Twenty-eight RCTs (895 patients) were included in the meta-analysis:
9 RCTs (295 patients) were used to assess interventions for nausea and vomiting;
5 RCTs (193 patients) were used to assess interventions for pain;
4 RCTs (163 patients) were used to assess interventions for anxiety;
2 RCTs (47 patients) were used to assess interventions for alopecia;
2 RCTs (46 patients) were used to assess interventions for infection;
2 RCTs (72 patients) were used to assess interventions for chemotherapy side-effects;
1 RCT (20 patients) was used to assess interventions for shivering;
1 RCT (16 patients) was used to assess interventions for radiodermatitis;
1 RCT (25 patients) was used to assess interventions for anorexia; and
1 RCT (18 patients) was used to assess interventions for mucositis.
Overall effectiveness of interventions for symptom management: mean d 0.47 (95% CI: 0.33, 0.61, P=5.17E-12). The BED showed an improvement of 23% for patients receiving the experimental intervention. Heterogeneity was significant (chi-squared 66.574, P<0.00001). The quality of the studies ranged from 0.79 to 1.95.
Symptom intervention effectiveness analysis.
Nausea or vomiting: mean d 0.31 (P=0.004), chi-squared for heterogeneity 34.828 (P=2.87E-5).
Pain: mean d 0.55 (P=0.004), chi-squared 10.491 (P=0.033).
Anxiety: mean d 0.5 (P=0.001), chi-squared 13.380 (P=0.004).
Alopecia: mean d 0.55 (P=9.82E-5), chi-squared 1.897 (P=0.275).
Infection: mean d 0.55 (P=0.035), chi-squared 0.644 (P=0.422).
Side-effects of chemotherapy: mean d 0.46 (P=0.028), chi-squared 0.057 (P=0.811).
The number of studies required to overturn results, i.e. the fail-safe N, was 1,236.