Yun, Y. H., Lee, K. S., Kim, Y. W., Park, S. Y., Lee, E. S., Noh, D. Y., . . . Park, S. (2012). Web-based tailored education program for disease-free cancer survivors with cancer-related fatigue: a randomized controlled trial. Journal of Clinical Oncology, 30, 1296–1303.

To determine if an internet-based, tailored, psychoeducational program was effective in the management of fatigue and other symptoms for patients with cancer-related fatigue.

Patients were randomly assigned to a tailored, web-based, health navigation program or usual care. The 12-week intervention program covered energy conservation, physical activity, nutrition, sleep hygiene, pain control, and distress management. The program included online education, health advice, message services, caregiver monitoring, and support and educational sessions. Principles of cognitive-behavioral therapy were used in the program design. The program was provided via a health navigation web site. Study measures were obtained at baseline and at the end of 12 weeks. Intention-to-treat (ITT) analysis was performed using the last observation carried forward for missing values.

• In total, 243 patients (23% male, 77% female) were included.    
• Mean age was not provided; 53.5% of the patients were 45 years or older. 
• Multiple tumor sites were included, with 38.6% being breast cancer.
• Slightly greater than 94% of the patients had completed high school or higher education. 
• Global Brief Fatigue Inventory (BFI) scores at baseline were an average of 4.13 across the study groups. 
• At baseline, mean anxiety score was 6.46 and mean depression score was 5.7. 
• All patients had fatigue scores at baseline of 4 or greater for at least one week and had completed primary treatment within the past 24 months.

• Single site 
• Home 
• South Korea

The study was a randomized, controlled trial with a wait-list control.

• BFI
• Health-related quality of life (HRQOL)
• European Organization for Research and Treatment of Cancer Quality of Life Questionnare (EORTC QLQ-C30)
• Hospital Anxiety and Depression Scale (HADS)
• Brief Pain Inventory (BPI)
• Mini Nutritional Assessment (MNA)
• Medical Outcomes Study (MOS) Sleep Scale

The intervention group had a significantly larger reduction in fatigue scores (p = 0.0011), with an effect size of 0.29 (Cohen’s d). The intervention group also had a greater improvement in anxiety score and several quality of life–related scale scores (p < 0.05). Multiple variables were statistically significant predictors of change in fatigue scores.

Health navigation, the psychoeducational intervention used here, had a slight to moderate positive effect in reducing fatigue.

• The study had risks of bias due to no blinding and no appropriate attentional control condition.
• Key sample group differences could have influenced the results.
• Patient withdrawals were 10% or greater. The patient withdrawal rate was 29% overall and 31% in the intervention group.
• At baseline, BFI scores were lower in the intervention group, so the method of ITT analysis may have overestimated the lower fatigue scores at follow-up for this group.
• The withdrawal and loss to follow-up rate in the intervention group suggested that the intervention may not be well received by several patients.

The findings suggested that a psychoeducational program delivered via a web-based program may be helpful for some patients for the management of fatigue. Although the study was limited by a high withdrawal rate in the intervention group, the majority of patients continued with the program. This may be a practical approach that is helpful to some patients. Further research in the area of facilitating and encouraging patient participation in such programs would be useful.