Please select the eligibility criteria that correspond to the clinical trial below.
Title: An Explorative Study on Physiological and Neurophysiological Determinants of Fatigue in Cancer Survivors
Brief Summary: Postcancer fatigue is a severe and invalidating problem, impairing quality of life. About 20 to 40% of the patients remain fatigued, at least one year after successful cancer treatment. Fortunately, there is an effective treatment for postcancer fatigue; cognitive behavior therapy. However, no cause for postcancer fatigue has been identified yet. The aim of the study is to identify factors that (partly) cause postcancer fatigue to improve the theoretical understanding of fatigue and to improve the diagnostics of fatigue, predict therapy outcome, and facilitate other treatment options.

In this study, disease-free fatigued cancer patients, who finished treatment for cancer at least one year and maximally ten years ago, will be approached for this study. They will be compared to non-fatigued patients.

First, a baseline assessment will take place. Magnetic resonance imaging of the brains will be performed to assess brain volume and magnetic resonance spectroscopy will be performed to measure the concentrations of specific substances in the brains. Changes in the volume of parts of the brains have been observed in (non-cancer) patients with the chronic fatigue syndrome (CFS), in comparison with healthy controls. In addition, abnormal concentrations of specific substances have been observed in patients with CFS compared to healthy controls. To assess muscle fatigue, a two-minute endurance test of the upper arm will be administered at maximal voluntary contraction. Next to differences in the brains, CFS patients showed (central) muscle fatigue. A maximal exercise test on a bicycle will be performed to assess physical fitness. Physical activity in fatigued cancer survivors is decreased, compared to healthy controls. It is not known whether physical deconditioning originated during the cancer treatment is the reason why these patients are still less active. In addition, patients and controls will wear an actometer for two weeks to register baseline daily physical activity and for an additional 5 days after the maximal exercise test, to assess the effect of exercise on the daily physical activity. Finally, patients and controls will complete standardized questionnaires and will perform neurological/psychological tests, like a reaction time test and a short time memory task, at baseline.

The results of the non-fatigued and the fatigued patients will be compared at baseline. For the non-fatigued participants, the study will be finished after the baseline measurements. The fatigued participants will start with cognitive behavior therapy immediately after the baseline measurements or after 6 months, depending on the randomization.

At the end of the therapy, after six months, or after 6 months of waiting for cognitive behavior therapy, a second assessment will take place, comparable to the baseline measurements. These results will be compared with the baseline situation to analyze the effect of cognitive behavior therapy on the (possible) causes of postcancer fatigue.


Options:
A: Inclusion Criteria:

* Treated for a malignant solid tumour.
* Completion of treatment for cancer minimal 1 year ago
* Single treatment modality surgery permitted
* Current hormonal therapy permitted
* Disease-free, as defined by the absence of somatic disease activity parameters.
* Age between 19 and 65.
* Age at disease onset minimal 18 years

Exclusion Criteria:

* Brain tumour in the past
* Current psychological or psychiatric treatment.
* Physical comorbidity which could explain the fatigue.
* Contra-indication for MR examinations (e.g. claustrophobia).
* Treatment with anti-depressive drugs, anti-epileptic drugs, benzodiazepines.
* Insufficient command of the Dutch language to fill out questionnaires.
B: Inclusion Criteria:

* Young adult between ages 21-39 diagnosed with cancer (excluding non-melanoma skin cancer) at age 18 or older
* At least 1 year beyond date of diagnosis with no evidence of progressive disease or second primary cancers
* Completed cancer treatment
* English-speaking and writing
* No pre-existing medical condition(s) or contraindications that preclude adherence to an unsupervised exercise program, including cardiovascular disease, congestive heart failure, pulmonary conditions, renal disease, and severe orthopedic conditions
* Not adhering to the American Cancer Society's recommendation of at least 150 minutes of moderate-intensity exercise per week (\<150 minutes/week)
* Have access to Internet service and an active Facebook account
* Willing to be randomized
* Have indicated consent by checking "yes" to the online consent form

Exclusion Criteria:

* Non-English speaking
* \< 21 and \> 39 years of age
* Diagnosed with cancer less than one year previously or still in treatment
* Pre-existing medical condition(s) that preclude adherence to an unsupervised exercise program, including cardiovascular disease, congestive heart failure, pulmonary conditions, renal disease, and severe orthopedic conditions
C: Inclusion Criteria:

* Non-hodgkin's lymphoma (including chronic lymphocytic leukemia) or Hodgkin's disease
* Approval of the treating oncologist
* Scheduled to receive no chemotherapy or chemotherapy for at least 8 weeks
* Able to understand and provide written informed consent in English
* 18+ years of age
* No uncontrolled hypertension, cardiac illness, psychiatric condition
* No contraindication to exercise as determined by a fitness test

Exclusion Criteria:

* Pregnant.
* Transplant candidate.
* Unwilling to accept randomization.
* Any medical condition that would be a contraindication to exercise. The clinicians will make this decision.
* Unwilling to travel to/participate in the exercise program as defined by the protocol.
* Planned/known absence of greater than 2 weeks during the intended study period
D: Inclusion Criteria:

* Medical indication: allogeneic stem cell transplantation

Exclusion Criteria:

* Orthopeadic limitations that hamper the exercise intervention
* Osseous degenerations that have an improved fracture risk

Answer: A