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Adapting an Evidence-Based Intervention to Address Targeted Therapy–Related Fatigue in Chronic Myeloid Leukemia Patients

Poort, Hanneke MSc; Meade, Cathy D. PhD, RN, FAAN; Knoop, Hans PhD; Gielissen, Marieke F.M. PhD; Pinilla-Ibarz, Javier MD, PhD; Jacobsen, Paul B. PhD

doi: 10.1097/NCC.0000000000000446

Background: Fatigue is one of the most important quality of life issues experienced by patients being treated with oral targeted therapy for chronic myeloid leukemia (CML). However, no intervention exists that specifically addresses strategies to reduce targeted therapy–related fatigue.

Objective: This study adapted an evidence-based clinic-delivered intervention (EBI) “cognitive behavior therapy for post-cancer fatigue” for use in CML patients. The existing EBI was based on 6 established perpetuating factors of fatigue (ie, sleep, activity, helpful thinking, coping with cancer, social support, and fear of disease recurrence). Study aims were to gauge reactions to (1) existing content and (2) a new Internet-assisted intervention delivery format.

Methods: Guided by the ADAPT-ITT framework, we used a series of systematic steps and adaptation methodologies, including semistructured interviews with CML patients and providers and feedback from topical experts.

Results: Patients were receptive to existing content topics and an Internet-assisted delivery format was acceptable. A key theme reflected the need for a new customized psychoeducational module about CML as a disease and its treatment. Both providers and patients held positive views about the potential of the adapted EBI to improve fatigue.

Conclusions: Findings offered essential guidance for the adaptation and reinforced the utility of the adapted intervention.

Implications for Practice: Adapting existing EBIs for new audiences contributes to advancing findings of evidence-based research, ultimately providing nurses and other healthcare providers with important referral options to interventions that may provide useful strategies to improve quality of life and reduce targeted therapy–related fatigue.

Author Affiliations: Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, the Netherlands (Ms Poort and Drs Knoop and Gielissen); Division of Population Science, Department of Health Outcomes and Behavior (Drs Meade and Jacobsen), Department of Malignant Hematology (Dr Pinilla-Ibarz), H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (Drs Knoop and Gielissen).

This study was supported by grant no. R21CA191594 from the National Institutes of Health (Paul B. Jacobsen, principal investigator). Hanneke Poort was supported by a travel grant from the Dutch Cancer Society.

The authors have no conflicts of interest to disclose.

Correspondence: Hanneke Poort, MSc, Expert Center for Chronic Fatigue, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (

Accepted for publication August 30, 2016.

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