Randomized controlled trial of a cognitive-behavioral therapy plus hypnosis intervention to control fatigue in patients undergoing radiotherapy for breast cancer

Abstract

Purpose: The objective of this study was to test the efficacy of cognitive-behavioral therapy plus hypnosis (CBTH) to control fatigue in patients with breast cancer undergoing radiotherapy. We hypothesized that patients in the CBTH group receiving radiotherapy would have lower levels of fatigue than patients in an attention control group.

Patients and methods: Patients (n = 200) were randomly assigned to either the CBTH (n = 100; mean age, 55.59 years) or attention control (n = 100; mean age, 55.97 years) group. Fatigue was measured at four time points (baseline, end of radiotherapy, 4 weeks, and 6 months after radiotherapy). Fatigue was measured using the Functional Assessment of Chronic Illness Therapy (FACIT) -Fatigue subscale and Visual Analog Scales (VASs; Fatigue and Muscle Weakness).

Results: The CBTH group had significantly lower levels of fatigue (FACIT) at the end of radiotherapy (z, 6.73; P < .001), 4-week follow-up (z, 6.98; P < .001), and 6-month follow-up (z, 7.99; P < .001) assessments. Fatigue VAS scores were significantly lower in the CBTH group at the end of treatment (z, 5.81; P < .001) and at the 6-month follow-up (z, 4.56; P < .001), but not at the 4-week follow-up (P < .07). Muscle Weakness VAS scores were significantly lower in the CBTH group at the end of treatment (z, 9.30; P < .001) and at the 6-month follow-up (z, 3.10; P < .02), but not at the 4-week follow-up (P < .13).

Conclusion: The results support CBTH as an evidence-based intervention to control fatigue in patients undergoing radiotherapy for breast cancer. CBTH is noninvasive, has no adverse effects, and its beneficial effects persist long after the last intervention session. CBTH seems to be a candidate for future dissemination and implementation.

Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.

CONSORT diagram. CBTH, cognitive-behavioral therapy plus hypnosis.

Fig 2.

The effects over time of cognitive-behavioral therapy plus hypnosis (CBTH) on fatigue in patients with breast cancer undergoing radiotherapy (RT). Asterisks indicate adjusted P < .05, controlling for family-wise error (multiple comparisons). (A) CBTH effects on mean FACIT-F, (B) CBTH effects on mean Fatigue VAS, (C) CBTH effects on mean Muscle Weakness VAS. AC, attention control group; FACIT-F, Functional Assessment of Chronic Illness Therapy–Fatigue; VAS, Visual Analog Scale.

Fig 3.

Effects of baseline fatigue levels on intervention effects over time in (A) attention control group and (B) cognitive-behavioral therapy plus hypnosis group. Asterisks indicate adjusted P < .05, controlling for family-wise error (multiple comparisons). FACIT-F, Functional Assessment of Chronic Illness Therapy–Fatigue; RT, radiotherapy; SD, standard deviation.