Cancer-related fatigue (CRF) is a frequent and debilitating symptom among patients with lung cancer, with substantial adverse effects on physical function and quality of life. The symptom is recognized as a major determinant of posttreatment health-related quality of life in lung cancer populations and is a common clinical target for supportive interventions.
The review aimed to compare the relative effects of different Traditional Chinese Medicine (TCM)-based non-pharmacological therapies for reducing CRF in patients with lung cancer. The focus was on evaluating randomized controlled trial (RCT) evidence and producing a comparative ranking of multiple TCM interventions using network meta-analysis.
The authors searched eight electronic databases from inception through 24 November 2025 to identify RCTs assessing TCM-based non-pharmacological therapies for CRF in lung cancer. Included trials were assessed for methodological quality using the Cochrane Risk of Bias 2.0 tool. Details on individual trial selection criteria and the full search strategy are reported in the source article.
A network meta-analysis was conducted to synthesize direct and indirect comparisons across multiple interventions. Statistical analyses were performed using STATA 18.0. The network meta-analytic framework enabled estimation of standardized mean differences (SMDs) with 95% confidence intervals (CIs) to compare therapies against usual care and against each other.
The analysis included 32 RCTs encompassing eight distinct TCM-based non-pharmacological therapies. The source lists these therapies collectively; the network compared each therapy against usual care and within the network structure to derive relative effect estimates.
The network meta-analysis identified moxibustion as the most effective therapy in improving CRF compared with usual care, with a pooled effect size of SMD = -2.56 (95% CI -3.60 to -1.51).
Auricular acupressure also demonstrated a statistically significant benefit versus usual care (SMD = -1.82, 95% CI -3.61 to -0.03).
In head-to-head comparisons within the network, moxibustion was significantly more effective than qigong (SMD = -2.12, 95% CI -3.58 to -0.65).
The analysis found that qigong appeared less effective than several other TCM-based non-pharmacological therapies evaluated in the network.
These effect estimates are reported as standardized mean differences, reflecting pooled continuous outcomes for fatigue measures across trials.
The authors report a considerable risk of bias across the included RCTs based on the Cochrane Risk of Bias 2.0 assessment. This elevated risk of bias limits confidence in the magnitude and robustness of the pooled effects. Specific sources of bias in included trials are not enumerated in the abstract but are highlighted as an important caveat to interpreting the results.
Based on current evidence from the included RCTs and network meta-analysis, moxibustion and auricular acupressure emerged as the most promising TCM-based non-pharmacological therapies for alleviating CRF in lung cancer patients. The authors note that qigong appeared to have less benefit in this dataset.
However, because many trials exhibited notable risk of bias, the authors emphasize that these findings should be considered preliminary. Confirmation through well-designed, high-quality randomized trials is necessary before strong clinical recommendations can be made.
The principal limitation reported is the considerable risk of bias across included studies, which constrains certainty in effect estimates and clinical applicability. The authors call for further rigorously designed RCTs to validate the comparative efficacy of TCM-based non-pharmacological interventions for CRF in lung cancer. Future studies should address methodological quality issues, standardize fatigue outcome measures, and report harms and adherence data to enable more definitive guidance.
This systematic review and network meta-analysis synthesized evidence from 32 RCTs to compare eight TCM-based non-pharmacological therapies for cancer-related fatigue in lung cancer. Using STATA 18.0 and the Cochrane Risk of Bias 2.0 tool, the analysis found that moxibustion and auricular acupressure significantly reduced fatigue compared with usual care, with moxibustion also outperforming qigong. Given the overall risk of bias in the included trials, these conclusions are provisional and highlight the need for higher-quality clinical trials to confirm the most effective non-pharmacological TCM approaches for CRF in this population.