Review Effects of acceptance and commitment therapy on fatigue for patients with cancer and other chronic health conditions: 2023 Maunick et al

Abstract

Objective
Fatigue is significantly more prevalent in the chronically ill compared to healthy individuals. Fatigue is one of the most reported and debilitating symptoms in individuals with chronic health conditions. Despite this, there is limited evidence examining the efficacy of psychological interventions to reduce fatigue, with the majority having focused on Cognitive Behaviour Therapy. As Acceptance and Commitment Therapy (ACT) has shown to be efficacious in improving other outcomes for people with chronic health conditions, this systematic review and meta-analysis aimed to determine the efficacy of ACT in reducing fatigue for this population.

Methods
A systematic search in MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, US National Library of Medicine Clinical Trial Register and reference lists of relevant papers was conducted to obtain relevant studies. Inclusion criteria specified the study needed to be a randomised controlled trial which implemented an ACT predominant intervention and measured fatigue in adults with a chronic health condition. Data was pooled using the inverse-variance random effects model, with restricted maximum likelihood estimation, providing the standardized mean difference between control and experimental groups post intervention.

Results
The current systematic review and meta-analysis included eight RCTs. Participants with a chronic condition (including cancer and fibromyalgia) who received ACT interventions, displayed reduced levels of fatigue, indicative of a small effect (SMD = −0.16, 95% CI [−0.30, −0.01], p = 0.03).

Conclusion
While the evidence is limited to cancer and fibromyalgia, ACT shows promise in reducing fatigue. Future research should examine ACT for fatigue in other chronic health condition populations to broaden the scope of these findings.

Paywall but with "Section snippets", https://www.sciencedirect.com/science/article/abs/pii/S0022399923002234

 

"Direction for future research

The limitations of the current review provide important insights into directions for future research. It is recommended that future trials expand upon the current findings through examining other chronic health condition populations experiencing significant fatigue symptomology, such as Chronic Fatigue Syndrome, Inflammatory Bowel Disease and Major Depressive Disorder, which were not represented in this review. Future trials should also screen participants at baseline, to include those with..."

 

I don’t have any wish to waste time reading the actual paper, especially as I anticipate the experimental design(s) is such that meaningless positive results are guaranteed, however I wonder how it is possible to consider to address this anyway in such as cancer where fatigue will vary over the course of the illness and its treatment.

No one in their right mind would be offering psychotherapy for fatigue over and above general support to a cancer patient pre treatment or even during active treatment, especially during chemo, or for those left with ongoing terminal conditions, unless the individual felt a very strong need for such support, given any potential impact on fatigue would be overshadowed by the changing medical status and such patients have other overwhelming demands on their time and energy. Presumably this only leaves those who are post treatment and in remission, but do we know what percentage experience ongoing fatigue and of those what percentage experience spontaneous remission of that fatigue.

Given medicine’s current limited understanding of ‘fatigue’ what are we actually talking about on the spectrum from general tiredness to full blown ME/CFS with multiple symptoms of which fatigue is only a minor component in relation to post successful treatment cancer patients. If the former then would psychotherapy be any better than general convalescence, involving rest and good food in pleasant circumstances and if the latter surely addressing the specific symptoms would be more appropriate.

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