Cancer-related fatigue and rehabilitation: a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention

Ellen van Weert, Anne M May, Irene Korstjens, Wendy J Post, Cees van der Schans, Bart van den Borne, Ilse Mesters, Wynand J G Ros, Josette E H M Hoekstra-Weebers

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer. To date, it is unclear what type of rehabilitation is most beneficial.

OBJECTIVE: This randomized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention.

DESIGN: In this multicenter randomized controlled trial, 147 survivors of cancer were randomly assigned to a group that received physical training combined with cognitive-behavioral therapy (PT+CBT group, n=76) or to a group that received physical training alone (PT group, n=71). In addition, a nonintervention control group (WLC group) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included.

SETTING: The study was conducted at 4 rehabilitation centers in the Netherlands.

PATIENTS: All patients were survivors of cancer.

INTERVENTION: Physical training consisting of 2 hours of individual training and group sports took place twice weekly, and cognitive-behavioral therapy took place once weekly for 2 hours.

MEASUREMENTS: Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention (12 weeks after enrollment). The WLC group completed questionnaires at the same time points.

RESULTS: Baseline fatigue did not differ significantly among the 3 groups. Over time, levels of fatigue significantly decreased in all domains in all groups, except in mental fatigue in the WLC group. Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue, on physical and mental fatigue, and on reduced activation but not on reduced motivation. Compared with the WLC group, the PT group reported significantly greater decline in 4 domains of fatigue, whereas the PT+CBT group reported significantly greater decline in physical fatigue only. No significant differences in decline in fatigue were found between the PT+CBT and PT groups.

CONCLUSIONS: Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention. Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training.

Original languageEnglish
Pages (from-to)1413-1425
JournalPhysical therapy
Volume90
Issue number10
DOIs
Publication statusPublished - 2010

Keywords

  • Analysis of Variance
  • Chi-Square Distribution
  • Cognitive Therapy
  • Exercise Therapy
  • Fatigue
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms
  • Netherlands
  • Patient Compliance
  • Quality of Life
  • Surveys and Questionnaires
  • Survivors
  • Treatment Outcome
  • Comparative Study
  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

Cite this

van Weert, Ellen ; May, Anne M ; Korstjens, Irene ; Post, Wendy J ; van der Schans, Cees ; van den Borne, Bart ; Mesters, Ilse ; Ros, Wynand J G ; Hoekstra-Weebers, Josette E H M. / Cancer-related fatigue and rehabilitation : a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention. In: Physical therapy. 2010 ; Vol. 90, No. 10. pp. 1413-1425.
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abstract = "BACKGROUND: Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer. To date, it is unclear what type of rehabilitation is most beneficial.OBJECTIVE: This randomized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention.DESIGN: In this multicenter randomized controlled trial, 147 survivors of cancer were randomly assigned to a group that received physical training combined with cognitive-behavioral therapy (PT+CBT group, n=76) or to a group that received physical training alone (PT group, n=71). In addition, a nonintervention control group (WLC group) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included.SETTING: The study was conducted at 4 rehabilitation centers in the Netherlands.PATIENTS: All patients were survivors of cancer.INTERVENTION: Physical training consisting of 2 hours of individual training and group sports took place twice weekly, and cognitive-behavioral therapy took place once weekly for 2 hours.MEASUREMENTS: Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention (12 weeks after enrollment). The WLC group completed questionnaires at the same time points.RESULTS: Baseline fatigue did not differ significantly among the 3 groups. Over time, levels of fatigue significantly decreased in all domains in all groups, except in mental fatigue in the WLC group. Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue, on physical and mental fatigue, and on reduced activation but not on reduced motivation. Compared with the WLC group, the PT group reported significantly greater decline in 4 domains of fatigue, whereas the PT+CBT group reported significantly greater decline in physical fatigue only. No significant differences in decline in fatigue were found between the PT+CBT and PT groups.CONCLUSIONS: Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention. Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training.",
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author = "{van Weert}, Ellen and May, {Anne M} and Irene Korstjens and Post, {Wendy J} and {van der Schans}, Cees and {van den Borne}, Bart and Ilse Mesters and Ros, {Wynand J G} and Hoekstra-Weebers, {Josette E H M}",
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Cancer-related fatigue and rehabilitation : a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention. / van Weert, Ellen; May, Anne M; Korstjens, Irene; Post, Wendy J; van der Schans, Cees; van den Borne, Bart; Mesters, Ilse; Ros, Wynand J G; Hoekstra-Weebers, Josette E H M.

In: Physical therapy, Vol. 90, No. 10, 2010, p. 1413-1425.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Cancer-related fatigue and rehabilitation

T2 - a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention

AU - van Weert, Ellen

AU - May, Anne M

AU - Korstjens, Irene

AU - Post, Wendy J

AU - van der Schans, Cees

AU - van den Borne, Bart

AU - Mesters, Ilse

AU - Ros, Wynand J G

AU - Hoekstra-Weebers, Josette E H M

PY - 2010

Y1 - 2010

N2 - BACKGROUND: Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer. To date, it is unclear what type of rehabilitation is most beneficial.OBJECTIVE: This randomized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention.DESIGN: In this multicenter randomized controlled trial, 147 survivors of cancer were randomly assigned to a group that received physical training combined with cognitive-behavioral therapy (PT+CBT group, n=76) or to a group that received physical training alone (PT group, n=71). In addition, a nonintervention control group (WLC group) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included.SETTING: The study was conducted at 4 rehabilitation centers in the Netherlands.PATIENTS: All patients were survivors of cancer.INTERVENTION: Physical training consisting of 2 hours of individual training and group sports took place twice weekly, and cognitive-behavioral therapy took place once weekly for 2 hours.MEASUREMENTS: Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention (12 weeks after enrollment). The WLC group completed questionnaires at the same time points.RESULTS: Baseline fatigue did not differ significantly among the 3 groups. Over time, levels of fatigue significantly decreased in all domains in all groups, except in mental fatigue in the WLC group. Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue, on physical and mental fatigue, and on reduced activation but not on reduced motivation. Compared with the WLC group, the PT group reported significantly greater decline in 4 domains of fatigue, whereas the PT+CBT group reported significantly greater decline in physical fatigue only. No significant differences in decline in fatigue were found between the PT+CBT and PT groups.CONCLUSIONS: Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention. Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training.

AB - BACKGROUND: Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer. To date, it is unclear what type of rehabilitation is most beneficial.OBJECTIVE: This randomized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention.DESIGN: In this multicenter randomized controlled trial, 147 survivors of cancer were randomly assigned to a group that received physical training combined with cognitive-behavioral therapy (PT+CBT group, n=76) or to a group that received physical training alone (PT group, n=71). In addition, a nonintervention control group (WLC group) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included.SETTING: The study was conducted at 4 rehabilitation centers in the Netherlands.PATIENTS: All patients were survivors of cancer.INTERVENTION: Physical training consisting of 2 hours of individual training and group sports took place twice weekly, and cognitive-behavioral therapy took place once weekly for 2 hours.MEASUREMENTS: Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention (12 weeks after enrollment). The WLC group completed questionnaires at the same time points.RESULTS: Baseline fatigue did not differ significantly among the 3 groups. Over time, levels of fatigue significantly decreased in all domains in all groups, except in mental fatigue in the WLC group. Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue, on physical and mental fatigue, and on reduced activation but not on reduced motivation. Compared with the WLC group, the PT group reported significantly greater decline in 4 domains of fatigue, whereas the PT+CBT group reported significantly greater decline in physical fatigue only. No significant differences in decline in fatigue were found between the PT+CBT and PT groups.CONCLUSIONS: Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention. Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training.

KW - Analysis of Variance

KW - Chi-Square Distribution

KW - Cognitive Therapy

KW - Exercise Therapy

KW - Fatigue

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasms

KW - Netherlands

KW - Patient Compliance

KW - Quality of Life

KW - Surveys and Questionnaires

KW - Survivors

KW - Treatment Outcome

KW - Comparative Study

KW - Journal Article

KW - Multicenter Study

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

KW - variantieanalyse

KW - Chi-Square Distribution

KW - cognitieve therapie

KW - oefeningstherapie

KW - vermoeidheid

KW - vrouwelijk

KW - mensen

KW - mannelijk

KW - middelbaar

KW - neoplasma's

KW - nederland

KW - patientennazorg

KW - kwaliteit van leven

KW - enquetes en vragenlijsten

KW - overlevers

KW - behandelingsresultaat

KW - vergelijkende studie

KW - tijdschriftartikel

KW - multicenter studie

KW - gerandomiseeerd controle onderzoek

KW - Research Support, Non-U.S. Gov't

U2 - 10.2522/ptj.20090212

DO - 10.2522/ptj.20090212

M3 - Article

VL - 90

SP - 1413

EP - 1425

JO - Physical therapy

JF - Physical therapy

SN - 0031-9023

IS - 10

ER -