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Cognitive Behavior Therapy for Persistent Severe Fatigue in Childhood Cancer Survivors

A Pilot Study

Boonstra, Amilie, MSc*; Gielissen, Marieke, PhD; van Dulmen-den Broeder, Eline, PhD; Blijlevens, Nicole, MD, PhD*; Knoop, Hans, PhD§,∥; Loonen, Jacqueline, MD, PhD*

Journal of Pediatric Hematology/Oncology: May 2019 - Volume 41 - Issue 4 - p 313–318
doi: 10.1097/MPH.0000000000001345
Medical Progress

Objectives: Fatigue is a common and disabling late effect in childhood cancer survivors (CCS). In this pilot study, the effectiveness of cognitive behavior therapy (CBT) in CCS with persistent and severe fatigue was retrospectively evaluated.

Materials and Methods: In total, 33 consecutively referred CCS with persistent severe fatigue were offered CBT. The primary outcome was fatigue severity (Checklist Individual Strength, Fatigue Severity Subscale). Secondary outcomes were functional impairment, psychologic distress, and quality of life (QoL).

Results: In total, 25 CCS completed CBT (76%). The mean age of CCS was 23.1 years (range, 11 to 42 y), mean age at primary cancer diagnosis was 9.7 years (range, 0 to 17 y), and mean time since primary cancer diagnosis was 13 years (range, 5 to 34 y). Fatigue severity ([INCREMENT] 17.4; confidence interval (CI)=12.7-22.1; P<0.001), functional impairment (SIP8 [INCREMENT] 470.3; CI=312.3-628.4; P<0.001/SF36 [INCREMENT] 11.7; CI=17.2-6.3; P<0.001), and psychologic distress ([INCREMENT] 26.4; CI=15.6-34.9; P<0.001) were significantly decreased at second assessment. QoL ([INCREMENT] 13.5; CI=22.0-4.3; P=0.005) was significantly improved. A total of 23 CCS of the 33 CCS (70%) met the criteria for clinically significant improvement of fatigue.

Conclusions: In this pilot study, the majority of severely fatigued CCS showed a clinically significant reduction in fatigue following CBT. Moreover, daily function and QoL improved, and psychologic distress decreased.

*Department of Hematology

Department of Primary and Community Care, Radboud University Medical Center, Nijmegen

Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center

§Department of Medical Psychology, Academic Medical Center (AMC), Amsterdam Public Health Research Institute, University of Amsterdam

Department of Medical Psychology, Expert Center for Chronic Fatigue, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands

The authors declare no conflict of interest.

Reprints: Jacqueline Loonen, MD, PhD, Department of Hematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands (e-mail:

Received August 28, 2017

Accepted September 24, 2018

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