[CBT] for Cancer-Related Fatigue: A Comparison Between Patients Treated With Curative Intent and Patients With Advanced Cancer 2025 Knoop et al

[Andy]

ABSTRACT​

Background​

Cancer-related fatigue (CRF) is prevalent in patients who have been treated with curative intent and patients with advanced cancer. Cognitive behavioral therapy (CBT) has been shown effective in reducing CRF in both groups.

Aims​

To compare both groups with respect to: (1) pre-treatment levels of fatigue and fatigue-perpetuating cognitive-behavioral factors; (2) the magnitude of the effect of CBT on fatigue; and (3) mediators of the treatment response.

Methods​

Data of four randomized controlled trials testing the efficacy of CBT for CRF were pooled, three in patients treated with curative intent (n = 249), and one in patients with advanced cancer (n = 134). Baseline characteristics were compared with ANCOVAs. Moderation analysis was used to investigate whether the treatment effect differed between groups. With moderated mediation analyses differences in the mechanisms by which CBT reduces fatigue were evaluated.

Results​

The two groups differed significantly at baseline on fatigue-perpetuating factors, but not on fatigue severity. Patients with advanced cancer reported a smaller decrease in fatigue severity following CBT than patients treated with curative intent (p = 0.022). The multivariate moderated mediation analysis showed a larger decrease in fatigue catastrophizing in patients treated with curative intent than in patients with advanced cancer.

Conclusion​

CBT for CRF has less effect on catastrophizing, a known fatigue-perpetuating factor and mediator of the effect of CBT, and fatigue severity in patients with advanced cancer. Further research has to determine if the effectiveness of CBT for CRF in advanced cancer patients can be improved.

Open access

 

[Utsikt]

Data of four randomized controlled trials (RCTs) testing the efficacy of CBT for CRF were pooled and re-analyzed. Three RCTs evaluated the efficacy of CBT on fatigue severity in patients who have been treated with curative intent.

So a teeny tiny meta analysis of their own terrible trials, of course without any assessment of methodological quality or risk of bias.

Let’s do it for them:

In the trial by Gielissen and colleagues [12], patients were randomly assigned 1:1 to CBT or a waitlist control.

So open label, subjective outcomes and waitlist control. Worthless.

In the trial by Prinsen and colleagues [13] patients were assigned 3:1 to either CBT or the waitlist control group.

The same as the previous one. Worthless.

Abrahams' study [4] compared internet-based CBT (I-CBT) to care as usual in severely fatigued breast cancer survivors, with a 1:1 ratio.

Open label, A+B vs A so no real control. Worthless.

One RCT evaluated the efficacy of CBT for CRF in patients with advanced cancer: Poort and colleagues [1] compared CBT and graded exercise therapy (GET) with usual care for CRF, randomizing patients 1:1:1.

Worthless.

This is the only one I checked the numbers for. They used CIS-fatigue, and got a reduction between groups (CBT vs CAU) of 7.2, while the MCID is 9-10.

Knoop continues to challenge for the spot of the worst researcher in the Netherlands..

 

[bobbler]

Catastrophising being “a known perpetuating factor in fatigue”

That’s a lie and a distortion of what they actually measure which is their own coercion and manipulation of people’s responses but not the fatigue itself just their fear to be honest - which to me is silencing and mental health harm/psychological invalidation and isolating people

When I see them move into turf like cancer it just makes me hope and think that they might get called out finally if it’s victims they’ve a harder time telling others’ that their testimony is inaccurate for

But my faith is no longer that things might get more moral or truthful rather than the opposite at the moment and in near future given the increased in amount, boldness and untruthfulness of the type of propaganda charading as ‘research’ eg from bps/psychosomatic sellers these days, and other groups who came from propaganda but are now nicking those same tricks to do fake research etc to make dodgy inferential claims

Maybe that’s behind the mission creep or even more scary is the chance these people genuinely have convinced themselves of the beliefs. I still get scared of some of the self-convincing circular self-talk not completing circles pseudo philosophy in the Heins et al (2013) paper on which Knoop was an author. That year seems to hold a particular vintage for a few papers with conclusions and recommendations don’t follow from the results…

 

[Trish]

This seems to me cruel and unethical. Not only inflicting CBT on people with terminal cancer, but expecting them to fill in ridiculous catastrophising questionnaires.

 

[rvallee]

Mythbusters were much more serious and rigorous about their experiment, and it was a comedy TV show. It's not even close either. Mainly because they wanted to know what was true or not, not prove their hunches right. For entertainment. Here they do it with lives at stake and they take it even less seriously.

This is no longer embarrassing just for those involved. It's the entire systems that perpetuate this junk pseudoscience that deserve all the blame. The medical profession has zero credibility objecting to quacks like RFK Jr, and it must be noted that his team involves several actual MDs, or at least have a medical degree in the case of Bhattacharya (which comically Firefox wants to correct as Charlatanry) at the NIH, when they keep supporting junk of equal worthlessness like this. Praising it. Gushing over it. Lying about what it says, bullshitting about what it means.

And Trish is right, this is simply cruel. It's abject cruelty, even. This should be deserving of all the contempt in the world.

The two groups differed significantly at baseline on fatigue-perpetuating factors, but not on fatigue severity. Patients with advanced cancer reported a smaller decrease in fatigue severity following CBT than patients treated with curative intent (p = 0.022).

Junk statements like this are just ridiculous. There were not "two groups", they pooled different cohorts, they are making very spurious comparisons as always, and they can't seem to reason out why the second sentence is true, even though it tells them everything they need to know.

 

[Utsikt]

Mythbusters were much more serious and rigorous about their experiment, and it was a comedy TV show. It's not even close either. Mainly because they wanted to know what was true or not, not prove their hunches right. For entertainment. Here they do it with lives at stake and they take it even less seriously.

The people watching took it more seriously as well. They didn’t get away with the few mistakes they made, because people would write in an let them know.