Background and aims: Cancer-related fatigue (CRF) is a commonly experienced side effect of cancer or cancer treatment that can be debilitating years after treatment completion. The benefits of cognitive behavioural therapy (CBT) focusing on personal, social and lifestyle factors known to maintain fatigue are established. International guidelines recommend CBT for post-cancer fatigue, but it is not yet available in Australia. Traditional CBT is typically resource-intensive. Stepped-care provides a low-resource intervention for all, and a higher-resource intervention reserved for people with complex needs. The aim of this project is to develop and test the feasibility of stepped-care for persistent CRF.
Method/Design: This is a single-arm study investigating the feasibility of a stepped-care program entitled REFRESH - Finding new energy after cancer. 50 participants at least 12 weeks post-treatment, or on long-term or maintenance treatment who have moderate to severe CRF will enrol in REFRESH. All will undertake Step 1, a 5-week program of supported self-management. Participants work through an evidence-based CBT self-help booklet, with brief weekly contacts from a psychologist. After Step 1, change in fatigue and feasibility of the self-help program are evaluated. Step 2 is offered to participants whose fatigue remains severe, or is moderate but not improved. These participants are offered 4 sessions of tailored CBT with a clinical psychologist. All participants complete questionnaires before the program, and at 5 and 10 weeks.
Results: Preliminary data on feasibility (recruitment, retention and adherence rates; time taken to complete Step 1), proportion of people referred to ‘STEP 2’ and practicability of REFRESH in clinical practice will be presented.
Conclusion: A stepped-care approach could enable many survivors to access CBT for post-cancer fatigue to improve quality of life, in their own homes. Results of this study can be used as preliminary data for an efficacy study comparing stepped-care CBT with therapist-led CBT for post-cancer fatigue.