Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute.
Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, University of Amsterdam.
J Consult Clin Psychol. 2021 Sep;89(9):731-741. doi: 10.1037/ccp0000670. Epub 2021 Aug 26.
Fatigue remains one of the most common and distressing symptoms during treatment for advanced cancer. The TIRED trial demonstrated cognitive behavior therapy's (CBT) significant and clinically relevant effects to reduce fatigue among patients with advanced cancer, while graded exercise therapy (GET) did not prove beneficial. The present study aims to determine the mechanisms by which CBT and GET affect fatigue.
The TIRED trial randomized 134 patients with advanced cancer to CBT = 46), GET ( = 42), or usual care ( = 46). At 14 weeks, 126 evaluable patients provided fatigue data and of those 117 received ≥1 CBT or GET session or usual care. We tested a prespecified multiple mediation model with four potential mediators (physical activity, exercise capacity, self-efficacy, and fatigue catastrophizing) assessed at baseline and at 14 weeks. Post-hoc analyses also included perceived physical activity and emotional functioning as potential mediators.
A total of 82 of 117 patients completed all required measures. CBT reduced fatigue indirectly through its effect on self-efficacy, = -3.292; 97.5% bootstrap CI [-6.518 to -0.598]. CBT participants experienced an increase in fatigue self-efficacy, with greater self-efficacy associated with decreased fatigue severity. There was no evidence that changes in physical activity, exercise capacity, perceived physical activity, fatigue catastrophizing, or emotional functioning mediated CBT's or GET's effects on fatigue.
The effect of CBT was attributable to changes in that is, increased self-efficacy led to reduced fatigue severity. No significant mediators for GET were found. The findings inform further refinement of interventions for fatigue in this seriously ill population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
疲劳仍然是晚期癌症治疗过程中最常见和最令人痛苦的症状之一。TIRED 试验证明认知行为疗法（CBT）对减轻晚期癌症患者的疲劳具有显著且临床相关的效果，而分级运动疗法（GET）则没有证明是有益的。本研究旨在确定 CBT 和 GET 影响疲劳的机制。
TIRED 试验将 134 名晚期癌症患者随机分为 CBT 组（n = 46）、GET 组（n = 42）或常规护理组（n = 46）。在 14 周时，126 名可评估患者提供了疲劳数据，其中 117 名患者接受了≥1 次 CBT 或 GET 治疗或常规护理。我们测试了一个预先指定的多重中介模型，其中包含四个潜在的中介变量（体力活动、运动能力、自我效能和疲劳灾难化），这些变量在基线和 14 周时进行评估。事后分析还包括感知体力活动和情绪功能作为潜在的中介变量。
共有 117 名患者中的 82 名完成了所有要求的测量。CBT 通过其对自我效能的影响间接降低了疲劳程度，β = -3.292；97.5%的自举置信区间[-6.518 至-0.598]。CBT 组患者的疲劳自我效能感增加，自我效能感越高，疲劳严重程度越低。没有证据表明体力活动、运动能力、感知体力活动、疲劳灾难化或情绪功能的变化中介了 CBT 或 GET 对疲劳的影响。
CBT 的效果归因于 的变化，即自我效能感的提高导致疲劳严重程度的降低。没有发现 GET 的显著中介变量。这些发现为进一步完善针对这一重病患者群体的疲劳干预措施提供了信息。
