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Open Access 01-08-2018

Are the effects of cognitive behavior therapy for severe fatigue in cancer survivors sustained up to 14 years after therapy?

Authors: Lidewij D. Van Gessel, Harriët J. G. Abrahams, Hetty Prinsen, Gijs Bleijenberg, Marianne Heins, Jos Twisk, Hanneke W. M. Van Laarhoven, Stans C. A. H. H. V. M. Verhagen, Marieke F. M. Gielissen, Hans Knoop

Published in: Journal of Cancer Survivorship | Issue 4/2018

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.

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Ahlberg K, Ekman T, Gaston-Johansson F, Mock V. Assessment and management of cancer-related fatigue in adults. Lancet. 2003;362(9384):640–50. https://doi.org/10.1016/s0140-6736(03)14186-4.CrossRefPubMed

Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, et al. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32(17):1840–50. https://doi.org/10.1200/jco.2013.53.4495.CrossRefPubMedPubMedCentral

Abrahams HJG, Gielissen MFM, Schmits IC, Verhagen CAHHVM, Rovers MM, Knoop H. Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Ann Oncol. 2016;27(6):965–74. https://doi.org/10.1093/annonc/mdw099.CrossRefPubMed

Gielissen MF, Verhagen S, Witjes F, Bleijenberg G. Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. J Clin Oncol. 2006;24(30):4882–7. https://doi.org/10.1200/jco.2006.06.8270.CrossRefPubMed

Prinsen H, Bleijenberg G, Heijmen L, Zwarts MJ, Leer JWH, Heerschap A, et al. The role of physical activity and physical fitness in postcancer fatigue: a randomized controlled trial. Support Care Cancer. 2013;21(8):2279–88. https://doi.org/10.1007/s00520-013-1784-9.CrossRefPubMed

Abrahams HJ, Gielissen MF, Donders RR, et al. The efficacy of Internet-based cognitive behavioral therapy for severely fatigued survivors of breast cancer compared with care as usual: a randomized controlled trial. Cancer. 2017;123(19):3825–34. https://doi.org/10.1002/cncr.30815. CrossRefPubMed

MFM G, Verhagen CAHHVM, Bleijenberg G. Cognitive behaviour therapy for fatigued cancer survivors: long-term follow-up. Br J Cancer. 2007;97(5):612–8. https://doi.org/10.1038/sj.bjc.6603899.CrossRef

Janse A, Nikolaus S, Wiborg JF, Heins M, van der Meer JWM, Bleijenberg G, et al. Long-term follow-up after cognitive behaviour therapy for chronic fatigue syndrome. J Psychosom Res. 2017;97:45–51. https://doi.org/10.1016/j.jpsychores.2017.03.016.CrossRefPubMed

Akker LEVD, Beckerman H, Collette EH, et al. Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial. Mult Scler J. 2017;23(11):1542–53. https://doi.org/10.1177/1352458517709361.CrossRef

10.

Vestergaard S, Nayfield SG, Patel KV, Eldadah B, Cesari M, Ferrucci L, et al. Fatigue in a representative population of older persons and its association with functional impairment, functional limitation, and disability. J Gerontol Ser A Biol Med Sci. 2009;64A(1):76–82. https://doi.org/10.1093/gerona/gln017.CrossRef

11.

Worm-Smeitink M, Gielissen M, Bloot L, van Laarhoven HWM, van Engelen BGM, van Riel P, et al. The assessment of fatigue: psychometric qualities and norms for the Checklist individual strength. J Psychosom Res. 2017;98:40–6. https://doi.org/10.1016/j.jpsychores.2017.05.007.CrossRefPubMed

12.

Ware JE, Sherbourne CD. MOS 36-item short-form health survey. PsycTESTS Dataset. 1992. https://doi.org/10.1037/t06708-000.

13.

Stewart AL, Hays RD, Ware JE. The MOS short-form general health survey: reliability and validity in a patient population. Med Care. 1988;26:724–35.CrossRefPubMed

14.

Ploeg EVD, Mooren TTM, Kleber RJ, Velden PGVD, Brom D. Construct validation of the Dutch version of the impact of event scale. Psychol Assess. 2004;16(1):16–26. https://doi.org/10.1037/1040-3590.16.1.16.CrossRefPubMed

15.

Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, et al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet. 2001;357(9259):841–7. https://doi.org/10.1016/s0140-6736(00)04198-2.CrossRefPubMed

16.

Jacobs HM, Luttik A, Touw-Otten FW, de Melker RA. The sickness impact profile; results of an evaluation study of the Dutch version. Ned Tijdschr Geneeskd. 1990;40:1950–4.

17.

Van Sonderen E. Sociale Steun Lijst-Interacties (SSL-I) en Sociale Steun Lijst Discrepanties (SLL-D). Noorderlijk Centrum voor Gezondheidsvraagstukken: Rijksuniversiteit Groningen; 1993.

18.

Abrahams H J G, Gielissen M F M, Verhagen C A H H V M, Knoop H. The relationship of fatigue with quality of life and psychological factors in breast cancer survivors: a systematic review. Submitted for publication.

19.

Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, et al. The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomized controlled trial (the PREVENT study). Health Technol Assess. 2015;19(73):1–124. https://doi.org/10.3310/hta19730.CrossRefPubMedPubMedCentral

Title: Are the effects of cognitive behavior therapy for severe fatigue in cancer survivors sustained up to 14 years after therapy?
Authors: Lidewij D. Van Gessel
Harriët J. G. Abrahams
Hetty Prinsen
Gijs Bleijenberg
Marianne Heins
Jos Twisk
Hanneke W. M. Van Laarhoven
Stans C. A. H. H. V. M. Verhagen
Marieke F. M. Gielissen
Hans Knoop
Publication date: 01-08-2018
Publisher: Springer US
Published in: Journal of Cancer Survivorship / Issue 4/2018
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-018-0690-z

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Abstract

Purpose

Methods

Results

Conclusion

Implications for Cancer Survivors

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