Lidewij D Van Gessel1,2, Harriët J G Abrahams1,3, Hetty Prinsen4, Gijs Bleijenberg5, Marianne Heins6, Jos Twisk7, Hanneke W M Van Laarhoven8, Stans C A H H V M Verhagen4, Marieke F M Gielissen3, Hans Knoop9,10. 1. Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands. 2. Department of Medical Psychology, Hospital Gelderse Vallei, PO Box 9025, 6710 HN, Ede, The Netherlands. 3. Department of Medical Psychology, Academic Medical Center (AMC), Amsterdam Public Health Research Institute, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. 4. Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Radboud University Medical Center, Nijmegen, The Netherlands. 6. Netherlands Institute for Health Services Research (NIVEL), PO Box 1586, 3500 BN, Utrecht, The Netherlands. 7. Department of Methodology and Applied Biostatistics, Vrije Universiteit, Amsterdam, The Netherlands. 8. Department of Medical Oncology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands. 9. Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands. hans.knoop@amc.uva.nl. 10. Department of Medical Psychology, Academic Medical Center (AMC), Amsterdam Public Health Research Institute, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. hans.knoop@amc.uva.nl.
Abstract
PURPOSE: Cognitive behavior therapy (CBT) reduces cancer-related fatigue (CRF) in cancer survivors in the short term. We examined fatigue levels up to 14 years after CBT. METHODS: Eligible participants of two randomized controlled trials who had completed CBT for CRF and a post-treatment assessment were contacted (n = 81). Fatigue was assessed with the subscale "fatigue severity" of the Checklist Individual Strength (CIS-fatigue). The course of fatigue over time was examined with linear mixed model analyses. Fatigue levels of participants were compared to matched population controls at long-term follow-up. We tested with multiple regression analysis if fatigue at follow-up was predicted by the patients' fatigue level and fatigue-perpetuating factors directly after CBT (post-CBT). RESULTS: Seventy-eight persons completed a follow-up assessment (response rate = 96%, mean time after CBT = 10 years). The mean level of fatigue increased from 23.7 (SD = 11.1) at post-CBT to 34.4 (SD = 12.4) at follow-up (p < 0.001). Population controls (M = 23,9, SD = 11.4) reported lower fatigue levels than participants. Half of the patients (52%) who were recovered from severe fatigue at post-CBT (CIS-fatigue < 35) were still recovered at long-term follow-up. Patients with lower fatigue levels at post-CBT were less likely to show relapse. CONCLUSION: Despite initial improvement after CBT, levels of fatigue deteriorated over time. Half of the patients who were recovered from severe fatigue after CBT still scored within normal ranges of fatigue at long-term follow-up. IMPLICATIONS FOR CANCER SURVIVORS: It should be explored how to help patients with a relapse of severe fatigue following an initially successful CBT. They may profit from CBT again, or another evidence-based intervention for fatigue (like mindfulness or exercise therapy). Future research to gain insight into reasons for relapse is warranted.
PURPOSE: Cognitive behavior therapy (CBT) reduces cancer-related fatigue (CRF) in cancer survivors in the short term. We examined fatigue levels up to 14 years after CBT. METHODS: Eligible participants of two randomized controlled trials who had completed CBT for CRF and a post-treatment assessment were contacted (n = 81). Fatigue was assessed with the subscale "fatigue severity" of the Checklist Individual Strength (CIS-fatigue). The course of fatigue over time was examined with linear mixed model analyses. Fatigue levels of participants were compared to matched population controls at long-term follow-up. We tested with multiple regression analysis if fatigue at follow-up was predicted by the patients' fatigue level and fatigue-perpetuating factors directly after CBT (post-CBT). RESULTS: Seventy-eight persons completed a follow-up assessment (response rate = 96%, mean time after CBT = 10 years). The mean level of fatigue increased from 23.7 (SD = 11.1) at post-CBT to 34.4 (SD = 12.4) at follow-up (p < 0.001). Population controls (M = 23,9, SD = 11.4) reported lower fatigue levels than participants. Half of the patients (52%) who were recovered from severe fatigue at post-CBT (CIS-fatigue < 35) were still recovered at long-term follow-up. Patients with lower fatigue levels at post-CBT were less likely to show relapse. CONCLUSION: Despite initial improvement after CBT, levels of fatigue deteriorated over time. Half of the patients who were recovered from severe fatigue after CBT still scored within normal ranges of fatigue at long-term follow-up. IMPLICATIONS FOR CANCER SURVIVORS: It should be explored how to help patients with a relapse of severe fatigue following an initially successful CBT. They may profit from CBT again, or another evidence-based intervention for fatigue (like mindfulness or exercise therapy). Future research to gain insight into reasons for relapse is warranted.
Entities:
Keywords:
Cancer survivors; Cancer-related fatigue; Cognitive-behavioral therapy; Long-term follow-up
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