A Feasibility Study in Chronically Fatigued Cancer Survivors
Condition: Fatigue; Lymphoma
MeSH terms: Fatigue
Study type: Interventional

Summary: 
      Improved cancer survival has led to increased attention on long-term health and quality of
      life (QoL) among the survivors. Both the cancer diagnosis and intensive treatments increase
      the risk of late effects which may interfere with daily physical, psychological and social
      functioning, and thereby negatively affect their QoL. Well-documented late-effects among
      cancer survivors are second cancer, cardio-vascular disease, pain, hormone disturbances,
      mental distress and chronic fatigue (CF).

      CF is a subjective experience of substantial lack of energy, exhaustion and cognitive
      difficulties lasting for six months or longer. CF is one of the most common and distressing
      late effects after cancer, affecting 15-35 % of survivors, often for years beyond treatment.
      Despite the high prevalence and the huge negative consequences of CF on daily functioning and
      QoL and the economic and societal costs, effective treatment of CF and standardized follow-up
      care are currently lacking.

      CF is a complex condition best understood as a multifactorial phenomenon. Our and other
      research groups have examined various cohorts of cancer survivors in order to identify
      behavioral-, psychological-, and biological factors associated with CF, that can form the
      basis for targeted interventions. So far, few treatable biological factors have been
      identified, even though immune activation, flattened diurnal cortisol slopes and a blunted
      cortisol response to stress have been demonstrated in small studies among cancer survivors
      suffering from CF. On the other hand, several modifiable behavioral factors including
      emotional distress, physical inactivity, sleep disturbances and unhealthy diets are found to
      be associated with CF. So far, most of the interventions aiming to reduce fatigue during and
      shortly after cancer treatment have targeted only one of these factors at a time, with small
      to moderate effect sizes. No prior study has examined if CF in cancer survivors is better
      treated by a complex intervention targeting combinations of these factors, an approach which
      seems logical due to the complexity of the symptom.

      The Division of Cancer Medicine at Oslo University Hospital (OUH) presently offers limited
      rehabilitation programs, including patient education, physical exercise, cognitive behavioral
      program and nutrition counselling to cancer survivors with CF. However, these programs are
      not offered as an interdisciplinary intervention integrated in a standardized patient care
      pathway, and the effects of these interventions have not been assessed. Based on the
      investigators clinical experience and published studies on single-targeted interventions, the
      investigators hypothesize that a complex intervention including psycho-educational elements,
      physical exercise and nutrition counseling delivered as a standardized patient care pathway
      is well-founded and doable, and will improve fatigue, functioning and QoL in cancer survivors
      with CF.

      During the fall of 2021, the investigators will conduct a randomized controlled trial (RCT)
      with the overall objective to improve fatigue in lymphoma survivors with CF. To uncover
      strengths and weaknesses with the planned RCT, i.e. the inclusion procedures, the assessments
      and the complex intervention, the investigators are now conducting a small one-armed
      feasibility study before the RCT during spring 2021.
    


Intervention name(s): A 12-week interdisciplinary complex intervention
Intervention type(s): Other
Intervention description(s): The intervention will last for 12 weeks and includes four components; patient education, physical exercise, cognitive behavioral program and nutritional counseling.
The patient education will include an online 2-hours group-based patient-education sessions in week 1.
The physical exercise program includes two weekly exercise sessions, one supervised by a physiotherapist and one unsupervised, including aerobic exercise, resistance exercise and psychometric physiotherapy. Half of the intervention group (N=7) will perform the supervised exercise session individually with a physiotherapist in the municipality, while the other half (n=8) will exercise in online groups lead by physiotherapists.
The cognitive behavioral program will begin in week 3 and include six group-based online sessions every week lead by a clinical psychologist.
The nutritional counseling will include three individual digital nutrition counselling sessions in week 2, 6 and 10 by a clinical dietitian.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: exercise; chronic fatigue; lymphoma; cancer survivors; nutrition; cognitive therapy; patient education