Effects of Internet-Based Psychotherapy on Symptom Improvement, Quality of Life, and Mood in Cancer-Related Fatigue: A Meta-Analysis of Randomized Controlled Trials

<title>Abstract</title> <p> Background Cancer-related fatigue (CRF) is a prevalent symptom among individuals with cancer, significantly impairing patients' quality of life (QoL), increasing the likelihood of treatment discontinuation, and contributing to poorer survival outcomes. Our aim was to investigate the efficacy of internet-based psychological interventions on alleviating fatigue symptoms, comorbid anxiety and depression, and improving QoL in patients with CRF. Methods We conducted a meta-analysis of randomized controlled trials (RCTs) that required significant CRF as an eligibility criterion. The primary outcome was improvement in fatigue symptoms; secondary outcomes included QoL and mood-related measures. A random-effects model was used. Heterogeneity was quantified using <italic>I².</italic> Results Nine RCTs were included. Internet-Based Psychotherapy significantly alleviated fatigue symptoms compared to control conditions (post-treatment between-group SMD [95% CI] = 0.54[0.16,0.92]; <italic>I²</italic> =84.8%). At follow-up, the between-group effect was no longer statistically significant (SMD = 0.46 [-0.07,0.98]; <italic>I²</italic> =81.0%). For secondary outcomes, we observed non-significant trends toward improved QoL (SMD = 0.48[-0.01, 0.98]), reduced anxiety (between-group SMD = 0.58 [0.00, 1.16]), and reduced depression (between-group SMD = 0.70[-0.16, 1.57]), though these estimates were based on few studies with wide confidence intervals. Conclusion Internet-based psychological interventions reduce fatigue symptoms in patients with CRF immediately post-treatment, with effects that may not be statistically sustained at follow-up based on limited data. Improvements in QoL, anxiety, and depression remain inconclusive and require further high-quality RCTs. </p>