Advances in assessment systems and non-pharmacological intervention strategies for cancer-related fatigue following transarterial chemoembolization in hepatocellular carcinoma: a narrative review

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. © The Author(s) 2026.