Melatonin for alleviating cancer-related fatigue in cancer patients.

Abstract

e24047 Background: Cancer-related fatigue is a common symptom among patients with cancer and is debilitating, significantly impacting their quality of life. Melatonin, commonly used to manage insomnia, has been proposed as a potential therapeutic agent to relieve fatigue symptoms in cancer patients. Methods: A systematic search was conducted across EMBASE, PubMed, Web of Science, and Cochrane databases to identify randomized controlled trials (RCTs) that evaluated the effects of melatonin compared to placebo on cancer-related fatigue in patients with cancer. Data were pooled using a random-effects model and the standard mean difference (SMD) with 95% CIs was used in the computation of fatigue scores. Data were collected in Excel and analyzed using Review Manager software 5.4.1. Results: Study comprised of 1,222 cancer patients from Seven RCTs . Of these, 615 patients were in the melatonin group and 607 in the placebo group. The dose of melatonin was 18 mg or 20 mg in most studies, with follow-up periods ranging from 2 weeks to 3 years across studies. The pooled analysis demonstrated effect of melatonin over placebo to be boderline statistically significant , with a standard mean difference (SMD) of -0.31 (-0.50, -0.00; p = 0.05; I² = 78%). Subgroup analysis focusing on breast cancer patients, including 212 patients in the melatonin group and 205 in the placebo group, showed an SMD of -0.45 (-0.95, 0.05), nearing statistical significance (p = 0.08; I² = 82%). Conclusions: Melatonin demonstrates some potential in reducing cancer-related fatigue across different types of cancer, showing a favorable effect compared to placebo. While these results are promising, further research with larger, more homogenous populations is necessary to validate these findings and better understand the factors contributing to heterogeneity. Standard mean of difference (SMD) of fatigue score between different RCTs. Study Melatonin Mean (SD) Placebo Mean (SD) Total melatonin Total placebo Weight (%) Std. Mean Difference (95% CI) Hansen et al 2014 306.17 (226.88) 325.4 (221.13) 28 22 12.9 -0.08 [-0.64, 0.47] Rasmussen et al 2015 59.6 (19.3) 68.2 (21.5) 21 23 12.2 -0.41 [-1.01, 0.19] Yennurajalingam et al 2019 35.82 (17.13) 34 (11.86) 6 8 6.3 0.12 [-0.94, 1.18] Grutsh et al 2021 54.3 (24.15) 64.5 (35.21) 20 18 11.4 -0.33 [-0.98, 0.31] Seely et al 2021 61.4 (33.7) 62.4 (33.55) 356 353 20.8 -0.04 [-0.33, 0.25] Pashaki et al 2022 1.99 (1.02) 2.93 (1.04) 91 92 18.1 -0.91 [-1.21, -0.60] Amlashi et al 2023 4.52 (0.62) 4.77 (1.12) 93 91 18.4 -0.28 [-0.57, 0.01]