Virtual Delivery of Stepped-Care Cognitive Behaviour Therapy for Cancer Related Fatigue: A Feasibility Study

Abstract

Purpose: About 1 in 3 people experience persistent fatigue after cancer treatment. People with severe fatigue describe a disabling lack of stamina, anxiety, depression and distressing cognitive changes. Cognitive behavior therapy (CBT) is recommended for people with severe fatigue after cancer treatment, however due to limited resources and lack of available clinicians very few people with cancer have access. This study explored feasibility of a virtual stepped-care CBT program.

Methods: English speaking adults experiencing persistent fatigue who had either completed cancer treatment, or with stable disease on maintenance therapies were recruited. All participants engaged in a 6-week supported self-help program using a CBT workbook targeting fatigue (STEP 1). After the self-help program, participants with severe ongoing fatigue were stepped-up to a telehealth CBT group focused to fatigue led by a Clinical Psychologist (STEP 2). Feasibility and perceived changes were assessed at baseline, 6 and 12 weeks.

Results: Of 19 participants, 17 completed STEP 1 and 8 completed STEP 2. Remotely delivered CBT was feasible with high retention, adherence, participant feasibility and satisfaction scores. Cost to deliver STEP 1 was AUD $145 and STEP 2, AUD $280 per participant. Overall, fatigue and self-efficacy improved significantly following STEP 1. Participants with higher baseline fatigue achieved limited improvements with self-help alone, requiring guidance to set achievable goals and reframe cognitions. Fatigue, self-efficacy and mood improved with STEP 2.

Conclusions: Remotely delivered CBT for cancer fatigue was feasible. The effectiveness of stratified rather than stepped CBT approach, based on fatigue severity should be trialed.

Trial registration: Australian and New Zealand Clinical Trials Registry (ACTRN # 11 12622000420741).

Keywords: CBT; cancer; cognitive behavior therapy; fatigue; feasibility; psychological; stepped-care.

Figure 1.

Recruitment and participation.

Figure 2.

Perceived improvements in symptoms and activities following participation in REFRESH: Group A. (a) Perceived improvements in symptoms and activities following participation in REFRESH: Group A at T1 and T2 and (b) Perceived improvements in symptoms and activities following participation in REFRESH: Group B at T1 and T2. T1 = Time 1: End STEP 1 Self-Management; T2 = Time 2: 12 weeks (Group A) or End STEP 2 CBT Group Therapy (Group B). Missing data T1 n = 5 (missing n = 3: Group A n = 1, Group B n = 2; drop-out n = 2). Missing data T2 n = 4 (missing n = 2group A; drop-out n = 2).