature search focused on CRF epidemiology, pathophysiology, validated assessment tools, non-pharmacological interventions (including exercise, psychosocial support, nutritional management, and traditional Chinese medicine therapies), and nursing management models in HCC patients following TACE.Results CRF following TACE is a multifactorial symptom driven by treatment-induced inflammation, hepatic dysfunction, and psychological distress. Validated screening tools, including the Brief Fatigue Inventory (BFI), Cancer Fatigue Scale (CFS), and EORTC QLQ-C30 fatigue subscale, are recommended for routine use, though to the best of our knowledge, no CRF assessment tool developed specifically for the post-TACE HCC population has been validated to date. A structured screening pathway encompassing baseline assessment, perioperative monitoring, and long-term follow-up was identified as essential for early detection. Among non-pharmacological interventions, individualized exercise prescriptions (aerobic and resistance training) have been most consistently supported across randomised trials and meta-analyses for alleviating CRF, followed by cognitive behavioral therapy, mindfulness-based stress reduction, and nutritional support. Traditional Chinese medicine approaches, including acupoint massage, auricular acupressure, and moxibustion, showed preliminary potential but require further high-quality validation. A nurse-led multidisciplinary care model integrating assessment, individualized intervention planning, and continuous coordination has been proposed as a promising operational framework for CRF management, endorsed by international CRF practice frameworks.Conclusions Effective management of CRF after TACE requires a comprehensive, evidence-based approach spanning standardized screening, multimodal non-pharmacological interventions, and a nurse-coordinated multidisciplinary care model. Integrating routine CRF assessment into standard TACE clinical pathways and developing TACE-specific assessment tools are priorities for future research and clinical practice.
SN - 0941-4355
SN - 1433-7339
ER -