Are the effects of cognitive behavior therapy for severe fatigue in cancer survivors sustained up to 14 years after therapy?

[Dolphin]

Free full text:
https://link.springer.com/article/10.1007/s11764-018-0690-z

Some of these researchers are active in the CFS field


Journal of Cancer Survivorship

pp 1–9| Cite as

Are the effects of cognitive behavior therapy for severe fatigue in cancer survivors sustained up to 14 years after therapy?

• Authors
• Authors and affiliations

• Lidewij D. Van Gessel
• Harriët J. G. Abrahams
• Hetty Prinsen
• Gijs Bleijenberg
• Marianne Heins
• Jos Twisk
• Hanneke W. M. Van Laarhoven
• Stans C. A. H. H. V. M. Verhagen
• Marieke F. M. Gielissen
• Hans Knoop Email author

• Open Access

Article
First Online: 12 April 2018

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Abstract
Purpose
Cognitive behavior therapy (CBT) reduces cancer-related fatigue (CRF) in cancer survivors in the short term. We examined fatigue levels up to 14 years after CBT.

Methods
Eligible participants of two randomized controlled trials who had completed CBT for CRF and a post-treatment assessment were contacted (n = 81). Fatigue was assessed with the subscale “fatigue severity” of the Checklist Individual Strength (CIS-fatigue). The course of fatigue over time was examined with linear mixed model analyses. Fatigue levels of participants were compared to matched population controls at long-term follow-up. We tested with multiple regression analysis if fatigue at follow-up was predicted by the patients’ fatigue level and fatigue-perpetuating factors directly after CBT (post-CBT).

Results
Seventy-eight persons completed a follow-up assessment (response rate = 96%, mean time after CBT = 10 years). The mean level of fatigue increased from 23.7 (SD = 11.1) at post-CBT to 34.4 (SD = 12.4) at follow-up (p < 0.001). Population controls (M = 23,9, SD = 11.4) reported lower fatigue levels than participants. Half of the patients (52%) who were recovered from severe fatigue at post-CBT (CIS-fatigue < 35) were still recovered at long-term follow-up. Patients with lower fatigue levels at post-CBT were less likely to show relapse.

Conclusion
Despite initial improvement after CBT, levels of fatigue deteriorated over time. Half of the patients who were recovered from severe fatigue after CBT still scored within normal ranges of fatigue at long-term follow-up.

Implications for Cancer Survivors
It should be explored how to help patients with a relapse of severe fatigue following an initially successful CBT. They may profit from CBT again, or another evidence-based intervention for fatigue (like mindfulness or exercise therapy). Future research to gain insight into reasons for relapse is warranted.

Keywords
Cognitive-behavioral therapy Cancer-related fatigue Cancer survivors Long-term follow-up

 

[John Mac]

It should be explored how to help patients with a relapse of severe fatigue following an initially successful CBT.

Or what should we do when the brain-washing wears off.

 

[Cinders66]

I personally can't understand why anyone would think that CBT should help with fatigue caused by cancer or aggressive treatment. Is this The assumption the fatigue can be behavioured away or is caused by psychological factors? If it is I think it's wrong. It seems a rotten platform for understanding fatigue in illness and we have had the sharp end of it.
Mindfulness and exercise aren't magic treatments either

 

[John Mac]

I personally can't understand why anyone would think that CBT should help with fatigue caused by cancer or aggressive treatment.

I honestly think that CBT is just a service offered by psychiatrists to doctors allowing them to get rid of patients who they can't help but who keep coming back to them asking for help.

 

[Snow Leopard]

Is this The assumption the fatigue can be behavioured away or is caused by psychological factors?

From the manuscript:

The cognitive-behavioral model of CRF makes a distinction between precipitating and perpetuating factors of fatigue. It is assumed that cancer and its treatment trigger fatigue, but that cognitive and behavioral factors perpetuate it. Six perpetuating factors are distinguished: (1) insufficient coping with the experience of cancer, (2) excessive fear of disease recurrence, (3) dysfunctional cognitions concerning fatigue, (4) deregulation of the sleepwake pattern, (5) deregulation of activity or low activity, and (6) perceived lack of social support and negative social interactions [4].

There are several possible explanations for the deterioration after successful treatment of CRF: it is possible that patients who developed CRF after being treated for cancer had a pre-existent vulnerability for developing fatigue in response to a stressor, i.e., a serious somatic illness like cancer. According to the cognitive-behavioral model of CRF, cancer and its treatment trigger the fatigue but the fatigue perpetuates due to cognitive-behavioral factors. Perhaps patients remain vulnerable for developing fatigue in response to stressors. The likelihood to encounter one or more serious stressors will increase over time, this may explain the partial relapse at long-term follow-up with sustained treatment effects at the follow-up 2 years post-treatment. This vulnerability could also be caused by cancer and its treatment; up to date, it is largely unclear how biological processes influence the mechanisms underlying CRF and its persistence. It could be that CBT for CRF addresses the fatigue but does not change an underlying somatic vulnerability which makes cancer survivors prone to develop severe fatigue. An alternative explanation is that patients relapse into dysfunctional coping in response to “everyday” fatigue, and dysfunctional behaviors and cognitions eventually lead to severe and persistent fatigue. Our outcome measure at long-term follow-up was restricted to fatigue severity. Measurement of scores on fatigue-perpetuating factors would have been valuable as well. Insight in these factors at long-term follow-up would enable us to test whether deterioration of fatigue scores is associated with changes in the perpetuating factors over time.

Notice the language used: "assume" "possible" "perhaps" "could".

The simplest conclusion is that there is no long term effect of CBT on chronic fatigue, regardless of the underlying cause.

 

[Cheshire]

(1) insufficient coping with the experience of cancer

I can imagine the "therapist" explaining a cancer survivor; "you've just been so loosy at coping with a life threatening illness with difficult to bear side effects, you know".
Of course there are people who cope better than others with cancer, but using the word "insufficient" is just infuriating.
I am really starting to wonder what the skills to become a psychotherapist are.

 

[Snow Leopard]

I am really starting to wonder what the criteria to become a psychotherapist are.

Coping with cancer is just a walk in the park these days. Didn't you know? It says right here in my psychotherapist training manual.

 

[Indigophoton]

It could be that CBT for CRF addresses the fatigue but does not change an underlying somatic vulnerability which makes cancer survivors prone to develop severe fatigue.

So once again they acknowledge that CBT can change perceptions without influencing the underlying biology.

 

[Cinders66]

From the manuscript:





Notice the language used: "assume" "possible" "perhaps" "could".

The simplest conclusion is that there is no long term effect of CBT on chronic fatigue, regardless of the underlying cause.

It is just bullshit. The model is wrong, it's dangerous to assume anything, how does it haveany place in the science world why is this not seem as the baloney it is. I hadn't read this paper but have read many others on illness CBT claims to treat where medicine can't, ugh.
At least they recognise that cancer and treatment itself might have caused some somatic processes that CBT doesn't address (YOU DONT SAY ) but then they relapse into their dysfunctional coping, behaviour and cognitions causing the fatigue .,.,

Given that I doubt cancer fatigue is anywhere as disabling as CFS, these people are still living semi normal lives , they've got to be really anxious, hyperchondriac, dysfunctional to be causing pervasive life limiting fatigue and I bet they're not.

 

[Marco]

'Lily the Pink' should sue them for intellectual property theft.

 

[Sly Saint]

Are the effects of cognitive behavior therapy for severe fatigue in cancer survivors sustained up to 14 years after therapy?

Conclusion
Despite initial improvement after CBT, levels of fatigue deteriorated over time. Half of the patients who were recovered from severe fatigue after CBT still scored within normal ranges of fatigue at long-term follow-up.

In other words, the answer to the question is 'No'

 

[Amw66]

I have nit read the paper so this may be bullshit, but if these people still had cancer why would they not be fatigued.

Cancer highjacks metabolic processes ( there are striking similarities to glucose mechanisms with some pwme) , immune processes etc - if these do not return fully to normal ( are there any studies on this?), then why would fatigue itself change- you can only kid yourself on about how you perceive it for so long...

Most people i know who have had cancer have seen it return elsewhere at a later date.

 

[Lidia]

Interesting use of the word “profit” in the Implications section. “Benefit” would be more appropriate. Freudian slip?

 

[alktipping]

So once again they acknowledge that CBT can change perceptions without influencing the underlying biology.

where is the proof that cbt addresses the fatigue self report forms are not proof.

 

[Sean]

Notice the language used: "assume" "possible" "perhaps" "could".

An old propaganda trick, found in many of their CFS/ME papers.

Another trick to watch out for is the language of certainty/risk, etc, changing throughout a paper.

 

[Esther12]

These researchers also released a paper showing null results for actimeters with CBT for CRF, and I remember their justifications for that being pretty funny.