28 January 2020

In Annals of Oncology, the TIRED trial study group including former RIHS PhD candidate Hanneke Poort, Marlies PetersWinette van der Graaf, Ria Nijhuis-van der Sanden and colleagues described the results of a RCT assessing the effects of cognitive behavioral therapy (CBT) or graded exercise therapy (GET) on fatigue in patients with advanced cancer during treatment with palliative intent in nine centers in The Netherlands.
Adult patients  (n=134, 57 % female) with locally advanced or metastatic cancer who reported severe fatigue during treatment were randomly assigned to either 12 weeks of CBT or GET, or usual care (1 : 1: 1, computer-generated sequence). Primary outcome was CIS-fatigue severity at 14 weeks. Secondary outcomes included fatigue measured with the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC-QLQ-C30), quality of life, emotional functioning, physical functioning, and functional impairments at baseline, 14, 18, and 26 weeks. A total of 126 participants completed assessment at 14 weeks. Compared with usual care, CBT significantly reduced fatigue, whereas GET reduced fatigue, however effects were not significant compared with usual care. Moreover CBT improved also the secondary outcomes, while GET did not. No significant improvements in emotional functioning and functional impairments were observed. The TIRED trial study team concluded that a CBT intervention was more effective than usual care for reducing severe fatigue. Following GET, patients reported lower fatigue, but results were not significant, probably due to a smaller sample size and lower adherence than anticipated.

Cognitive behavioral therapy or graded exercise therapy compared with usual care for severe fatigue in patients with advanced cancer during treatment: a randomized controlled trial.
Poort H, Peters MEWJ, van der Graaf WTA, Nieuwkerk PT, van de Wouw AJ, Nijhuis-van der Sanden MWG, Bleijenberg G, Verhagen CAHHVM, Knoop H.


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