van der Lee, M. L., & Garssen, B. (2012). Mindfulness-based cognitive therapy reduces chronic cancer-related fatigue: a treatment study. Psycho-Oncology, 21, 264–272.

To evaluate the efficacy of group mindfulness-based cognitive therapy (MBCT) in reducing fatigue in cancer survivors with mixed diagnoses.

Randomization and assignment to either the intervention condition or the wait-list condition was performed one week prior to the start of each group. Fatigue severity (Checklist Individual Strength [CIS]), functional impairment (Sickness Impact Profile [SIP]), and well-being (Health and Disease Inventory) were assessed before and after the nine-week intervention. The intervention group had a follow-up six months after the intervention.

Eighty-three patients (32% male, 68% female) were included. All cancer types were included; more than half of the patients had breast cancer. Three patients had a history of two types of cancer. 

Patients were included if 

• Completion of their last anticancer treatment (all cancer types accepted) was at least one year prior
• They were curatively treated
• They were 18 years or older
• They scored 35 or greater on the severity of fatigue subscale of the self-report CIS
• There was no other somatic disease or medicine use that could explain or influence fatigue. 

Patients were excluded if they were seen on intake by one of two therapists for assessment of psychiatric morbidity or if they were identified to be at risk for psychosis or severe depression.

• Single site   
• Helen Dowling Institute, Netherlands

• Patients were undergoing the long-term follow-up phase of care.
• The study has applicability for late effects and survivorship.

The study used a pre- and postrandomized, controlled trial design.

• CIS   
• SIP
• Health and Disease Inventory
• Sleep Quality Scale (SQS)
• Hospital Anxiety and Depression Scale (HADS)
   

Ninety-one percent of all participants attended at least seven sessions; the mean number of sessions attended was eight. One-third (30.6%) of all participants suffered from sleep disturbances at follow-up, and 39% in the intervention group showed clinically relevant improvement in fatigue severity. Fatigue severity postintervention was 35.7 in the intervention group compared to 43.4 in the control group (p = 0.00). The effect size for fatigue was 0.74 (d) (no confidence interval was provided for effect size). The mean well-being score at postmeasurement was significantly higher in the intervention group than in the wait-list group. Six months after the intervention, participants in both groups reported significantly less fatigue severity. There was no difference between groups in fatigue at six months.

MBCT was effective in the short term for chronic cancer-related fatigue (CCRF). Longer-term follow-up showed no differences with mindfulness-based stress reduction versus the controls.

• The study lacked an appropriate control group.
• The study had limited generalizability to other therapists, as the same two therapists led all groups.
• The protocol that the therapists used was not assessed for adherence.
• There were unequal numbers of participants in the two condition groups.
• Heterogenicity of the sample and the small sample size limited the control of confounding medical variables.
• Limited economic resources exist for program development in support of a standardized practice for therapist-led sessions at local cancer centers. 
• The study lacked an attentional control. 
• Timing of the first posttest measure was not stated, so it was not clear if any effects were lasting.

MBCT is an acceptable and potentially effective treatment for CCRF. Additional better randomized, controlled trials of the intervention should be conducted prior to routinely referring to MBCT therapists.