BackgroundApproximately 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.ObjectiveThe current paper reports on the results of a 3-armed randomized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition.MethodsSeverely fatigued cancer survivors were recruited via online and offline channels, and self-registered on an open-access website. After eligibility checks, 167 participants were randomized via an embedded automated randomization 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.ResultsMultiple group latent growth curve analysis, corrected for individual time between assessments, 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 researcher who was blind to allocation. Clinically 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.ConclusionsBoth the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails.Trial RegistrationTrialregister.nl NTR3483; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3483 (Archived by WebCite at http://www.webcitation.org/6NWZqon3o)

PurposeThis study aims to investigate how perceived work ability, job self-efficacy, value of work, and fatigue predict return to work (RTW) in cancer patients who received chemotherapy.MethodsData of a before-after study on a multidisciplinary intervention that aimed to enhance RTW was used, consisting of four assessments up to 18 months. Time to partial and full RTW of 76 and 81 participants, respectively, was analyzed in Cox proportional hazard analysis with time-dependent variables. Univariate analyses of work ability, job self-efficacy, value of work, or fatigue as covariates were succeeded by multivariate analyses of work ability and either job self-efficacy, value of work, or fatigue as covariates.ResultsParticipants were mostly female (93%), and diagnosed with breast cancer (87%). Most participants were permanently employed (84%) and 48% was sole breadwinner. When adjusted for timing variables and prognostic factors, all hypothesized factors were predictive for earlier RTW (p < .05). In models that also included work ability, only job self-efficacy significantly predicted earlier full RTW: hazard ratio = 1.681; p = .025.ConclusionsLower fatigue and higher value of work, work ability, and job self-efficacy of cancer survivors are associated with earlier RTW. Work ability and job self-efficacy seem to be key predictors.Implications for cancer survivorsLimiting fatigue, increasing value of work, job self-efficacy, and perceived work ability are promising goals for enhancing earlier RTW. Occupational rehabilitation should empower patients to organize appropriate conditions for work and to educate them on rights and obligations during sick leave.Electronic supplementary materialThe online version of this article (10.1007/s11764-017-0655-7) contains supplementary material, which is available to authorized users.

Receiving a cancer diagnosis has a major impact on patients' lives. One of the most prevalent long-term sideeffects of cancer and its treatment is fatigue. Patients who suffer from severe fatigue also often suffer from symptoms of depression and/or anxiety (Donovan et al., 2013; Hofman et al., 2007; Zhu et al., 2017). In addition, depression and anxiety often co-occur in cancer patients (Mitchell et al., 2011). Multiple studies have demonstrated high correlations among these three problem areas in cancer patients (Brown & Kroenke, 2009). Agasi-Idenburg et al. (2017) demonstrated that fatigue, depression and anxiety form a symptom cluster: a set of multiple co-occurring symptoms that are strongly interrelated (Miaskowski et al., 2017). Compared with a single symptom, the occurrence of Electronic supplementary material The online version of this article (

BackgroundInternet interventions offer advantages that especially cancer survivors who suffer from fatigue could benefit from. Given the growing number of such patients, Internet interventions could supplement and strengthen currently available health care.ObjectiveThis paper describes the design and analysis plan that will be used to study 2 Internet interventions aimed at reducing severe fatigue in cancer survivors: a mobile ambulant activity feedback therapy supported through a weekly email by a physiotherapist and a weekly Web- and mindfulness-based cognitive therapy supported online by a psychologist. The data resulting from this trial will be used to (1) investigate the effectiveness, (2) investigate potential mediators of these interventions, and (3) explore participant characteristics that can predict the effect of these interventions.MethodsA 3-armed randomized controlled trial is proposed that compares both Internet interventions with an active control condition that solely consists of receiving psycho-educational emails. The intervention period is 9 weeks for all 3 conditions. Six months after baseline, participants in the control condition can choose to follow 1 of the 2 experimental Internet interventions. Outcomes are measured in terms of fatigue severity, mental health, and self-perceived work ability. All are Web-assessed at baseline, 2 weeks after the intervention period, and at 6 and 12 months after baseline. Fatigue severity, mindfulness, physical activity, expectations and credibility of the intervention, therapeutic working alliance, sleep quality, and sense of control over fatigue are assessed 3 times during the intervention period for identifying mediators of the interventions. Recruitment is performed nationally throughout the Netherlands through patient organizations and their websites, newspapers, and by informing various types of health professionals. All participants register at an open-access website. We aim at including 330 cancer survivors who have finished curative-intent cancer treatment at least 3 months previously, and have been suffering from severe fatigue ever since. All cancer types are included. A detailed analysis plan is described to address the research questions, which allows for individual variation, and fully exploits the longitudinal design.ResultsRecruitment started in April 2013 and will proceed until April 2015.ConclusionsThis paper describes a systematic trial design for studying 2 different interventions for chronic cancer-related fatigue in order to gain insight into the effectiveness and mediators of the interventions. This design will also be used to identify predictors for the interventions’ effect on fatigue. By publishing our hypotheses and analysis plan before completion of data collection, this paper is a first step in reporting on this trial comprehensively.Trial RegistrationThe Netherlands National Trial Register (NTR3483). (Archived by WebCite at http://www.webcitation.org/6NWZqon3o).