title: Randomized controlled trial of a cognitive-behavioral therapy plus hypnosis intervention to control fatigue in patients undergoing radiotherapy for breast cancer.
abstract: OBJECTIVE
  The objective of this study was to test the efficacy of cognitive-behavioral therapy plus hypnosis (CBTH) to control fatigue in patients with breast cancer undergoing radiotherapy. We hypothesized that patients in the CBTH group receiving radiotherapy would have lower levels of fatigue than patients in an attention control group.
  
  
  METHODS
  Patients (n = 200) were randomly assigned to either the CBTH (n = 100; mean age, 55.59 years) or attention control (n = 100; mean age, 55.97 years) group. Fatigue was measured at four time points (baseline, end of radiotherapy, 4 weeks, and 6 months after radiotherapy). Fatigue was measured using the Functional Assessment of Chronic Illness Therapy (FACIT) -Fatigue subscale and Visual Analog Scales (VASs; Fatigue and Muscle Weakness).
  
  
  RESULTS
  The CBTH group had significantly lower levels of fatigue (FACIT) at the end of radiotherapy (z, 6.73; P < .001), 4-week follow-up (z, 6.98; P < .001), and 6-month follow-up (z, 7.99; P < .001) assessments. Fatigue VAS scores were significantly lower in the CBTH group at the end of treatment (z, 5.81; P < .001) and at the 6-month follow-up (z, 4.56; P < .001), but not at the 4-week follow-up (P < .07). Muscle Weakness VAS scores were significantly lower in the CBTH group at the end of treatment (z, 9.30; P < .001) and at the 6-month follow-up (z, 3.10; P < .02), but not at the 4-week follow-up (P < .13).
  
  
  CONCLUSIONS
  The results support CBTH as an evidence-based intervention to control fatigue in patients undergoing radiotherapy for breast cancer. CBTH is noninvasive, has no adverse effects, and its beneficial effects persist long after the last intervention session. CBTH seems to be a candidate for future dissemination and implementation.
authors.affiliation: Guy H. Montgomery, Daniel David, Sheryl Green, Madalina Sucala, and Julie B. Schnur, Icahn School of Medicine at Mount Sinai, New York, NY; Daniel David and Madalina Sucala, Babeş-Bolyai University, Cluj-Napoca, Romania; Maria Kangas, Macquarie University, Sydney, New South Wales, Australia; Dana H. Bovbjerg, University of Pittsburgh Cancer Institute, University of Pittsburgh; and Michael N. Hallquist, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Guy H
authors.initials: GH
authors.lastname: Montgomery
authors.forename: Daniel
authors.initials: D
authors.lastname: David
authors.forename: Maria
authors.initials: M
authors.lastname: Kangas
authors.forename: Sheryl
authors.initials: S
authors.lastname: Green
authors.forename: Madalina
authors.initials: M
authors.lastname: Sucala
authors.forename: Dana H
authors.initials: DH
authors.lastname: Bovbjerg
authors.forename: Michael N
authors.initials: MN
authors.lastname: Hallquist
authors.forename: Julie B
authors.initials: JB
authors.lastname: Schnur
mesh_terms: D001943:Breast Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005221:Fatigue / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D006990:Hypnosis / Q000379:methods*; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome