Poort Hanneke, Onghena Patrick, Abrahams Harriët J G, Jim Heather S L, Jacobsen Paul B, Blijlevens Nicole M A, Knoop Hans
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Faculty of Psychology and Educational Sciences, KU Leuven-University of Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
J Clin Psychol Med Settings. 2019 Dec;26(4):440-448. doi: 10.1007/s10880-019-09607-5.
Treatment-related fatigue significantly limits quality of life among chronic myeloid leukemia (CML) patients receiving tyrosine kinase inhibitors (TKIs), yet no interventions to reduce this symptom have been studied. We examined preliminary feasibility and efficacy of cognitive behavioral therapy for TKI treatment-related fatigue in patients with CML. We used a mixed methods convergent design and collected quantitative data through randomized single-case experiments. We included CML patients receiving TKIs and reporting severe fatigue. Within each participant, we compared CBT to a no-treatment baseline period. Fatigue severity was measured weekly with the Checklist Individual Strength. Fatigue scores were subjected to visual analyses and randomization tests for single-case experimental designs. We conducted qualitative interviews after study participation and focused on feasibility and efficacy of CBT. Visual inspection of line graphs indicated downward trends in the expected direction for fatigue in two of the four participants. The test statistics showed a decrease in fatigue severity for all participants but randomization tests did not reach statistical significance (overall p = 0.18). Participants reported qualitative improvements in level of functioning and coping with fatigue. CBT was considered feasible and acceptable for severely fatigued CML patients. Our study provided preliminary evidence for the feasibility and acceptability of CBT for severely fatigued CML patients receiving targeted therapy. We recommend further efficacy testing of this promising intervention in a pilot randomized controlled trial.
治疗相关疲劳显著限制了接受酪氨酸激酶抑制剂（TKIs）治疗的慢性髓性白血病（CML）患者的生活质量，但尚未有研究针对减轻这种症状的干预措施。我们研究了认知行为疗法对CML患者TKI治疗相关疲劳的初步可行性和疗效。我们采用了混合方法收敛性设计，并通过随机单病例实验收集定量数据。我们纳入了接受TKIs治疗且报告有严重疲劳的CML患者。在每个参与者中，我们将认知行为疗法与无治疗的基线期进行比较。每周使用个人力量检查表测量疲劳严重程度。对疲劳评分进行单病例实验设计的视觉分析和随机化检验。研究参与后，我们进行了定性访谈，重点关注认知行为疗法的可行性和疗效。折线图的视觉检查表明，四名参与者中有两名的疲劳程度呈预期方向下降趋势。检验统计数据显示所有参与者的疲劳严重程度均有所下降，但随机化检验未达到统计学显著性（总体p = 0.18）。参与者报告在功能水平和应对疲劳方面有定性改善。认知行为疗法被认为对严重疲劳的CML患者是可行且可接受的。我们的研究为认知行为疗法对接受靶向治疗的严重疲劳CML患者的可行性和可接受性提供了初步证据。我们建议在一项初步随机对照试验中对这种有前景的干预措施进行进一步的疗效测试。
