Cognitive Behavioral Therapy for Cancer-Related Fatigue: A Comparison Between Patients Treated With Curative Intent and Patients With Advanced Cancer

Abstract

Background: Cancer-related fatigue (CRF) is prevalent in patients who have been treated with curative intent and patients with advanced cancer. Cognitive behavioral therapy (CBT) has been shown effective in reducing CRF in both groups. Aims: To compare both groups with respect to: (1) pre-treatment levels of fatigue and fatigue-perpetuating cognitive-behavioral factors; (2) the magnitude of the effect of CBT on fatigue; and (3) mediators of the treatment response. Methods: Data of four randomized controlled trials testing the efficacy of CBT for CRF were pooled, three in patients treated with curative intent (n = 249), and one in patients with advanced cancer (n = 134). Baseline characteristics were compared with ANCOVAs. Moderation analysis was used to investigate whether the treatment effect differed between groups. With moderated mediation analyses differences in the mechanisms by which CBT reduces fatigue were evaluated. Results: The two groups differed significantly at baseline on fatigue-perpetuating factors, but not on fatigue severity. Patients with advanced cancer reported a smaller decrease in fatigue severity following CBT than patients treated with curative intent (p = 0.022). The multivariate moderated mediation analysis showed a larger decrease in fatigue catastrophizing in patients treated with curative intent than in patients with advanced cancer. Conclusion: CBT for CRF has less effect on catastrophizing, a known fatigue-perpetuating factor and mediator of the effect of CBT, and fatigue severity in patients with advanced cancer. Further research has to determine if the effectiveness of CBT for CRF in advanced cancer patients can be improved.