Efficacy of different non-pharmacological therapies on cancer-related fatigue in breast cancer patients: a network meta-analysis

Background: Cancer-related fatigue (CRF) is a highly prevalent and debilitating symptom among breast cancer patients, yet optimal non-pharmacological management strategies remain uncertain. We aimed to compare the relative efficacy of various non-pharmacological interventions for alleviating CRF in this population through a systematic review and network meta-analysis (NMA). Methods: We systematically searched PubMed, EMBASE, Web of Science, CINAHL, and CENTRAL from inception to June 2025 for randomized controlled trials (RCTs). Studies were included if they evaluated any non-pharmacological intervention for CRF in adult women with breast cancer. A frequentist random-effects NMA was conducted, and interventions were ranked using the Surface Under the Cumulative Ranking Curve (SUCRA). The primary outcome was CRF severity measured by validated scales. Results: Twenty-six RCTs involving 2,811 patients were included, evaluating 21 distinct interventions. The network demonstrated good connectivity and no significant inconsistency (P > 0.05 for both global and local tests). Tai Chi Chih (TCC) was ranked as the most effective intervention (SUCRA = 99.1%), followed by cognitive behavioral therapy (CBT; SUCRA = 92.0%) and massage therapy (MT; SUCRA = 90.6%). Compared with usual care, all three showed large and statistically significant reductions in fatigue: TCC (SMD = –4.61, 95% CI: –6.20 to –3.02), CBT (SMD = –3.63, 95% CI: –4.87 to –2.40), and MT (SMD = –3.43, 95% CI: –4.66 to –2.20). Health education ranked lowest among active interventions (SUCRA = 19.4%). The funnel plot indicated no significant publication bias. Conclusion: This comprehensive NMA identifies Tai Chi Chih, cognitive behavioral therapy, and massage therapy as the most effective non-pharmacological strategies for reducing cancer-related fatigue in breast cancer patients. These findings provide robust evidence to prioritize these mind–body, psychological, and somatic approaches in clinical practice and supportive care guidelines. Trial registration: The study was registered at PROSPERO on 5 February 2025 (CRD42025642351). © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.