title: Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial.
abstract: OBJECTIVE
  Persistent fatigue is a long-term adverse effect experienced by 30% to 40% of patients cured of cancer. The main objective of this randomized controlled trial was to show the effectiveness of cognitive behavior therapy (CBT) especially designed for fatigue in cancer survivors.
  
  
  METHODS
  A total of 112 cancer survivors with somatically unexplained fatigue were allocated randomly to immediate cognitive behavior therapy or to a waiting list condition for therapy. Both conditions were assessed two times, at baseline and 6 months later. The primary outcome variables were fatigue severity (Checklist Individual Strength) and functional impairment (Sickness Impact Profile). Data were analyzed by intention to treat.
  
  
  RESULTS
  Analyses were based on 50 patients in the intervention condition and 48 patients in the waiting list condition. Patients in the intervention condition reported a significantly greater decrease than patients in the waiting list condition in fatigue severity (difference, 13.3; 95% CI, 8.6 to 18.1) and in functional impairment (difference, 383.2; 95% CI, 197.1 to 569.2). Clinically significant improvement for the CBT group compared with the waiting list group was seen in fatigue severity (54% v 4% of the patients, respectively) and in functional impairment (50% v 18% of the patients, respectively).
  
  
  CONCLUSIONS
  Cognitive behavior therapy has a clinically relevant effect in reducing fatigue and functional impairments in cancer survivors.
authors.affiliation: Expert Centre Chronic Fatigue Nijmegen, and the Department of Medical Oncology and Urology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands. m.gielissen@nkcv.umcn.nl
authors.forename: Marieke F M
authors.initials: MF
authors.lastname: Gielissen
authors.forename: Stans
authors.initials: S
authors.lastname: Verhagen
authors.forename: Fred
authors.initials: F
authors.lastname: Witjes
authors.forename: Gijs
authors.initials: G
authors.lastname: Bleijenberg
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy; D005221:Fatigue / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D017741:Survivors / Q000523:psychology; D016896:Treatment Outcome; D014850:Waiting Lists