Goedendorp, M. M., Peters, M. E., Gielissen, M. F., Witjes, J. A., Leer, J. W., Verhagen, C. A., & Bleijenberg, G. (2010). Is increasing physical activity necessary to diminish fatigue during cancer treatment? Comparing cognitive behavior therapy and a brief nursing intervention with usual care in a multicenter randomized controlled trial. The Oncologist, 15, 1122–1132.

The primary aim was to demonstrate the efficacy of a brief nursing intervention (BNI) and cognitive-behavioral therapy (CBT) compared to usual care (UC). The secondary aim was to determine the role of physical activity in reducing fatigue during cancer treatment.

In total, 220 patients were randomly assigned to one of three groups:  BNI, CBT, or UC.

• The study was comprised of 220 patients (139 females and 81 males), and two patients dropped out.
• Age ranged from 18 to 75 years.
• Diagnoses included breast cancer (48%), prostate cancer (23%), other tumors (29%).
• The marital statuses of the patients were married/cohabiting (81%) and other (19%).
• Patients were excluded if they had head and neck and lung cancers.

• Setting Type 1:  Multisite
• Radboud University Nijmegen Medical Centre and six regional hospitals in The Netherlands

The study was a multicenter, randomized, controlled trial.

• Fatigue severity was assessed using the fatigue subscale of the Checklist Individual Strength (CIS-fat).
• Functioning was assessed using the Dutch language version of the Short Form-36 (SF-36) Health Survey.
• Symptom Checklist-90 (SCL-90) measured psychological distress.
• European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
• Physical activity was measured by an actometer and the Daily Observed Activity score, and the Questionnaire Physical Activity (QPA) measured whether patients complied with advice concerning physical activity.

The CBT group was significantly less fatigued than the UC group. Between the BNI and the UC groups, no significant difference in fatigue was found. Physical activity was found not to mediate the effect of CBT on fatigue.

CBT during curative cancer treatment resulted in less fatigue compared to the BNI and UC groups. The mediation hypothesis was rejected.

• The majority of patients were from the university hospital.
• Contamination could have occurred.
• The BNI intervention by the nurses consisted only of two one-hour sessions and a booklet, whereas the CBT intervention consisted of up to ten one-hour sessions over six months with trained therapists given a protocol and supervision every two weeks with case discussions, with the nurses being less experienced than the therapists.
• Actometer and self-report data were not obtained for all patients.

Further study is warranted to determine the effects of specific nursing interventions on the experience of fatigue in patients with cancer.