Potential mechanisms of the fatigue‐reducing effect of [CBT] in cancer survivors: Three randomized controlled trials, 2021, Mueller, Knoop et al

[Andy]

Full title: Potential mechanisms of the fatigue‐reducing effect of cognitive‐behavioral therapy in cancer survivors: Three randomized controlled trials

Abstract

Objective
Fatigue is a common symptom among cancer survivors that can be successfully treated with cognitive‐behavioral therapy (CBT). Insights into the working mechanisms of CBT are currently limited. The aim of this study was to investigate whether improvements in targeted cognitive‐behavioral variables and reduced depressive symptoms mediate the fatigue‐reducing effect of CBT.

Methods
We pooled data from three randomized controlled trials that tested the efficacy of CBT to reduce severe fatigue. In all three trials, fatigue severity (checklist individual strength) decreased significantly following CBT. Assessments were conducted pre‐treatment and 6 months later. Classical mediation analysis testing a pre‐specified model was conducted and its results compared to those of causal discovery, an explorative data‐driven approach testing all possible causal associations and retaining the most likely model.

Results
Data from 250 cancer survivors (n=129 CBT, n=121 waitlist) were analyzed. Classical mediation analysis suggests that increased self‐efficacy and decreased fatigue catastrophizing, focusing on symptoms, perceived problems with activity and depressive symptoms mediate the reduction of fatigue brought by CBT. Conversely, causal discovery and post‐hoc analyses indicate that fatigue acts as mediator, not outcome, of changes in cognitions, sleep disturbance and depressive symptoms.

Conclusions
Cognitions, sleep disturbance and depressive symptoms improve during CBT. When assessed pre‐ and post‐treatment, fatigue acts as a mediator, not outcome, of these improvements. It seems likely that the working mechanism of CBT is not a one‐way causal effect but a dynamic reciprocal process. Trials integrating intermittent assessments are needed to shed light on these mechanisms and inform optimization of CBT.

Paywalled, https://onlinelibrary.wiley.com/doi/10.1002/pon.5710

 

[rvallee]

Psychosomatic papers read more and more like marketing brochures each year. There is clearly no serious process of peer review going on.

 

[Snowdrop]

Is there anyone with access to this paper? I would like to know who funded it.

 

[TigerLilea]

I would like to know who funded it.

Funding was from "The Dutch Cancer Society" (KWF Kankerbestrijding) and the "Pink Ribbon Foundation" (a UK charity for breast cancer).

 

[TigerLilea]

Having been through cancer treatment, this is a load of nonsense. As my two oncologists explained to me the fatigue is a result of the body trying to heal itself from the effects of the radiation and/or chemo treatment.

 

[Hoopoe]

Maybe Fluge and Mella could weigh in on these comparisons of CBT between cancer and ME.

 

[Mithriel]

Having been through cancer treatment, this is a load of nonsense. As my two oncologists explained to me the fatigue is a result of the body trying to heal itself from the effects of the radiation and/or chemo treatment.

Cancer treatments are very harsh, never mind the damage from the disease itself. Basically, they are reframing all the physical symptoms as psychological by calling them "fatigue catastrophizing, focusing on symptoms, perceived problems with activity and depressive symptoms".

 

[shak8]

Why do psychs think that people need to be led like toddlers through the CBT wicket?

Isn't fatigue due to cancer something you can figure out for yourself by trial and error. Must we start eating CBT with every meal?

 

[Esther12]

Conversely, causal discovery and post‐hoc analyses indicate that fatigue acts as mediator, not outcome, of changes in cognitions, sleep disturbance and depressive symptoms.

Not read this paper, but that reminded me of @Simon M 's letter on PACE mediation.

 

[rvallee]

Why do psychs think that people need to be led like toddlers through the CBT wicket?

Isn't fatigue due to cancer something you can figure out for yourself by trial and error. Must we start eating CBT with every meal?

The alternative is that medicine still has a whole lot of learning to go through and meanwhile is doing a whole lot of silly harmful things. Which is readily accepted when it doesn't matter. Never is when it does matter, though. How convenient. In hindsight it's we all make mistakes, before that though it's unthinkable that even the idea of a mistake could occur.

 

[Sean]

Psychosomatic papers read more and more like marketing brochures each year. There is clearly no serious process of peer review going on.

Yep. Peer-review is clearly badly broken in this area of medicine. (Not every journal and reviewer, of course, but as a whole.)

Cancer treatments are very harsh, never mind the damage from the disease itself.

Cancer treatment is still basically cut (surgery), poison (chemotherapy), or burn (radiation).

A close friend of mine died last year from Hodgkins lymphoma. After a couple rounds of chemo she said she couldn't do any more of it, and decided to let nature take its course. Yeah, it was that horrible.

She was also one of the most positive constructive pragmatic people I ever met. So much for having the 'right attitude'.

 

[Amw66]

Yep. Peer-review is clearly badly broken in this area of medicine. (Not every journal and reviewer, of course, but as a whole.)

Cancer treatment is still basically cut (surgery), poison (chemotherapy), or burn (radiation).

A close friend of mine died last year from Hodgkins lymphoma. After a couple rounds of chemo she said she couldn't do any more of it, and decided to let nature take its course. Yeah, it was that horrible.

She was also one of the most positive constructive pragmatic people I ever met. So much for having the 'right attitude'.

You had a brave friend.
I do wonder if risk and side effects are properly explained for chemo.

One of my aunts in her 80s died this year from cancer. She agreed to chemo as it is the treatment pathway everyone knows of. She was not prepared for the side effects and the fact that it would potentially only provide a few more weeks.
Chemo was horrific and the few weeks gained had low quality of life.

Another relative in their 80s with the same type of cancer is not being offered chemo at all, nor surgery.

After some shock as they expected to be offered these options, they are fine with the outlook and ticking off the bucket list as best they can. I think seeing friends in similar situations has informed this.

Sorry for taking this off thread