Is Increasing Physical Activity Necessary to Diminish Fatigue During Cancer Treatment? Comparing Cognitive Behavior Therapy and a Brief Nursing Intervention with Usual Care in a Multicenter Randomized Controlled Trial
Is Increasing Physical Activity Necessary to Diminish Fatigue During Cancer Treatment? Comparing Cognitive Behavior Therapy and a Brief Nursing Intervention with Usual Care in a Multicenter Randomized Controlled Trial
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DOI：
10.1634/theoncologist.2010-0092
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发表时间：
2010-10-01
期刊：
影响因子：
5.8
通讯作者：
Bleijenberg, Gijs
中科院分区：
文献类型：
--
作者：
Goedendorp, Martine M.;Peters, Marlies E. W. J.;Bleijenberg, Gijs
背景资料。在根治性癌症治疗期间，对疲劳进行了两次干预。这项多中心随机对照试验(RCT)有三个条件，目的是证明疗效和确定体力活动的贡献。从7家医院招募了220名各种恶性肿瘤患者参加了随机对照试验。短期护理干预(BNI)由12名训练有素的护士进行，每次1小时，相隔3个月，只关注体力活动。认知行为疗法(CBT)包括在6个月内由两名治疗师提供的最多10次1小时的治疗，重点是身体活动和心理社会因素。对照组仅接受常规护理(UC)。评估是在癌症治疗前和治疗后至少2个月进行的，当时患者已经从急性疲劳中恢复。疲劳是主要的结果。疗效检验采用协方差分析。使用非参数Bootstrap方法检验疲劳效应是否通过体力活动来调节。CBT组的疲劳程度明显低于UC组。在疲劳方面，BNI组与UC组之间无显著差异。中介假说被驳回。讨论。在根治性癌症治疗期间给予CBT被证明是一种有效的干预措施，可以在癌症治疗至少2个月后减少疲劳。BNI并不奏效。与预期相反，体力活动并没有调节CBT对疲劳的影响。因此，CBT引起的疲劳的减少是在没有持续增加体力活动的情况下实现的。《肿瘤学家》2010；15：1122-1132
Background. Two interventions for fatigue were given during curative cancer treatment. The aim of this multicenter randomized controlled trial (RCT) with three conditions was to demonstrate the efficacy and to determine the contribution of physical activity.Methods. Recruited from seven hospitals, 220 patients with various malignancies participated in a RCT. The brief nursing intervention (BNI) consisted of two 1-hour sessions, 3 months apart, given by 12 trained nurses, focusing only on physical activity. Cognitive behavior therapy (CBT) consisted of up to ten 1-hour sessions, within 6 months, provided by two therapists, focusing on physical activity and psychosocial elements. The control group received only usual care (UC). Assessments took place before and at least 2 months after cancer treatment, when patients had recovered from acute fatigue. Fatigue was the primary outcome. Efficacy was tested using analyses of covariance. A nonparametric bootstrap approach was used to test whether the effect on fatigue was mediated by physical activity.Results. The CBT group was significantly less fatigued than the UC group. Between the BNI and the UC groups, no significant difference was found in fatigue. The mediation hypothesis was rejected.Discussion. CBT given during curative cancer treatment proved to be an effective intervention to reduce fatigue at least 2 months after cancer treatment. The BNI was not effective. Contrary to what was expected, physical activity did not mediate the effect of CBT on fatigue. Thus, the reduction in fatigue elicited by CBT was realized without a lasting increase in physical activity. The Oncologist 2010;15:1122-1132