Medically-unexplained chronic fatigue states inlcude Post-Cancer Fatigue (PCF)1 and Chronic Fatigue Syndrome (CFS)2. Both have similar natural history and clinical characteristics including complaints of fatigue, neurocognitive difficulties, disturbances in sleep and mood. Evidence suggests multi-disciplinary interventions incorporating cognitive-behaviour therapy, activity pacing, and graded exercise improves symptoms and functional status3-6.
An outpatient program was established with research components aimed at optimizing the intervention. The 12-week program includes independent treatment modules delivered by exercise physiologists and clinical psychologists to form an integrated approach, including four core modules: Activity pacing and Graded exercise therapy; Psycho-education; Interventions for sleep-wake cycle disturbance; and Interventions for neurocognitive disturbance. Additionally three optional modules targeting: Depression, Anxiety, and Coping. Regular case discussions are conducted between clinicans and expert medical practitioners.
Outcomes at 12 and 24-weeks for the first 155 patients (CFS=146; PCF=9) have been analysed. Subjects included 106 women (68%), with mean age of 36 years, a mean duration of illness of 5.2 years. By both intention-to-treat and complete dataset analyses significant improvements were recorded at 12 and 24-weeks in self-reported fatigue (12-week:Mdiff =1.5, CI:0.97-2.10, (p<0.001); 24-weeks:Mdiff=1.1, CI:0.54-1.66 (p<0.001)) and mood disturbance (12-week:Mdiff = 1.2, CI: 0.55 – 1.84 (p<0.001); 24wk:Mdiff=1.1, CI: 0.53 – 1.68 (p<0.001)). Increases in physical functioning was also seen after treatment between baseline and follow up (Mdiff=3.8, CI: 0.83 -6.76 (p<0.01)) and end treatment and follow-up (Mdiff=2.8, CI: 0.13 – 5.52 (p<0.05). Younger age and lower pain levels revealed to be predictors for treatment response. Similar but non-statistically significant trends were observed in the PCF sample.
A modularized, multi-disciplinary intervention for patients with chronic fatigue states has been developed. Subsequently, a randomized control trial dedicated to applying this approached specifically to Post-Cancer Fatigue has been developed. Additionally, an operations manuals, DVD and web-based training package for clinicians are in progress.