CBT on Fatigue in Survivors of Hodgkin Lymphoma
Cognitive Behavioral Therapy (CBT) Web-based Intervention on Fatigue in Survivors of Hodgkin Lymphoma - a Pilot Study
Background: Cancer-related fatigue is one of the most common patient-reported impairments in survivors of Hodgkin lymphoma and is associated with adverse effects on psychological well-being and everyday life including family, work and social participation.
Methods: The investigators here present a bi-centric (Cologne and Leipzig) pilot-study for a web-based intervention (Cognitive Behavioral Therapy) on cancer-related fatigue. In detail, the investigators will conduct a non-randomized and non-controlled before-and-after study in a minimum of 20 survivors of Hodgkin lymphoma. Levels of fatigue and quality of life will be measured before the intervention (T0), post-intervention (T1) and at 3-months follow-up (T2).
Results: The investigators will provide information regarding the feasibility of the intervention (i.e., response rate, patient and therapist adherence, and patient satisfaction) and preliminary results on the efficacy of the program in reducing CRF and increasing levels of quality of life.
Aims: The results of this pilot-study will provide essential information to conduct a future randomized clinical trial to investigate the efficacy of this intervention in reducing cancer-related fatigue in survivors with Hodgkin lymphoma.
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
Concrete Aims: The investigators aim to conduct a a feasibility study, e.g., a pilot study before a randomized controlled trial can be planned in detail. This initial pilot-study is intended to test out the standard operating procedures, evaluate the feasibility, acceptance and adherence to the study protocol as well as preliminary efficacy of the web-based intervention for survivors of Hodgkin lymphoma. In detail, this study contains all preparation for conducting a trial, i.e., the translation, the adaptation and evaluation of the cognitive-behavioral web-based intervention manual from the original Dutch Version, the adaptation and implementation of all necessary technical and research-administrative requirements to successfully conduct the web-based randomized controlled trial and the evidence-based training of all study therapists including the implementation of therapists supervision. The investigators further assess adherence of the patients and therapists, the response rate and the patient satisfaction. Furthermore, preliminary efficacy of the intervention will be tested assessing levels of fatigue and quality of life at each measurement point.
Study Design: The design of this pilot web-based intervention on treating fatigue will be a non-randomised prospective non-controlled before-and-after study, in which observations will be made only in a patient group that receives the intervention. No control group will be recruited. Assessments will be conducted on the three measurement points: before the therapy (T0), after the intervention (T1) and 3 months after the intervention (T2).
Intervention: The internet-based cognitive behavioral therapy on postcancer fatigue includes two face-to-face sessions with their therapist and eight web-based treatment modules, each approximately 45 minutes in length, delivered over 6 months. The intervention will be specifically tailored to the individual needs of each patient: The therapy model of cancer-related fatigue distinguishes six perpetuating factors: 1) insufficient processing of being diagnosed with Hodgkin lymphoma and being treated for it; 2) excessive fear of disease recurrence; 3) inactivity or a dysregulated (physical) activity pattern; 4) dysfunctional fatigue-related beliefs; 5) dysregulated sleep-wake pattern and 6) lack of social support. For each of these six cognitive-behavioural factors that can perpetuate fatigue a treatment module has been developed. The intervention will consist of a maximum of eight treatment modules: aside from the six modules addressing the fatigue maintaining factor there is a module on goal formulation and realization of goals.
Recruitment: the recruitment will be realized on the basis of two ongoing trials of the German Hodgkin study group (HD 16- HD18) where fatigue of the patients is measured continuously.
Duration: The duration for patients will be 9 months (6 months intervention, 3 month-follow-up assessment). The duration of the whole study will be 18 months.
Studietype
Inschrijving (Werkelijk)
Fase
- Niet toepasbaar
Contacten en locaties
Studie Locaties
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Cologne, Duitsland
- University Medical Center Cologne
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Saxony
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Leipzig, Saxony, Duitsland, 04103
- University Medical Center Leipzig
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- fluency in German language
- able to access the internet and use and follow a web-based Cognitive Behavioral intervention
- in complete remission after treatment for newly diagnosed HL without signs of relapse (no previous relapse)
- clinically relevant fatigue symptoms enduring at least 12 months after end of treatment (QLQ-C30 FA-12 ≥ 30 over at least two time points within the previous assessments in the course of the GHSG-trials)
- fatigue being related to HL and its treatment and interferes with usual functioning, i.e. fulfills the definition of CRF [1, 16].
Exclusion Criteria:
- Major communication difficulties
- severe cognitive impairment that would interfere with a patient's ability to give informed consent for research (indicated by the medical care team)
- Karnofsky Performance Status scale score < 70 predicting an expected survival of less than 6 months
- somatic co-morbidities that could explain the presence of severe fatigue (e.g. Chronic Obstructive Pulmonary Disease or heart failure) according to the hemato-oncologists examining the potential participant before inclusion for the study
- history of relapsed or refractory HL
- clinical symptoms which may indicate a relapse of HL
- current depressive disorder and related psychotropic or psychological treatment
- Currently receiving medical and/or psychological treatment for a psychiatric disorder, other than the use of an anti-depressant
- current treatment aimed at fatigue
- previous attempt to treat fatigue with behavioral psychological therapy
- pregnant or breastfeeding women
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Ondersteunende zorg
- Toewijzing: NVT
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Experimenteel: Cognitive Behavioral Therapy for Treating Fatigue
This is the patient group that receives the intervention (IG), i.e., the cognitive behavioral therapy for reducing fatigue.
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The internet-based CBT postcancer fatigue intervention includes two face-to-face sessions with their therapist and eight web-based treatment modules, each approximately 45 minutes in length, delivered over 6 months. The intervention will be specifically tailored to the individual needs of each patient: The CBT model of cancer-related fatigue distinguishes six perpetuating factors: 1) insufficient processing of being diagnosed with HL and being treated for it; 2) excessive fear of disease recurrence; 3) inactivity or a dysregulated (physical) activity pattern; 4) dysfunctional fatigue-related beliefs; 5) dysregulated sleep-wake pattern and 6) lack of social support. For each of these six cognitive-behavioural factors that can perpetuate fatigue a treatment module has been developed. |
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Responspercentage
Tijdsspanne: De beoordelingsperiode voor deze uitkomst loopt van het begin van de werving tot de opname van de laatste patiënt, wat ongeveer 1 jaar zal zijn.
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De onderzoekers zullen het aantal in aanmerking komende patiënten dat bereid is deel te nemen aan het onderzoek beoordelen in verhouding tot het aantal patiënten dat werd uitgenodigd om deel te nemen.
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De beoordelingsperiode voor deze uitkomst loopt van het begin van de werving tot de opname van de laatste patiënt, wat ongeveer 1 jaar zal zijn.
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Patiënt therapietrouw
Tijdsspanne: Tijdens de interventiefase voor elke patiënt, die ongeveer zes maanden zal duren.
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De therapietrouw van de patiënt zal worden beoordeeld aan de hand van documentatie over de uitval van patiënten.
In detail zullen we documenteren of patiënten het onderzoek tijdens de behandeling verlaten (en zo ja, in welk stadium).
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Tijdens de interventiefase voor elke patiënt, die ongeveer zes maanden zal duren.
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Tevredenheid van de patiënt
Tijdsspanne: Slechts één keer per patiënt beoordeeld, direct nadat de patiënt de ingreep heeft voltooid.
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Beoordeeld aan de hand van een vragenlijst (Working Alliance Inventory - short form herzien).
De totale somscore over de 12 items, beoordeeld op een vijfpunts Likert-schaal, wordt gepresenteerd (variërend van 12 tot 60).
Hogere waarden zorgen voor meer tevredenheid.
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Slechts één keer per patiënt beoordeeld, direct nadat de patiënt de ingreep heeft voltooid.
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Therapist adherence
Tijdsspanne: Assessed during the intervention phase for each patient, i.e., within about 6 six months.
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Using information of the therapy protocols of each participant, it will be assessed if the treatment sessions were done according to the treatment protocol.
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Assessed during the intervention phase for each patient, i.e., within about 6 six months.
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Levels of fatigue 1
Tijdsspanne: Assessed at three time points: before the intervention, immediately after the intervention and 3 months after the intervention
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Assessed by a questionnaire, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Module Measuring Cancer-Related Fatigue (EORTC QLQ-FA12).
The questionnaire assesses the level of cancer-related fatigue.
The sum score across all 12 items, rated on a 4-point Likert scale, will be reported (total range: 12-48).
Higher values indicate higher levels of fatigue (i.e., higher values indicate a worse outcome).
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Assessed at three time points: before the intervention, immediately after the intervention and 3 months after the intervention
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Levels of fatigue 2
Tijdsspanne: Assessed at three time points: before the intervention, immediately after the intervention and 3 months after the intervention
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Levels of fatigue will additionally assessed by a second questionnaire, the Checklist Individual Strength - Subscale Fatigue Severity.
The scale assesses the level of cancer-related fatigue.
The sum score across all 8 items, rated on a 7-point Likert scale, will be presented (total range: 8 - 56).
Higher values indicate higher levels of fatigue (i.e., higher values indicate a worse outcome).
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Assessed at three time points: before the intervention, immediately after the intervention and 3 months after the intervention
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Global quality of life
Tijdsspanne: Assessed at three time points: before the intervention, immediately after the intervention and 3 months after the intervention
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Global quality of Life will be assessed by the European Organisation for Research and Treatment of Cancer (EORTC), Quality of Life-questionnaire (EORTC QLQ-C30).
Global quality of life is assessed in a 2-item subscale of the questionnaire, each rated on a 7-point-Likert scale (total range: 2-14).
According to the questionnaire manual, however, the sum score of the two items will be linear-transformed to a 0-100 scale, with higher values indicating higher levels of quality of life (i.e., higher values indicate a better outcome).
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Assessed at three time points: before the intervention, immediately after the intervention and 3 months after the intervention
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Anja Mehnert, Prof. Dr., University of Leipzig
- Hoofdonderzoeker: Peter Borchmann, Prof. Dr., University of Cologne
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
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Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- 933 000-146
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