Carolina X Sandler1, David Goldstein2, Sarah Horsfield3, Barbara K Bennett4, Michael Friedlander5, Patricia A Bastick6, Craig R Lewis5, Eva Segelov7, Frances M Boyle8, Melvin T M Chin5, Kate Webber4, Benjamin K Barry9, Andrew R Lloyd10. 1. National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia; Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia. 2. National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia; The Prince of Wales Hospital, Sydney, Australia. 3. Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia. 4. National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia. 5. The Prince of Wales Hospital, Sydney, Australia. 6. The St George Hospital, Sydney, Australia. 7. Monash University and Monash Health, Victoria, Australia. 8. The University of Sydney, Australia; Mater Hospital, North Sydney, Australia. 9. Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia; Neuroscience Research Australia, The University of New South Wales, Sydney, Australia. 10. National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia; Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia; Viral Immunology Systems Program (VISP), The Kirby Institute, The University of New South Wales, Sydney, Australia. Electronic address: a.lloyd@unsw.edu.au.
Abstract
CONTEXT: Cancer-related fatigue is prevalent and disabling. When persistent and unexplained, it is termed post-cancer fatigue (PCF). Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) may improve symptoms and functional outcomes. OBJECTIVES: To evaluate the outcomes of a randomized controlled trial, which assigned patients with post-cancer fatigue to education, or 12 weeks ofintegrated cognitive-behavioral therapy (CBT) and graded exercise therapy (GET). METHODS: Three months after treatment for breast or colon cancer, eligible patients had clinically significant fatigue, no comorbid medical or psychiatric conditions that explained the fatigue, and no evidence of recurrence. The CBT/GET arm included individually tailored consultations at approximately two weekly intervals. The education arm included a single visit with clinicians describing the principles of CBT/GET and a booklet. The primary outcome was clinically significant improvement in self-reported fatigue (Somatic and Psychological HEalth REport 0-12), designated a priori as greater than one SD of improvement in fatigue score. The secondary outcome was associated improvement in function (role limitation due to physical health problems-36-Item Short Form Health Survey 0-100) comparing baseline, end treatment (12 weeks), and follow-up (24 weeks). RESULTS: There were 46 patients enrolled, including 43 women (94%), with a mean age of 51 years. Fatigue severity improved in all subjects from a mean of 5.2 (±3.1) at baseline to 3.9 (±2.8) at 12 weeks, suggesting a natural history of improvement. Clinically significant improvement was observed in 7 of 22 subjects in the intervention group compared with 2 of 24 in the education group (P < 0.05, χ2). These subjects also had improvement in functional status compared with nonresponders (P < 0.01, t-test). CONCLUSION:Combined CBT/GET improves fatigue and functional outcomes for a subset of patients with post-cancer fatigue. Further studies to improve the response rate and the magnitude of the benefit are warranted.
RCT Entities:
CONTEXT: Cancer-related fatigue is prevalent and disabling. When persistent and unexplained, it is termed post-cancer fatigue (PCF). Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) may improve symptoms and functional outcomes. OBJECTIVES: To evaluate the outcomes of a randomized controlled trial, which assigned patients with post-cancer fatigue to education, or 12 weeks of integrated cognitive-behavioral therapy (CBT) and graded exercise therapy (GET). METHODS: Three months after treatment for breast or colon cancer, eligible patients had clinically significant fatigue, no comorbid medical or psychiatric conditions that explained the fatigue, and no evidence of recurrence. The CBT/GET arm included individually tailored consultations at approximately two weekly intervals. The education arm included a single visit with clinicians describing the principles of CBT/GET and a booklet. The primary outcome was clinically significant improvement in self-reported fatigue (Somatic and Psychological HEalth REport 0-12), designated a priori as greater than one SD of improvement in fatigue score. The secondary outcome was associated improvement in function (role limitation due to physical health problems-36-Item Short Form Health Survey 0-100) comparing baseline, end treatment (12 weeks), and follow-up (24 weeks). RESULTS: There were 46 patients enrolled, including 43 women (94%), with a mean age of 51 years. Fatigue severity improved in all subjects from a mean of 5.2 (±3.1) at baseline to 3.9 (±2.8) at 12 weeks, suggesting a natural history of improvement. Clinically significant improvement was observed in 7 of 22 subjects in the intervention group compared with 2 of 24 in the education group (P < 0.05, χ2). These subjects also had improvement in functional status compared with nonresponders (P < 0.01, t-test). CONCLUSION: Combined CBT/GET improves fatigue and functional outcomes for a subset of patients with post-cancer fatigue. Further studies to improve the response rate and the magnitude of the benefit are warranted.
Authors: Yufen Lin; Deborah W Bruner; Sudeshna Paul; Andrew H Miller; Nabil F Saba; Kristin A Higgins; Dong M Shin; Wenhui Zhang; Christine Miaskowski; Canhua Xiao Journal: Cancer Date: 2022-08-15 Impact factor: 6.921
Authors: Chloe Grimmett; Teresa Corbett; Jennifer Brunet; Jonathan Shepherd; Bernardine M Pinto; Carl R May; Claire Foster Journal: Int J Behav Nutr Phys Act Date: 2019-04-27 Impact factor: 6.457
Authors: Anouk Verveen; Fabiola Müller; Andrew Lloyd; Rona Moss-Morris; Torbjørn Omland; Brenda Penninx; Ruud P H Raijmakers; Marike van der Schaaf; Carolina X Sandler; Knut Stavem; Simon Wessely; Vegard B B Wyller; Pythia Nieuwkerk; Hans Knoop Journal: J Psychosom Res Date: 2022-01-22 Impact factor: 4.620