Lee, H., Lim, Y., Yoo, M. S., & Kim, Y. (2011). Effects of a nurse-led cognitive-behavior therapy on fatigue and quality of life of patients with breast cancer undergoing radiotherapy: an exploratory study. Cancer Nursing, 34, E22–E30.

To examine the effects of nurse-led cognitive-behavior therapy (CBT) on fatigue and quality of life (QOL) experienced by patients with breast cancer who were currently undergoing radiotherapy.

An oncology nurse-led six-week intervention program that included cognitive restructuring, education about breast cancer and medical treatment, relaxation therapy, and rehabilitation exercise was offered to women receiving radiation therapy at a university hospital in Korea. Nurses who led the course attended the beginner’s course of CBT for 36 hours.

• In total, 71 patients (71% female) were included.           
• Age ranged from 25 to 60 years.
• Patients had breast cancer.
• Of the patients, more than half had a partial mastectomy, 93% had no family history of breast cancer, and nearly half had received chemotherapy.

Single site

Patients were undergoing the active antitumor treatment phase of care. 

The study used a quasiexperimental pre-/posttest design with a nonequivalent control group.

• Korean version of the Revised Piper Fatigue Scale (PFS)
• QOL Scale for Korean Patients With Cancer

Levels of fatigue increased in both groups at the posttests. Increases in the levels of fatigue were greater in the control group than in the experimental group. Levels of QOL increased in the experimental group and decreased in the control group.

Nurse-led CBT did not show a significant effect in reducing the levels of cancer-related fatigue, although the increments of fatigue were significantly lower than the control group. Nurse-led CBT was effective in increasing QOL.

• The study had a small sample size, with less than 100 patients.
• The study had a risk of bias due to no blinding.
• Findings were not generalizable
• Intervention expensive, impractical, or training needs.
• Authors mentioned seasonal influence – fatigue is exacerbated in the winter and alleviated in the summer.

There is a role for oncology nurses to lead a structured cognitive-based intervention program to help alleviate cancer-related fatigue in women with breast cancer receiving radiotherapy.