Cognitive Behavior Therapy for Persistent Severe Fatigue in Childhood Cancer Survivors: A Pilot Study

Objectives: Fatigue is a common and disabling late effect in childhood cancer survivors (CCS). In this pilot study, the effectiveness of cognitive behavior therapy (CBT) in CCS with persistent and severe fatigue was retrospectively evaluated. Materials and Methods: In total, 33 consecutively referred CCS with persistent severe fatigue were offered CBT. The primary outcome was fatigue severity (Checklist Individual Strength, Fatigue Severity Subscale). Secondary outcomes were functional impairment, psychologic distress, and quality of life (QoL). Results: In total, 25 CCS completed CBT (76%). The mean age of CCS was 23.1 years (range, 11 to 42 y), mean age at primary cancer diagnosis was 9.7 years (range, 0 to 17 y), and mean time since primary cancer diagnosis was 13 years (range, 5 to 34 y). Fatigue severity (Delta 17.4; confidence interval (CI)=12.7-22.1; P<0.001), functional impairment (SIP8. 470.3; CI=312.3-628.4; P<0.001/SF36. 11.7; CI=17.2-6.3; P<0.001), and psychologic distress (Delta 26.4; CI=15.6-34.9; P<0.001) were significantly decreased at second assessment. QoL (Delta 13.5; CI=22.0-4.3; P=0.005) was significantly improved. A total of 23 CCS of the 33 CCS (70%) met the criteria for clinically significant improvement of fatigue. Conclusions: In this pilot study, the majority of severely fatigued CCS showed a clinically significant reduction in fatigue following CBT. Moreover, daily function and QoL improved, and psychologic distress decreased.