Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. A web-based intervention (RESTORE) to support self-management of cancer-related fatigue following primary cancer treatment: a multi-centre proof of concept randomised controlled trial Protocol for a systematic review of psychological interventions for cancer-related fatigue in post-treatment cancer survivors A randomized controlled trial of physical activity, dietary habit, and distress management with the Leadership and Coaching for Health (LEACH) program for disease-free cancer survivors Effectiveness of Two Web-Based Interventions for Chronic Cancer-Related Fatigue Compared to an Active Control Condition: Results of the “Fitter na kanker” Randomized Controlled Trial Long-term effectiveness and moderators of a web-based tailored intervention for cancer survivors on social and emotional functioning, depression, and fatigue: randomized controlled trial Randomized Evaluation of Cognitive-Behavioral Therapy and Graded Exercise Therapy for Post-Cancer Fatigue. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. Short‐term effectiveness of a web‐based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial Physical Activity and Health Outcomes Three Months After Completing a Physical Activity Behavior Change Intervention: Persistent and Delayed Effects Surviving and Thriving With Cancer Using a Web-Based Health Behavior Change Intervention: Randomized Controlled Trial A randomized trial comparing live and telemedicine deliveries of an imagery-based behavioral intervention for breast cancer survivors: reducing symptoms and barriers to care. Feasibility of Cognitively-Based Compassion Training (CBCT) for breast cancer survivors: a randomized, wait list controlled pilot study The Sickness Impact Profile: Development and Final Revision of a Health Status Measure The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. A Brief Intervention for Fatigue Management in Breast Cancer Survivors Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. A patient education program is effective in reducing cancer-related fatigue: a multi-centre randomised two-group waiting-list controlled intervention trial. Cognitive behavioral therapy for insomnia, but not armodafinil, improves fatigue in cancer survivors with insomnia: a randomized placebo-controlled trial The role of physical activity and physical fitness in postcancer fatigue: a randomized controlled trial Mindfulness-based cognitive therapy reduces chronic cancer-related fatigue: a treatment study. Effects of a multicomponent physical activity behavior change intervention on fatigue, anxiety, and depressive symptomatology in breast cancer survivors: randomized trial A randomized trial of videoconference‐delivered cognitive behavioral therapy for survivors of breast cancer with self‐reported cognitive dysfunction Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia. Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: a randomized, controlled trial. Motivational Interviewing to Increase Physical Activity in Long-Term Cancer Survivors: A Randomized Controlled Trial Web-based tailored education program for disease-free cancer survivors with cancer-related fatigue: a randomized controlled trial. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. Mindfulness-Based Stress Reduction in Post-treatment Breast Cancer Patients: Immediate and Sustained Effects Across Multiple Symptom Clusters. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. Cancer-Related Fatigue and Rehabilitation: A Randomized Controlled Multicenter Trial Comparing Physical Training Combined With Cognitive-Behavioral Therapy With Physical Training Only and With No Intervention
PURPOSE The purpose of this r and omized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer ( MBSR[BC ] ) program in improving psychological and physical symptoms and quality of life among breast cancer survivors ( BCSs ) who completed treatment . Outcomes were assessed immediately after 6 weeks of MBSR(BC ) training and 6 weeks later to test efficacy over an extended timeframe . PATIENTS AND METHODS A total of 322 BCSs were r and omly assigned to either a 6-week  MBSR(BC ) program ( n = 155 ) or a usual care group ( n = 167 ) . Psychological ( depression , anxiety , stress , and fear of recurrence ) and physical symptoms ( fatigue and pain ) and quality of life ( as related to health ) were assessed at baseline and at 6 and 12 weeks . Linear mixed models were used to assess MBSR(BC ) effects over time , and participant characteristics at baseline were also tested as moderators of MBSR(BC ) effects . RESULTS Results demonstrated extended improvement for the MBSR(BC ) group compared with usual care in both psychological symptoms of anxiety , fear of recurrence overall , and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference ( P < .01 ) . Overall effect sizes were largest for fear of recurrence problems ( d = 0.35 ) and fatigue severity ( d = 0.27 ) . Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC ) . CONCLUSION The MBSR(BC ) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC ) training , with generally small to moderate overall effect sizes Purpose Cancer-related fatigue ( CRF ) is a frequent and distressing symptom experienced after cancer treatment . RESTORE is the first web-based re source design ed to enhance self-efficacy to manage CRF following curative-intent treatment . The aim of this study is to test the proof of concept and inform the design of an effectiveness trial . Methods A multi-centre parallel-group two-armed ( 1:1 ) exploratory r and omised controlled trial ( RCT ) with qualitative process evaluation was employed in the study . Participants ( ≥18 years ; ≤5 years post treatment with moderate to severe fatigue ) were recruited and r and omly assigned to RESTORE or a leaflet . Feasibility and acceptability were measured by recruitment , attrition , intervention adherence , completion of outcome measures and process evaluation . Change in self-efficacy to manage CRF was also explored . Outcome measures were completed at baseline ( T0 ) , 6 weeks ( T1 ) and 12 weeks ( T2 ) . Data were analysed using mixed-effects linear regression and directed content analysis . Results One hundred and sixty-three people participated in the trial and 19 in the process evaluation . The intervention was feasible ( 39 % of eligible patients consented ) and acceptable ( attrition rate 36 % ) . There was evidence of higher fatigue self-efficacy at T1 in the intervention group vs comparator ( mean difference 0.51 [ −0.08 to 1.11 ] ) , though the difference in groups decreased by 12 weeks . Time since diagnosis influenced perceived usefulness of the intervention . Modifications were suggested . Conclusion Proof of concept was achieved . The RESTORE intervention should be subject to a definitive trial with some adjustments . Provision of an effective supportive re source would empower cancer survivors to manage CRF after treatment completion . Trial registration IS RCT Background Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase . Some evidence has been reported for interventions for fatigue during active treatment . However , to date , there is no systematic review on psychological interventions for fatigue after the completion of curative treatment for cancer . This is a protocol for a systematic review that aims to evaluate the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors . This systematic review protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) data base . Methods / design We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ; The Cochrane Library ) , PubMed , MEDLINE , EMBASE , CINAHL , PsycINFO , and relevant sources of grey literature . R and omised controlled trials ( RCTs ) which have evaluated psychological interventions in adult cancer patients after the completion of treatment , with fatigue as an outcome measure , will be included . Two review authors will independently extract data from the selected studies and assess the method ological quality using the Cochrane Collaboration Risk of Bias Tool . Discussion Most existing evidence on cancer-related fatigue is from those in active cancer treatment . This systematic review and meta- analysis will build upon previous evaluations of psychological interventions in people during and after cancer treatment . With the growing need for stage-specific research in cancer , this review seeks to highlight a gap in current practice and to strengthen the evidence base of r and omised controlled trials in the area . Systematic review registration PROSPERO CRD42014015219 Background We aim ed to evaluate the potential benefits of the Leadership and Coaching for Health ( LEACH ) program on physical activity ( PA ) , dietary habits , and distress management in cancer survivors . Methods We r and omly assigned 248 cancer survivors with an allocation ratio of two-to-one to the LEACH program ( LP ) group , coached by long-term survivors , or the usual care ( UC ) group .  At baseline , 3 , 6 , and 12 months , we used PA scores , the intake of vegetables and fruits ( VF ) , and the Post Traumatic Growth Inventory ( PTGI ) as primary outcomes and , for secondary outcomes , the Ten Rules for Highly Effective Health Behavior adhered to and quality of life ( QOL ) , the Hospital Anxiety and Depression Scale ( HADS ) , and the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30 ) . Results For primary outcomes , the two groups did not significantly differ in PA scores or VF intake but differed marginally in PTGI . For secondary outcomes , the LP group showed a significantly greater improvement in the HADS anxiety score , the social functioning score , and the appetite loss and financial difficulties scores of the EORTC QLQ-C30 scales from baseline to 3 months . From baseline to 12 months , the LP group showed a significantly greater decrease in the EORTC QLQ-C30 fatigue score and a significantly greater increase in the number of the Ten Rules for Highly Effective Health Behavior . Conclusion Our findings indicate that the LEACH program , coached by long-term survivors , can provide effective management of the QOL of cancer survivors but not of their PA or dietary habits . Trial registration Clinical trial information can be found for the following : NCT01527409 ( the date when the trial was registered : February 2012 ) Background Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue ( CCRF ) . Effective and easily accessible interventions are needed for these patients . Objective The current paper reports on the results of a 3-armed r and omized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition . Methods Severely fatigued cancer survivors were recruited via online and offline channels , and self-registered on an open-access website . After eligibility checks , 167 participants were r and omized via an embedded automated r and omization function into : ( 1 ) physiotherapist-guided Ambulant Activity Feedback ( AAF ) therapy encompassing the use of an accelerometer ( n=62 ) ; ( 2 ) psychologist-guided Web-based mindfulness-based cognitive therapy ( eMBCT ; n=55 ) ; or ( 3 ) an unguided active control condition receiving psycho-educational emails ( n=50 ) . All interventions lasted nine weeks . Fatigue severity was self-assessed using the Checklist Individual Strength - Fatigue Severity subscale ( primary outcome ) six times from baseline ( T0b ) to six months ( T2 ) . Mental health was self-assessed three times using the Hospital Anxiety and Depression Scale and Positive and Negative Affect Schedule ( secondary outcome ) . Treatment dropout was investigated . Results Multiple group latent growth curve analysis , corrected for individual time between assessment s , showed that fatigue severity decreased significantly more in the AAF and eMBCT groups compared to the psycho-educational group . The analyses were checked by a research er who was blind to allocation . Clinical ly relevant changes in fatigue severity were observed in 66 % ( 41/62 ) of patients in AAF , 49 % ( 27/55 ) of patients in eMBCT , and 12 % ( 6/50 ) of patients in psycho-education . Dropout was 18 % ( 11/62 ) in AAF , mainly due to technical problems and poor usability of the accelerometer , and 38 % ( 21/55 ) in eMBCT , mainly due to the perceived high intensity of the program . Conclusions Both the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails . Trial Registration Trialregister.nl NTR3483 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=3483 ( Archived by WebCite at http://www.webcitation.org/6NWZqon3o Purpose The web-based computer-tailored Kanker Nazorg Wijzer ( Cancer Aftercare Guide ) supports cancer survivors with psychosocial issues during cancer recovery . The current study investigates whether the 6-month effects in increasing emotional and social functioning and reducing depression and fatigue hold at 12 months from baseline . Moreover , it explores whether patient characteristics moderate the 6- and 12-month intervention effectiveness . Methods Cancer survivors from 21 Dutch hospitals ( November 2013–June 2014 ) were r and omized to an intervention ( n = 231 ) or a wait-list control group ( n = 231 ) . Intervention effects on emotional and social functioning ( EORTC QLQ-C30 ) , depression ( HADS ) , and fatigue ( CIS ) were evaluated through multilevel linear regression analyses . Results At 12 months from baseline , the intervention group no longer differed from the control group in emotional and social functioning , depression , and fatigue . Moderator analyses indicated that , at 6 months , the intervention was effective in improving social functioning for men ( d = 0.34 ) , reducing fatigue for participants ≤56 years ( d = 0.44 ) , and reducing depression for participants who received chemotherapy ( d = 0.36 ) . At 12 months , participants with a medium educational level reported higher social functioning ( d = 0.19 ) , while participants with a low educational level reported lower social functioning ( d = 0.22 ) than participants with a similar educational level in the control group . Conclusions The intervention gave cancer patients a head start to psychological recovery after the end of cancer treatment . The control group caught up in the long run . Implication s for cancer survivorsThe Cancer Aftercare Guide expedited recovery after cancer treatment . Being a low intensity , easy accessible , and relatively low cost intervention , it could serve as a relevant step in recovery and stepped care CONTEXT Cancer-related fatigue is prevalent and disabling . When persistent and unexplained , it is termed post-cancer fatigue ( PCF ) . Cognitive behavioral therapy ( CBT ) and grade d exercise therapy ( GET ) may improve symptoms and functional outcomes . OBJECTIVES To evaluate the outcomes of a r and omized controlled trial , which assigned patients with post-cancer fatigue to education , or 12 weeks of integrated cognitive-behavioral therapy ( CBT ) and grade d exercise therapy ( GET ) . METHODS Three months after treatment for breast or colon cancer , eligible patients had clinical ly significant fatigue , no comorbid medical or psychiatric conditions that explained the fatigue , and no evidence of recurrence . The CBT/GET arm included individually tailored consultations at approximately two weekly intervals . The education arm included a single visit with clinicians describing the principles of CBT/GET and a booklet . The primary outcome was clinical ly significant improvement in self-reported fatigue ( Somatic and Psychological HEalth REport 0 - 12 ) , design ated a priori as greater than one SD of improvement in fatigue score . The secondary outcome was associated improvement in function ( role limitation due to physical health problems-36-Item Short Form Health Survey 0 - 100 ) comparing baseline , end treatment ( 12 weeks ) , and follow-up ( 24 weeks ) . RESULTS There were 46 patients enrolled , including 43 women ( 94 % ) , with a mean age of 51 years .  Fatigue severity improved in all subjects from a mean of 5.2 ( ±3.1 ) at baseline to 3.9 ( ±2.8 ) at 12 weeks , suggesting a natural history of improvement . Clinical ly significant improvement was observed in 7 of 22 subjects in the intervention group compared with 2 of 24 in the education group ( P < 0.05 , χ2 ) . These subjects also had improvement in functional status compared with nonresponders ( P < 0.01 , t-test ) . CONCLUSION Combined CBT/GET improves fatigue and functional outcomes for a subset of patients with post-cancer fatigue . Further studies to improve the response rate and the magnitude of the benefit are warranted To investigate prevalence and severity of symptoms and symptom clustering in breast cancer survivors who attended MBSR(BC ) .  Women were r and omly assigned into MBSR(BC ) or Usual Care ( UC ) . Eligible women were ≥ 21 years , had been diagnosed with breast cancer and completed treatment within 18 months of enrollment . Symptoms and interference with daily living were measured pre- and post-MBSR(BC ) using the M.D. And erson Symptom Inventory . Symptoms were reported as highly prevalent but severity was low . Fatigue was the most frequently reported and severe symptom among groups . Symptoms clustered into 3 groups and improved in both groups . At baseline , both  MBSR(BC ) and the control groups showed similar mean symptom severity and interference ; however , after the 6-week post-intervention , the MBSR(BC ) group showed statistically-significant reduction for fatigue and disturbed sleep ( P < 0.01 ) and improved symptom interference items , compared to the control group . For the between-group comparisons , 11 of 13 symptoms and 5 of 6 interference items had lower means in the MBSR(BC ) condition than the control condition . These results suggest that MBSR(BC ) modestly decreases fatigue and sleep disturbances , but has a greater effect on the degree to which symptoms interfere with many facets of life . Although these results are preliminary , MBSR intervention post-treatment may effectively reduce fatigue and related interference in QOL of breast cancer survivors PURPOSE To compare the efficacy of the following two empirically supported group interventions to help distressed survivors of breast cancer cope : mindfulness-based cancer recovery ( MBCR ) and supportive-expressive group therapy ( SET ) . PATIENTS AND METHODS This multisite , r and omized controlled trial assigned 271 distressed survivors of stage I to III breast cancer to MBCR , SET , or a 1-day stress management control condition . MBCR focused on training in mindfulness meditation and gentle yoga , whereas SET focused on emotional expression and group support . Both intervention groups included 18 hours of professional contact . Measures were collected at baseline and after intervention by assessors blind to study condition . Primary outcome measures were mood and diurnal salivary cortisol slopes . Secondary outcomes were stress symptoms , quality of life , and social support . RESULTS Using linear mixed-effects models , in intent-to-treat analyses , cortisol slopes were maintained over time in both SET ( P = .002 ) and MBCR ( P = .011 ) groups relative to the control group , whose cortisol slopes became flatter . Women in MBCR improved more over time on stress symptoms compared with women in both the SET ( P = .009 ) and control ( P = .024 ) groups . Per- protocol analyses showed greater improvements in the MBCR group in quality of life compared with the control group ( P = .005 ) and in social support compared with the SET group ( P = .012 ) . CONCLUSION In the largest trial to date , MBCR was superior for improving stress levels , quality of life and social support [ CORRECTED ] for distressed survivors of breast cancer . Both SET and MBCR also result ed in more normative diurnal cortisol profiles than the control condition . The clinical implication s of this finding require further investigation AIM This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue , mood and quality of life in breast cancer survivors . BACKGROUND Women who receive primary treatment for breast cancer often complain of insomnia . Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue , mood and quality of life . METHOD Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post-completion of primary treatment without current evidence of disease . Women were r and omly assigned to either the cognitive behavioural therapy for insomnia group , which received stimulus control instructions , sleep restriction therapy and sleep education and hygiene , or the component control group which received sleep education and hygiene only . The 10-week study consisted of 2 weeks of pre-treatment , 6 weeks of treatment and 2 weeks of post-treatment . Fatigue , mood and quality of life were measured at pre- and post-treatment . FINDINGS Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue , trait anxiety , depression and quality of life . The component control group also had statistically significant increases in quality of life , with a trend suggestive of lower depression at post-treatment . CONCLUSION Globally , as the number of survivors in this population continues to grow , it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue , anxiety and depression BACKGROUND The aim of this study was to evaluate the short-term effectiveness of the web-based computer-tailored intervention Kanker Nazorg Wijzer ( Cancer Aftercare Guide ) . The intervention aims to support cancer survivors with managing psychosocial and lifestyle-related issues . In this study , the impact on quality of life , anxiety , depression , and fatigue were evaluated . METHODS Cancer survivors were recruited through 21 Dutch hospitals ( November 2013-June 2014 ) . Outcome measures included quality of life ( European Organization for Research and Treatment of Cancer Quality of Life Question naire-C30 ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , and fatigue ( Checklist Individual Strength ) . In a r and omized controlled trial with an intervention group ( n = 231 ) and a waiting list control group ( n = 231 ) , the short-term effectiveness was evaluated through multilevel linear regression analyses , controlling for selective dropout , baseline differences , and several demographic and disease-related characteristics . RESULTS In total , 188 participants of the intervention group and 221 of the control group completed the 6-month measurement ( dropout = 11.5 % ) . The intervention was effective in reducing depression ( B = -0.63 , p = 0.007 , f2 = 0.019 , d = 0.21 ) and fatigue ( B = -4.36 , p = 0.020 , f2 = 0.013 , d = 0.21 ) . In addition , effects were found for emotional ( B = 3.47 , p = 0.022 , f2 = 0.013 , d = 0.15 ) and social functioning ( B = 3.95 , p = 0.011 , f2 = 0.017 , d = 0.15 ) , although this evidence was less strong . There were indications that the effects of fatigue and social functioning were influenced by module use . CONCLUSIONS While effect sizes were small , they can be considered as clinical ly relevant . With the Cancer Aftercare Guide being an effective , low-intensive , and easy accessible intervention , it could serve as a first step in stepped care for needs assessment and initial support for psychosocial problems that are present after cancer treatment . Copyright © 2016 John Wiley & Sons , Purpose : We previously reported the effectiveness of a 12-week physical activity behavior change intervention for breast cancer survivors postintervention with this report , aim ing to determine delayed and /or persistent effects 3 months after intervention completion . Methods : Forty-one sedentary women with stage I , II , or IIIA breast cancer currently receiving hormonal therapy were r and omly assigned to receive the 12-week Better Exercise Adherence after Treatment for Cancer intervention or usual care . Assessment s occurred at baseline , postintervention , and 3 months postintervention . Results : Weekly minutes of greater than or equal to moderate intensity physical activity measured by accelerometer showed a significant group by time interaction ( F = 3.51 ; P = 0.035 ; between group difference in the mean change from baseline to 3 months postintervention , 100.1 minute , P = 0.012 ) . Significant group by time interactions also showed sustained improvements from baseline to 3 months postintervention in strength ( F = 3.82 ; P = 0.027 ; between group difference , 11.2 kg ; P = 0.026 ) , waist-to-hip ratio ( F = 3.36 ; P = 0.041 ; between group difference , −0.04 ; P = 0.094 ) , and social well-being ( F = 4.22 ; P = 0.023 ; between group difference , 3.9 ; P = 0.039 ) . A delayed reduction in lower extremity dysfunction 3 months postintervention was noted ( F = 3.24 ; P = 0.045 ; between group difference in the mean change from postintervention to 3 months follow-up ; P = −7.6 ; P = 0.015 ) . No group by time effect was noted for fitness , body mass index , percent fat , bone density , total quality of life ( Functional Assessment of Cancer Therapy-General ) , fatigue , endocrine symptoms , cognitive function , or sleep . Conclusions : The intervention result ed in sustained improvements in physical activity , strength , central adiposity , and social well-being with lower extremity function benefits appearing 3 months after intervention completion . Testing translation in a multisite study is warranted . ( Cancer Epidemiol Biomarkers Prev 2009;18(5):1410–8 Background Given the substantial improvements in cancer screening and cancer treatment in the United States , millions of adult cancer survivors live for years following their initial cancer diagnosis and treatment . However , latent side effects can occur and some symptoms can be alleviated or managed effectively via changes in lifestyle behaviors . Objective The purpose of this study was to test the effectiveness of a six-week Web-based multiple health behavior change program for adult survivors . Methods Participants ( n=352 ) were recruited from oncology clinics , a tumor registry , as well as through online mechanisms , such as Facebook and the Association of Cancer Online Re sources ( ACOR ) . Cancer survivors were eligible if they had completed their primary cancer treatment from 4 weeks to 5 years before enrollment . Participants were r and omly assigned to the Web-based program or a delayed-treatment control condition . Results In total , 303 survivors completed the follow-up survey ( six months after completion of the baseline survey ) and participants in the Web-based intervention condition had significantly greater reductions in insomnia and greater increases in minutes per week of vigorous exercise and stretching compared to controls . There were no significant changes in fruit and vegetable consumption or other outcomes . Conclusions The Web-based intervention impacted insomnia and exercise ; however , a majority of the sample met or exceeded national recommendations for health behaviors and were not suffering from depression or fatigue at baseline . Thus , the survivors were very healthy and well-adjusted upon entry and their ability to make substantial health behavior changes may have been limited . Future work is discussed , with emphasis placed on ways in which Web-based interventions can be more specifically analyzed for benefit , such as in regard to social networking . Trial Registration Clinical trials.gov NCT00962494 ; http://www . clinical trials.gov/ct2/show/NCT00962494 ( Archived by WebCite at http://www.webcitation.org/6NIv8Dc6Q ) OBJECTIVE This multi-site r and omized trial evaluates the quality of life ( QOL ) benefits of an imagery-based group intervention titled ' Envision the Rhythms of Life'(ERL ) . METHODS Breast cancer survivors > 6 weeks post-treatment were r and omized to attend five weekly 4-h group sessions at a community center with therapist present ( live delivery ( LD ) , n = 48 ) , therapist streamed via telemedicine ( telemedicine delivery ( TD ) , n = 23 ) , or to a waitlist control ( WL ) group ( n = 47 ) . Weekly individual phone calls to encourage at-home practice began at session one and continued until the 3-month follow-up . Seven self-report measures of QOL were examined at baseline , 1-month and 3-month post-treatments including health-related and breast cancer-specific QOL , fatigue , cognitive function , spirituality , distress , and sleep . RESULTS The Bonferroni method was used to correct for multiple comparisons , and alpha was adjusted to 0.01 . Linear multilevel modeling analyses revealed less fatigue , cognitive dysfunction , and sleep disturbance for LD and TD compared with WL across the follow-up ( p 's < 0.01 ) . Changes in fatigue , cognitive dysfunction , sleep disturbance , and health-related and breast cancer-related QOL were clinical ly significant . There were no differences between LD and TD . CONCLUSIONS Both the live and telemedicine delivered ERL intervention result ed in improvements in multiple QOL domains for breast cancer survivors compared with WL . Further , there were no significant differences between LD and TD , suggesting telemedicine delivered ERL intervention may represent an effective and viable option for cancer survivors in remote areas Purpose This study assessed the feasibility of a meditation-based program called Cognitively-Based Compassion Training ( CBCT ) with breast cancer survivors . Enrollment and participant satisfaction with a novel intervention , adherence to program requirements , and differences between the intervention group and wait list controls on self-report measures were also assessed . Additionally , cortisol , a stress-related endocrine biomarker , was assessed . Methods Participants ( n = 33 ) were r and omly assigned to CBCT or the wait list . CBCT provided eight weekly , 2-h classes and a “ booster ” CBCT session 4 weeks later . CBCT participants were expected to attend classes and meditate between classes at least three times per week . Pre-/post-intervention and follow-up question naires measured symptom change ( depression , intrusive thoughts , perceived stress , fear of cancer recurrence , fatigue/vitality , loneliness , and quality of life ) . Saliva sample s were collected at the same periods to assess the slope of diurnal cortisol activity . Results Enrollment , class attendance , home practice time , and patient satisfaction exceeded expectations . Compared to controls , post-intervention , the CBCT group showed suggestions of significant improvements in depression , avoidance of intrusive thoughts , functional impairment associated with fear of recurrence , mindfulness , and vitality/fatigue . At follow-up , less perceived stress and higher mindfulness were also significant in the CBCT group . No significant changes were observed on any other measure including diurnal cortisol activity . Conclusions Within the limits of a pilot feasibility study , results suggest that CBCT is a feasible and highly satisfactory intervention potentially beneficial for the psychological well-being of breast cancer survivors . However , more comprehensive trials are needed to provide systematic evidence . Relevance CBCT may be very beneficial for improving depression and enhancing well-being during breast cancer survivorship The final development of the Sickness Impact Profile ( SIP ) , a behaviorally based measure of health status , is presented . A large field trial on a r and om sample of prepaid group practice enrollees and smaller trials on sample s of patients with hyperthyroidism , rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses . Test-retest reliability ( r = 0.92 ) and internal consistency ( r = 0.94 ) were high . Convergent and discriminant validity was evaluated using the multitrait – multi method technique . Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores . The relationship between the SIP and criterion measures were moderate to high and in the direction hypotheszed . A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis . The final SIP contains 136 items in 12 categories . Overall , category , and dimension scores may be calculated BACKGROUND Many women with breast cancer need psychological help to cope more effectively after treatment . Cognitive and behavioural techniques are not yet well established in France . A multi-site r and omized study was conducted to evaluate the effects of a psycho-educational group intervention in this population . METHODS Two hundred and three patients , recruited after primary treatment , were r and omly assigned either to a treatment group ( psycho-educational intervention ) or to a waiting-list control group . The 8-week programme of 2 h sessions comprised of thematic discussion s , information and training in stress management techniques . Evaluation at baseline , after 8 sessions , and 1 month after programme completion , included evaluations using the STAI , POMS , MAC , EORTC QLQ-C30 and EORTC QLQ-BR23 breast module scales . RESULTS We observed a significant reduction in anxiety ( STAI , POMS ) among group participants , a reduction in anger , depression and fatigue ( POMS ) , a significant improvement in vigor and interpersonal relationships ( POMS ) , in emotional and role functioning , in health status and fatigue level ( EORTC QLQ-C30 ) . In contrast , coping strategies ( MAC ) were not significantly different between groups . No group-related negative effects were observed and the global satisfaction levels were very high . CONCLUSION This study demonstrates the feasibility and effectiveness of a psycho-educational intervention , which can accelerate the reduction of those negative affects which are present at the end of treatment . It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support , widely proposed in France , and should now be tested in groups with other types of cancer and at other disease phases The purpose of this r and omized control trial was to verify the effectiveness of a brief group intervention that combines stress management psycho-education and physical activity ( ie , independent variable ) intervention in reducing fatigue and improving energy level , quality of life ( mental and physical ) , fitness ( VO2submax ) , and emotional distress ( ie , dependent variables ) in breast cancer survivors . This study applied Lazarus and Folkman stress-coping theoretical framework , as well as Salmon 's unifying theory of physical activity . Eighty-seven French-speaking women who had completed their treatments for nonmetastatic breast cancer at a university hospital in Quebec City , Canada , were r and omly assigned to either the group intervention ( experimental ) or the usual-care ( control ) condition . Data were collected at baseline , postintervention , and at 3-month follow-up . The 4-week group intervention was cofacilitated by 2 nurses . Results showed that participants in the intervention group showed greater improvement in fatigue , energy level , and emotional distress at 3-month follow-up , and physical quality of life at postintervention , compared with the participants in the control group . These results suggest that a brief psycho-educational group intervention focusing on active coping strategies and physical activity is beneficial to cancer survivors after breast cancer treatments PURPOSE Chronic insomnia is highly prevalent in cancer patients .  Cognitive-behavioral therapy ( CBT ) is considered the treatment of choice for chronic primary insomnia . However , no r and omized controlled study has been conducted on its efficacy for  insomnia secondary to cancer . Using a r and omized controlled design , this study conducted among breast cancer survivors evaluated the effect of CBT on sleep , assessed both subjectively and objective ly , and on hypnotic medication use , psychological distress , and quality of life . PATIENTS AND METHODS Fifty-seven women with insomnia caused or aggravated by breast cancer were r and omly assigned to CBT ( n = 27 ) or a waiting-list control condition ( n = 30 ) . The treatment consisted of eight weekly sessions administered in a group and combined the use of stimulus control , sleep restriction , cognitive therapy , sleep hygiene , and fatigue management . Follow-up evaluations were carried out 3 , 6 , and 12 months after the treatment . RESULTS Participants who received the insomnia treatment had significantly better subjective sleep indices ( daily sleep diary , Insomnia Severity Index ) , a lower frequency of medicated nights , lower levels of depression and anxiety , and greater global quality of life at post-treatment compared with participants of the control group after their waiting period . Results were more equivocal on polysomnographic indices . Therapeutic effects were well maintained up to 12 months after the intervention and generally were clinical ly significant . CONCLUSION This study supports the efficacy of CBT for insomnia secondary to breast cancer OBJECTIVE To evaluate a patient education program that aims at reducing perceived fatigue in cancer survivors . METHODS In ten German centres , 261 patients with cancer-related fatigue were r and omly assigned to a patient education program consisting of 6 sessions à 90 min or st and ard care . The primary outcome measure was cancer-related fatigue . Data were analysed using analysis of variance ( ANOVA ) with repeated measures . RESULTS Patients in the intervention group showed statistically significant reduction in cancer-related fatigue ( F = 76.510 , p < 0.001 , η(2 ) = 0.248 ) . Secondary outcomes also showed significant improvements in all measures , including quality of life ( F = 29.607 , p < 0.001 , η(2 ) = 0.113 ) , general self-efficacy ( F = 27.680 , p < 0.001 , η(2 ) = 0.107 ) , exercise self-efficacy ( F = 49.230 , p < 0.001 , η(2 ) = 0.175 ) , physical activity ( F = 8.036 , p < 0.001 , η(2 ) = 0.033 ) , anxiety ( F = 33.194 , p < 0.001 , η(2 ) = 0.125 ) , depression ( F = 24.604 , p < 0.001 , η(2 ) = 0.096 ) , and fatigue knowledge ( F = 55.157 , p < 0.001 , η(2 ) = 0.192 ) . CONCLUSION The program was effective in reducing perceived fatigue as well as further outcomes . PRACTICE IMPLICATION S This newly developed education program has the potential to fill a gap in the care of cancer survivors . The program needs further evaluation in other countries employing a control group of patients receiving equal time and attention as the intervention group Purpose Fatigue is a prevalent , distressing side effect of cancer and cancer treatment which commonly coexists with insomnia . Cognitive behavioral therapy for insomnia ( CBT-I ) has been shown to improve insomnia  in cancer patients , but less is known about its ability to impact fatigue . This work is the analysis for a secondary aim of a four-arm r and omized controlled trial ( RCT ) study assessing the combined and comparative effect of CBT-I and a wakefulness-promoting agent , armodafinil ( A ) , to improve sleep and daytime functioning in cancer survivors . Herein , we examine the effect of CBT-I , with and without A , on fatigue in cancer survivors . Patients and methods This study was a four-arm factorial study with CBTI-I ( yes/no ) versus A ( yes/no ) . It consisted of 96 cancer survivors ( average age 56 years ; 88 % female ; 68 % breast cancer ) .  Fatigue was assessed by the brief fatigue inventory ( BFI ) and the FACIT-Fatigue scale . The analysis assessed the additive effects of CBT-I and A and possible non-additive effects where the effect of CBT-I changes depending on the presence or absence of A. Results Analyses adjusting for baseline differences showed that CBT-I  improved fatigue as measured by two separate scales ( BFI : P = 0.002 , Std . error = 0.32 , effect size ( ES ) = 0.46 ; FACIT-Fatigue : P < 0.001 , Std . error = 1.74 , ES = 0.64 ) . Armodafinil alone did not show a statistically significant effect on fatigue levels ( all Ps > 0.40 ) nor did the drug influence the efficacy of CBT-I. Structural equation analysis revealed that reductions in insomnia severity were directly responsible for improving cancer-related fatigue . Conclusions CBT-I with and without armodafinil result ed in a clinical ly and statistically significant reduction of subjective daytime fatigue in cancer survivors with chronic insomnia . Armodafinil did not improve cancer-related fatigue ( CRF ) and did not change the efficacy of CBT-I. Patients reporting CRF should be screened and , if indicated , treated for insomnia as part of a comprehensive fatigue management program Purpose Patients suffering from postcancer fatigue have both an inferior physical activity and physical fitness compared to non-fatigued cancer survivors . The aims of this study were ( 1 ) to examine the effect of cognitive behavior therapy , an effective treatment for postcancer fatigue , on physical activity and physical fitness and ( 2 ) to examine whether the effect of cognitive behavior therapy on postcancer fatigue is mediated by physical activity and /or physical fitness . Methods Severely fatigued cancer survivors were r and omly assigned to either the intervention ( cognitive behavior therapy ) or the waiting list condition . After assigning 23 patients in the intervention condition and 14 patients in the waiting list condition  , they were assessed both at baseline and 6 months later . Physical activity was assessed via actigraphy and physical fitness was assessed by a maximal exercise test . A nonparametric bootstrap approach was used to test the statistical significance of the mediation effects . Results A significant increase in physical activity was observed in the intervention group from baseline to follow-up , whereas physical activity did not change from baseline to follow-up in the waiting list group . Physical fitness did not significantly change after cognitive behavior therapy or after 6 months of waiting for therapy .  Fatigue decreased more significantly in the intervention group than in the waiting list group . The mediation hypotheses were rejected . Conclusions Cognitive behavior therapy effectively reduced postcancer fatigue and increased physical activity but did not change physical fitness . The effect of cognitive behavior therapy on postcancer fatigue is not mediated by a change in physical activity or physical fitness INTRODUCTION About one-third of cancer survivors suffer from severe chronic fatigue . Aim of this study was to evaluate the efficacy of mindfulness-based cognitive group therapy in reducing severe chronic fatigue in cancer survivors with mixed diagnoses . PATIENTS AND METHODS Participants ( n = 100 ) were r and omly selected from a cohort and allocated to an intervention and a waiting list condition . Analyses were based on 59 participants in the intervention condition and 24 in the waiting-list condition . Fatigue severity ( Checklist Individual Strength ) , functional impairment ( Sickness Impact Profile ) and well being ( Health and Disease-Inventory ) were assessed before and after the 9-week intervention . The intervention group had a follow-up 6 months following the intervention . RESULTS At post-treatment measurement the proportion of clinical ly improved participants was 30 % , versus 4 % in the waiting list condition ( χ(2 ) ( 1 ) = 6.71 ; p = 0.007 ) . The mean fatigue score at post-measurement was significantly lower in the intervention group than in the waiting list group corrected for pre-treatment level of fatigue . The mean well-being score at post-measurement was significantly higher in the intervention group than in the waiting list group corrected for pre-treatment level of well-being . The treatment effect was maintained at 6-month follow-up . No difference between the two conditions was found in functional impairment . DISCUSSION Mindfulness-based cognitive therapy is an effective treatment for chronic cancer-related fatigue OBJECTIVES To determine the effects of the 3-month multicomponent Better Exercise Adherence after Treatment for Cancer ( BEAT Cancer ) physical activity behavior change intervention on fatigue , depressive symptomatology , and anxiety . METHODS Post primary treatment breast cancer survivors ( n = 222 ) were r and omized to BEAT Cancer or usual care .  Fatigue Symptom Inventory and Hospital Anxiety and Depression Scale were assessed at baseline , postintervention ( month 3 ; M3 ) , and follow-up ( month 6 ; M6 ) . RESULTS Adjusted linear mixed-model analyses demonstrated significant effects of BEAT Cancer vs usual care on fatigue intensity ( M3 mean between group difference [ M ] = -0.6 ; 95 % confidence interval [ CI ] = -1.0 to -0.2 ; effect size [ d ] = -0.32 ; P = .004 ) , fatigue interference ( M3 M = -0.8 ; CI = -1.3 to -0.4 ; d = -0.40 ; P < .001 ) , depressive symptomatology ( M3 M = -1.3 ; CI = -2.0 to -0.6 ; d = -0.38 ; P < .001 ) , and anxiety ( M3 M = -1.3 ; CI = -2.0 to -0.5 ; d = -0.33 ; P < .001 ) . BEAT Cancer effects remained significant at M6 for all outcomes ( all P values < .05 ; d = -0.21 to -.35 ) . Clinical ly meaningful effects were noted for fatigue intensity , fatigue interference , and depressive symptomatology . CONCLUSIONS BEAT Cancer  reduces fatigue , depressive symptomatology , and anxiety up to 3 months postintervention in post primary treatment breast cancer survivors . Further study is needed to determine sustainable methods for disseminating and implementing the beneficial intervention components Long‐term chemotherapy‐related cognitive dysfunction ( CRCD ) affects a large number of cancer survivors . To the authors ' knowledge , to date there is no established treatment for this survivorship problem . The authors herein report results of a small r and omized controlled trial of a  cognitive behavioral therapy ( CBT ) , Memory and Attention Adaptation Training ( MAAT ) , compared with an attention control condition . Both treatments were delivered over a videoconference device OBJECTIVE Insomnia is a common complaint among cancer survivors . Fortunately , cognitive-behavioral therapy for insomnia ( CBT-I ) has been shown to be an effective treatment in this population . However , it is rarely implemented given its limited availability . To address this barrier , we examined the ability of an easily accessible online CBT-I program to improve insomnia symptoms in cancer survivors . METHODS Twenty-eight cancer survivors with insomnia were r and omly assigned to either an Internet insomnia intervention ( n = 14 ) or to a waitlist control group ( n = 14 ) . The online program , Sleep Healthy Using The Internet , delivers the primary components of CBT-I ( sleep restriction , stimulus control , cognitive restructuring , sleep hygiene , and relapse prevention ) . Pre- and post- assessment data were collected via online question naires and daily sleep diaries . RESULTS Participants in the Internet group showed significant improvements at post- assessment compared with those in the control group in overall insomnia severity ( F(1,26 ) = 22.8 ; p<0.001 ) , sleep efficiency ( F(1,24 ) = 11.45 ; P = 0.002 ) , sleep onset latency ( F(1,24 ) = 5.18 ; P = 0.03 ) , soundness of sleep ( F(1,24 ) = 9.34 ; P = 0.005 ) , restored feeling upon awakening ( F(1,24 ) = 11.95 ; P = 0.002 ) , and general fatigue ( F(1,26 ) = 13.88 ; P = 0.001 ) . Although other group × time interactions were not significant , overall adjusted effect sizes for all sleep variables as well as for fatigue , depression , anxiety , and quality of life ranged from small to large . CONCLUSIONS CBT-I delivered through an interactive , individually tailored Internet intervention may be a viable treatment option for cancer survivors experiencing insomnia PURPOSE / OBJECTIVES To examine the effect of cognitive-behavioral therapy for insomnia ( CBTI ) on sleep improvement , daytime symptoms , and quality of life ( QOL ) in breast cancer survivors ( BCSs ) after cancer treatment . DESIGN A prospect i ve , longitudinal , r and omized , controlled trial . SETTING Oncology clinics , breast cancer support groups , and communities in Colorado . SAMPLE 56 middle-aged BCSs with chronic insomnia . METHODS Women were r and omly assigned to CBTI or behavioral placebo treatment ( BPT ) and completed measures of sleep , QOL , functioning , fatigue , and mood at baseline , postintervention , and at three- and six-month follow-ups . MAIN RESEARCH VARIABLES Sleep outcomes ( e.g. , sleep efficiency , sleep latency , total sleep time , wake after sleep onset , number of nightly awakenings ) ; secondary variables included sleep medication use , insomnia severity , QOL , physical function , cognitive function , fatigue , depression , anxiety , and sleep attitudes or knowledge . FINDINGS Sleep efficiency and latency improved more in the CBTI group than the BPT group ; this difference was maintained during follow-up . Women in the CBTI group had less subjective insomnia , greater improvements in physical and cognitive functioning , positive sleep attitudes , and increased sleep hygiene knowledge . No group differences in improvement were noted relative to QOL , fatigue , or mood . CONCLUSIONS Nurse-delivered CBTI appears to be beneficial for BCSs ' sleep latency/efficiency , insomnia severity , functioning , sleep knowledge , and attitudes more than active placebo , with sustained benefit over time . IMPLICATION S FOR NURSING Oncology nurses are in a unique position to identify insomnia in cancer survivors . When sleep disturbances become chronic , nurses need to make recommendations and referrals Background : Physical activity can confer many benefits on cancer survivors , including relief of persistent symptoms related to cancer treatment . Objectives : To evaluate the effect of a motivational interviewing ( MI ) intervention on increasing physical activity ( Community Healthy Activities Model Program for Seniors question naire ) and improving aerobic fitness ( 6-minute walk ) , health ( Medical Outcomes Study Short-Form 36 ) , and fatigue ( Schwartz Cancer Fatigue Scale ) in cancer survivors . A secondary purpose was to evaluate whether the effect of MI on physical activities depended on self-efficacy . Methods : Fifty-six physically inactive adult cancer survivors ( mean = 42 months since completion of treatment ) were assigned r and omly to intervention and control groups . The MI intervention consisted of one in-person counseling session followed by two MI telephone calls over 6 months . Control group participants received two telephone calls without MI content . Outcomes were measured at baseline , 3 months , and 6 months , and were analyzed using multilevel modeling . Results : The results of the MI intervention explained significant group differences in regular physical activities ( measured in caloric expenditure per week ) , controlling for time since completion of cancer treatment ( p < .05 ) . Aerobic fitness , physical and mental health , and fatigue were not different between groups . In the intervention group , individuals with high self-efficacy for exercise at baseline increased their physical activity more than those with low self-efficacy ( p < .05 ) . In the control group , increases in physical activity did not depend on self-efficacy . Discussion : Use of MI may increase physical activity in long-term cancer survivors , especially in persons with high self-efficacy for exercise . Multilevel modeling analysis revealed individual changes that would not have been shown by analysis of group means . Future studies with larger sample s or more intense MI interventions may show changes in aerobic fitness , physical and mental health , and fatigue PURPOSE To determine whether an Internet-based tailored education program is effective for disease-free cancer survivors with cancer-related fatigue ( CRF ) . PATIENTS AND METHODS We r and omly assigned patients who had completed primary cancer treatment within the past 24 months in any of four Korean hospitals and had reported moderate to severe fatigue for at least 1 week to participate in a 12-week , Internet-based , individually tailored CRF education program or to receive routine care .  We based the program on the CRF guidelines of the National Comprehensive Cancer Network ( NCCN ) and incorporated the transtheoretic model ( TTM ) . At baseline and 12 weeks , we used the Brief Fatigue Inventory ( BFI ) and Fatigue Severity Scale ( FSS ) as primary outcomes and the Hospital Anxiety and Depression Scale ( HADS ) and European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ( EORTC QLQ-C30 ) for secondary outcomes . RESULTS We recruited 273 participants and r and omly assigned 136 to the intervention group . Compared with the control group , the intervention group had an improvement in fatigue as shown by a significantly greater decrease in BFI global score ( -0.66 points ; 95 % CI -1.04 to -0.27 ) and FSS total score ( -0.49 ; 95 % CI , -0.78 to -0.21 ) . In secondary outcomes , the intervention group experienced a significantly greater decrease in HADS anxiety score ( -0.90 ; 95 % CI , -1.51 to -0.29 ) as well as global quality of life ( 5.22 ; 95 % CI , 0.93 to 9.50 ) and several functioning scores of the EORTC QLQ-C30 . CONCLUSION An Internet-based education program based on NCCN guidelines and TTM may help patients manage CRF BACKGROUND Mindfulness-based cancer recovery ( MBCR ) and supportive expressive group therapy ( SET ) are two well-vali date d psychosocial interventions , but they have not been directly compared , and little is known about long-term outcomes . This comparative effectiveness study measured the effects of these two interventions immediately following the groups and for 1 year thereafter in distressed breast cancer survivors . METHODS Two hundred fifty-two distressed Stage I-III breast cancer survivors were r and omized into either MBCR or SET . Women completed question naires addressing mood , stress symptoms , quality of life , social support , spirituality and post-traumatic growth before and after the interventions , and 6 and 12 months later . RESULTS Immediately following the intervention , women in MBCR reported greater reduction in mood disturbance ( primarily fatigue , anxiety and confusion ) and stress symptoms including tension , sympathetic arousal and cognitive symptoms than those in SET . They also reported increased emotional and functional quality of life , emotional , affective and positive social support , spirituality ( feelings of peace and meaning in life ) and post-traumatic growth ( appreciation for life and ability to see new possibilities ) relative to those in SET , who also improved to a lesser degree on many outcomes . Effect sizes of the time × group interactions were small to medium , and most benefits were maintained over 12 months of follow-up . CONCLUSIONS This study is the first and largest to demonstrate sustained benefits of MBCR in distressed breast cancer survivors relative to an active control . MBCR was superior to SET for improving psychological well-being with lasting benefits over 1 year , suggesting these women gained long-lasting and efficacious tools to cope with cancer . TRIAL REGISTRATION Registered on clinical trials.gov number NCT00390169 , October 2006 . Copyright © 2016 John Wiley & Sons , PURPOSE To assess the effectiveness of mindfulness-based stress reduction ( MBSR ) for mood , breast- and endocrine-specific quality of life , and well-being after hospital treatment in women with stage 0 to III breast cancer . PATIENTS AND METHODS A r and omized , wait-listed , controlled trial was carried out in 229 women after surgery , chemotherapy , and radiotherapy for breast cancer . Patients were r and omly assigned to the 8-week MBSR program or st and ard care .  Profile of Mood States ( POMS ; primary outcome ) , Functional Assessment of Cancer Therapy-Breast ( FACT-B ) , Functional Assessment of Cancer Therapy-Endocrine Symptoms ( FACT-ES ) scales and the WHO five-item well-being question naire ( WHO-5 ) evaluated mood , quality of life , and well-being at weeks 0 , 8 , and 12 . For each outcome measure , a repeated- measures analysis of variance model , which incorporated week 0 measurements as a covariate , was used to compare treatment groups at 8 and 12 weeks . RESULTS There were statistically significant improvements in outcome in the experimental group compared with control group at both 8 and 12 weeks ( except as indicated ) for POMS total mood disturbance ( and its subscales of anxiety , depression [ 8 weeks only ] , anger [ 12 weeks only ] , vigor , fatigue , and confusion [ 8 weeks only ] ) , FACT-B , FACT-ES , ( and Functional Assessment of Cancer Therapy subscales of physical , social [ 8 weeks only ] , emotional , and functional well-being ) , and WHO-5 . CONCLUSION MSBR improved mood , breast- and endocrine-related quality of life , and well-being more effectively than st and ard care in women with stage 0 to III breast cancer , and these results persisted at three months . To our knowledge , this study provided novel evidence that MBSR can help alleviate long-term emotional and physical adverse effects of medical treatments , including endocrine treatments . MBSR is recommended to support survivors of breast cancer PURPOSE Persistent fatigue is a long-term adverse effect experienced by 30 % to 40 % of patients cured of cancer . The main objective of this r and omized controlled trial was to show the effectiveness of cognitive behavior therapy ( CBT ) especially design ed for fatigue in cancer survivors . PATIENTS AND METHODS A total of 112 cancer survivors with somatically unexplained fatigue were allocated r and omly to immediate cognitive behavior therapy or to a waiting list condition for therapy . Both conditions were assessed two times , at baseline and 6 months later . The primary outcome variables were fatigue severity ( Checklist Individual Strength ) and functional impairment ( Sickness Impact Profile ) . Data were analyzed by intention to treat . RESULTS Analyses were based on 50 patients in the intervention condition and 48 patients in the waiting list condition . Patients in the intervention condition reported a significantly greater decrease than patients in the waiting list condition in fatigue severity ( difference , 13.3 ; 95 % CI , 8.6 to 18.1 ) and in functional impairment ( difference , 383.2 ; 95 % CI , 197.1 to 569.2 ) . Clinical ly significant improvement for the CBT group compared with the waiting list group was seen in fatigue severity ( 54 % v 4 % of the patients , respectively ) and in functional impairment ( 50 % v 18 % of the patients , respectively ) . CONCLUSION Cognitive behavior therapy has a clinical ly relevant effect in reducing fatigue and functional impairments in cancer survivors CONTEXT Breast cancer survivors ( BCS ) face adverse physical and psychological symptoms , often co-occurring . Biologic and psychological factors may link symptoms within clusters , distinguishable by prevalence and /or severity . Few studies have examined the effects of behavioral interventions or treatment of symptom clusters . OBJECTIVES The aim of this study was to identify symptom clusters among post-treatment BCS and determine symptom cluster improvement following the Mindfulness-Based Stress Reduction for Breast Cancer ( MBSR(BC ) ) program . METHODS Three hundred twenty-two Stage 0-III post-treatment BCS were r and omly assigned to either a six-week MBSR(BC ) program or usual care .  Psychological ( depression , anxiety , stress , and fear of recurrence ) , physical ( fatigue , pain , sleep , and drowsiness ) , and cognitive symptoms and quality of life were assessed at baseline , six , and 12 weeks , along with demographic and clinical history data at baseline . A three-step analytic process included the error-accounting models of factor analysis and structural equation modeling . RESULTS Four symptom clusters emerged at baseline : pain , psychological , fatigue , and cognitive . From baseline to six weeks , the model demonstrated evidence of MBSR(BC ) effectiveness in both the psychological ( anxiety , depression , perceived stress and QOL , emotional well-being ) ( P = 0.007 ) and fatigue ( fatigue , sleep , and drowsiness ) ( P < 0.001 ) clusters . Results between six and 12 weeks showed sustained effects , but further improvement was not observed . CONCLUSION Our results provide clinical effectiveness evidence that MBSR(BC ) works to improve symptom clusters , particularly for psychological and fatigue symptom clusters , with the greatest improvement occurring during the six-week program with sustained effects for several weeks after MBSR(BC ) training . TRIAL REGISTRATION Name and URL of Registry : Clinical Trials.gov . Registration number : NCT01177124 OBJECTIVE Cancer-related fatigue ( CRF ) is one of the most common , persistent , and disabling symptoms associated with cancer and its treatment . Evidence -based treatments that are acceptable to patients are critically needed . This study examined the efficacy of mindfulness-based stress reduction ( MBSR ) for CRF and related symptoms . METHOD A sample of 35 cancer survivors with clinical ly significant CRF was r and omly assigned to a 7-week MBSR-based intervention or wait-list control group . The intervention group received training in mindfulness meditation , yoga , and self-regulatory responses to stress .  Fatigue interference ( primary outcome ) and a variety of secondary outcomes ( e.g. , fatigue severity , vitality , disability , depression , anxiety , and sleep disturbance ) were assessed at baseline , post-intervention , and 1-month follow-up . Bonferroni correction was employed to account for multiple comparisons . Controls received the intervention after the 1-month follow-up . Participants in both groups were followed for 6 months after completing their respective MBSR courses to assess maintenance of effects . RESULTS Compared to controls , the MBSR group reported large post-intervention reductions as assessed by effect sizes ( d ) in the primary outcome , fatigue interference ( d = -1.43 , p < 0.001 ) , along with fatigue severity ( d = -1.55 , p < 0.001 ) , vitality ( d = 1.29 , p < 0.001 ) , depression ( d = -1.30 , p < 0.001 ) , and sleep disturbance ( d = -0.74 , p = 0.001 ) . Results were maintained or strengthened at 1-month follow-up , the point at which significant improvements in disability ( d = -1.22 , p < 0.002 ) and anxiety ( d = -0.98 , p = 0.002 ) occurred . Improvements in all outcomes were maintained 6 months after completing the course . MBSR adherence was high , with 90 % attendance across groups and high rates of participant-reported home practice of mindfulness . CONCLUSIONS Mindfulness-based stress reduction is a promising treatment for CRF and associated symptoms PURPOSE Persistent insomnia is a common complaint in cancer survivors , but is seldom satisfactorily addressed . The adaptation to cancer care of a vali date d , cost-effective intervention may offer a practicable solution . The aim of this study was to investigate the clinical effectiveness of protocol -driven cognitive behavior therapy ( CBT ) for insomnia , delivered by oncology nurses . PATIENTS AND METHODS R and omized , controlled , pragmatic , two-center trial of CBT versus treatment as usual ( TAU )  in 150 patients ( 103 females ; mean age , 61 years . ) who had completed active therapy for breast , prostate , colorectal , or gynecological cancer . The study conformed to CONSORT guidelines . Primary outcomes were sleep diary measures at baseline , post-treatment , and 6-month follow-up . Actigraphic sleep , health-related quality of life ( QOL ) , psychopathology , and fatigue were secondary measures . CBT comprised five , small group sessions across consecutive weeks , after a manualized protocol . TAU represented normal clinical practice ; the appropriate control for a clinical effectiveness study . RESULTS CBT was associated with mean reductions in wakefulness of 55 minutes per night compared with no change in TAU . These outcomes were sustained 6 months after treatment . St and ardized relative effect sizes were large for complaints of difficulty initiating sleep , waking from sleep during the night , and for sleep efficiency ( percentage of time in bed spent asleep ) . CBT was associated with moderate to large effect sizes for five of seven QOL outcomes , including significant reduction in daytime fatigue . There was no significant interaction effect between any of these outcomes and baseline demographic , clinical , or sleep characteristics . CONCLUSION CBT for insomnia may be both clinical ly effective and feasible to deliver in real world practice Background Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer . To date , it is unclear what type of rehabilitation is most beneficial . Objective This r and omized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention . Design In this multicenter r and omized controlled trial , 147 survivors of cancer were r and omly assigned to a group that received physical training combined with cognitive-behavioral therapy ( PT+CBT group , n=76 ) or to a group that received physical training alone ( PT group , n=71 ) . In addition , a nonintervention control group ( WLC group ) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included . Setting The study was conducted at 4 rehabilitation centers in the Netherl and s. Patients All patients were survivors of cancer . Intervention Physical training consisting of 2 hours of individual training and group sports took place twice weekly , and cognitive-behavioral therapy took place once weekly for 2 hours . Measurements Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention ( 12 weeks after enrollment ) . The WLC group completed question naires at the same time points . Results Baseline fatigue did not differ significantly among the 3 groups . Over time , levels of fatigue significantly decreased in all domains in all groups , except in mental fatigue in the WLC group . Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue , on physical and mental fatigue , and on reduced activation but not on reduced motivation . Compared with the WLC group , the PT group reported significantly greater decline in 4 domains of fatigue , whereas the PT+CBT group reported significantly greater decline in physical fatigue only . No significant differences in decline in fatigue were found between the PT+CBT and PT groups . Conclusions Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention . Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue , suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training
Background Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase .
This systematic review evaluated the effectiveness of psychological interventions for  cancer-related fatigue in post-treatment cancer survivors .
With the growing need for stage-specific research in cancer , this review sought to inform current practice and to summarise the existing evidence base of r and omised controlled trials in the area .