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

IF 3.5 2区医学 Q2 ONCOLOGY

Psycho‐Oncology Pub Date : 2025-09-01 DOI:10.1002/pon.70282

Hannah B van der Pas, Annemarie M J Braamse, Gijs Bleijenberg, Hanneke W M van Laarhoven, Pythia Nieuwkerk, Harm Westdorp, Lia van Zuylen, Fabiola Müller, Hans Knoop

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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.

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认知行为疗法治疗癌症相关疲劳：治疗意图与晚期癌症患者的比较。

背景：癌症相关性疲劳（CRF）在以治愈为目的接受治疗的患者和晚期癌症患者中普遍存在。认知行为疗法（CBT）在两组患者中均能有效降低CRF。目的：比较两组患者在以下方面的差异：(1)治疗前的疲劳水平和导致疲劳的认知行为因素；(2) CBT对疲劳的影响程度；(3)治疗反应的介质。方法：汇集4项随机对照试验的数据，验证CBT治疗CRF的疗效，其中3项为有治愈意图的患者（n = 249）， 1项为晚期癌症患者（n = 134）。将基线特征与ANCOVAs进行比较。采用适度分析探讨两组间治疗效果是否存在差异。通过适度的中介分析，评估CBT减少疲劳的机制差异。结果：两组在疲劳持久因素的基线上有显著差异，但在疲劳严重程度上没有差异。晚期癌症患者报告，CBT治疗后疲劳严重程度的下降幅度小于有治愈意图的患者（p = 0.022）。多变量调节的中介分析显示，与晚期癌症患者相比，以治愈为目的治疗的患者疲劳灾变的减少更大。结论：CBT治疗CRF对晚期癌症患者疲劳严重程度和灾难化的影响较小，灾难化是一种已知的疲劳持续因素和CBT效果的中介。进一步的研究必须确定CBT对晚期癌症患者的慢性肾功能衰竭的有效性是否可以提高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psycho‐Oncology 医学-心理学

CiteScore

6.30

自引率

8.30%

发文量

220

审稿时长

3-8 weeks

期刊介绍： Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology. This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues. Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.