Cancer-related fatigue is a distressing and disabling symptom. When cancer-related fatigue persists beyond the treatment period and is unexplained by alternative medical or psychiatric conditions, it is termed post-cancer-fatigue (PCF)1.
Since currently no clear understanding of the aetiological basis of PCF exists and no effective prevention or treatment strategy has been defined, a pragmatic approach to intervention is required based on existing evidence for management of patients with chronic fatigue syndromes. It’s likely that cognitive-behavioural therapy (CBT)2,coupled with graded exercise therapy (GET)3 will improve functional outcomes. A randomised control trial - Treatment of Post-cancer fatigue Study has been developed assigning patients to receiving either an education intervention (n=50), or a 12-week supervised (by exercise physiologist and clinical psychologist), GET and CBT intervention (n=50). The intervention arm is based on the successful Fatigue Clinic program developed by the Lifestyle Clinic. Potential subjects are screened for clinically-significant fatigue at 3 months post successful-treatment for breast or bowel cancer.
Protocols and ethics applications have been established. Recruitment began recently with 83 potential participants approached. Current recruitment sites include Prince of Wales public (n=33) and private hospitals (n=23), St George public and private hospitals (n=5), Register4 website (n=9) and various private consulting rooms (n=13). 43 patients have been screen with 16 (37%) eligible and 8 enrolled most of whom are female (n=15) with breast cancer (n=15). Of the 27 (63%) ineligible patients mostly with breast cancer (n=20) and female (n=22), major reason for exclusion was reporting not clinically significant fatigue (44%). 36 patients remain to be screened and 4 have been lost to follow-up. The limitations with recruitment numbers to date reflect recent findings that the rate of post-cancer fatigue is not as high as previously thought. Focusing on identification of patients who are at higher risk of sustained fatigue may be beneficial.4