Randomized evaluation of cognitive-behavioral therapy and graded exercise therapy for post-cancer fatigue

Carolyn X. Sandler, David A Goldstein, Sarah Horsfield, Barbara K. Bennett, Michael Friedlander, Patricia A. Bastick, Craig R. Lewis, Eva Segelov, Frances M. Boyle, Melvin T. M. Chin, Kate Webber, Benjamin K. Barry, Andrew R. Lloyd

Research output: Contribution to journalArticleResearchpeer-review

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 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.
LanguageEnglish
Pages74-84
Number of pages11
JournalJournal of Pain and Symptom Management
Volume54
Issue number1
DOIs
StatePublished - Jul 2017

Keywords

  • Cognitive-behavioral therapy
  • Exercise therapy
  • Graded exercise therapy
  • Multidisciplinary
  • Post-cancer fatigue

Cite this

Sandler, C. X., Goldstein, D. A., Horsfield, S., Bennett, B. K., Friedlander, M., Bastick, P. A., ... Lloyd, A. R. (2017). Randomized evaluation of cognitive-behavioral therapy and graded exercise therapy for post-cancer fatigue. Journal of Pain and Symptom Management, 54(1), 74-84. DOI: 10.1016/j.jpainsymman.2017.03.015
Sandler, Carolyn X. ; Goldstein, David A ; Horsfield, Sarah ; Bennett, Barbara K. ; Friedlander, Michael ; Bastick, Patricia A. ; Lewis, Craig R. ; Segelov, Eva ; Boyle, Frances M. ; Chin, Melvin T. M. ; Webber, Kate ; Barry, Benjamin K. ; Lloyd, Andrew R./ Randomized evaluation of cognitive-behavioral therapy and graded exercise therapy for post-cancer fatigue. In: Journal of Pain and Symptom Management. 2017 ; Vol. 54, No. 1. pp. 74-84
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title = "Randomized evaluation of cognitive-behavioral therapy and graded exercise therapy for post-cancer fatigue",
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 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.",
keywords = "Cognitive-behavioral therapy, Exercise therapy, Graded exercise therapy, Multidisciplinary, Post-cancer fatigue",
author = "Sandler, {Carolyn X.} and Goldstein, {David A} and Sarah Horsfield and Bennett, {Barbara K.} and Michael Friedlander and Bastick, {Patricia A.} and Lewis, {Craig R.} and Eva Segelov and Boyle, {Frances M.} and Chin, {Melvin T. M.} and Kate Webber and Barry, {Benjamin K.} and Lloyd, {Andrew R.}",
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Sandler, CX, Goldstein, DA, Horsfield, S, Bennett, BK, Friedlander, M, Bastick, PA, Lewis, CR, Segelov, E, Boyle, FM, Chin, MTM, Webber, K, Barry, BK & Lloyd, AR 2017, 'Randomized evaluation of cognitive-behavioral therapy and graded exercise therapy for post-cancer fatigue' Journal of Pain and Symptom Management, vol. 54, no. 1, pp. 74-84. DOI: 10.1016/j.jpainsymman.2017.03.015

Randomized evaluation of cognitive-behavioral therapy and graded exercise therapy for post-cancer fatigue. / Sandler, Carolyn X.; Goldstein, David A; Horsfield, Sarah; Bennett, Barbara K.; Friedlander, Michael; Bastick, Patricia A.; Lewis, Craig R.; Segelov, Eva; Boyle, Frances M.; Chin, Melvin T. M.; Webber, Kate; Barry, Benjamin K.; Lloyd, Andrew R.

In: Journal of Pain and Symptom Management, Vol. 54, No. 1, 07.2017, p. 74-84.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Randomized evaluation of cognitive-behavioral therapy and graded exercise therapy for post-cancer fatigue

AU - Sandler,Carolyn X.

AU - Goldstein,David A

AU - Horsfield,Sarah

AU - Bennett,Barbara K.

AU - Friedlander,Michael

AU - Bastick,Patricia A.

AU - Lewis,Craig R.

AU - Segelov,Eva

AU - Boyle,Frances M.

AU - Chin,Melvin T. M.

AU - Webber,Kate

AU - Barry,Benjamin K.

AU - Lloyd,Andrew R.

PY - 2017/7

Y1 - 2017/7

N2 - 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.

AB - 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.

KW - Cognitive-behavioral therapy

KW - Exercise therapy

KW - Graded exercise therapy

KW - Multidisciplinary

KW - Post-cancer fatigue

U2 - 10.1016/j.jpainsymman.2017.03.015

DO - 10.1016/j.jpainsymman.2017.03.015

M3 - Article

VL - 54

SP - 74

EP - 84

JO - Journal of Pain and Symptom Management

T2 - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

SN - 0885-3924

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Sandler CX, Goldstein DA, Horsfield S, Bennett BK, Friedlander M, Bastick PA et al. Randomized evaluation of cognitive-behavioral therapy and graded exercise therapy for post-cancer fatigue. Journal of Pain and Symptom Management. 2017 Jul;54(1):74-84. Available from, DOI: 10.1016/j.jpainsymman.2017.03.015