Oral Presentation FCIC Survivorship Conference 2013

Development of an optimised, multi-disciplinary intervention for chronic fatigue states. (#20)

Carolina Sandler 1 2 , Blake Hamilton 2 , Sarah Horsfield 2 , Richard McBride 2 , Barbara Bennett 1 , David Goldstein 1 3 , Sally Mildon 2 , Chris Tzar 1 2 , Andrew Lloyd 1 2 4
  1. NSW Cancer Survivors Centre, Sydney, NSW, Australia
  2. Fatigue Clinic , UNSW Lifestyle Clinic, Sydney, NSW, Australia
  3. Department of Medical Oncology, , Prince of Wales Hospital , Sydney, NSW, Australia
  4. Inflammation and Infection Research Centre, , School of Medical Sciences, University of New South Wales, Sydney, NSW , Australia

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.

  1. Portenoy RK, Itri LM. Cancer-related fatigue: Guidelines for evaluation and management. The Oncologist 1999;4:1-10
  2. Prins JB, van der Meer JWM, Bleijenberg G. Chronic fatigue syndrome. Lancet 2006;367(9507):346-55.
  3. Edmonds M, McGuire H, Price J. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2004(3):CD003200.
  4. Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev 2008(3):CD001027.
  5. White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. The Lancet 2011;377(9768):823-36
  6. Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008(2):CD006145