A randomised controlled trial of an optimized multidisciplinary intervention for post-cancer fatigue – TOPS Trial. — ASN Events
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A randomised controlled trial of an optimized multidisciplinary intervention for post-cancer fatigue – TOPS Trial. (#71)

Carolina Sandler 1 2 , Sarah Horsfield 2 , Chris Tzar 1 2 , Sally Mildon 2 , Richard McBride 2 , Barbara Bennett 1 , Blake Hamilton 2 , Kate Webber 1 , Michael Friedlander 3 4 , Craig Lewis 3 , Melvin Chin 3 , Ramya Venkateswaran 3 , Eva Segelov 1 5 , Patricia Bastick 1 6 7 8 , Fran Boyle 9 , Jodi Lynch 6 7 8 , David Thomas 6 7 , Winston Liauw 6 7 , David Goldstein 1 3 4 , Andrew Lloyd 1 2 10
  1. NSW Cancer Survivors Centre, Sydney, NSW, Australia
  2. Fatigue Clinic , UNSW Lifestyle Clinic, Sydney, NSW, Australia
  3. The Prince of Wales Hospital, Sydney, NSW, Australia
  4. Prince of Wales Private Hospital, Sydney, NSW, Australia
  5. St Vincents Clinic, Sydney, NSW, Australia
  6. St George Hospital, Sydney, NSW, Australia
  7. The Sutherland Hospital, Sydney, NSW, Australia
  8. St George Private Hospital, Sydney, NSW, Australia
  9. The Poche Centre, Sydney, NSW, Australia
  10. Inflammation and Infection Research Centre, , School of Medical Sciences, University of New South Wales, Sydney, NSW , Australia

Cancer-related fatigue is a distressing and disabling symptom. When cancer-related fatigue persists beyond the treatment period and is unexplained by alternative medical or psychiatric conditions, it is termed post-cancer-fatigue (PCF)1.
Since currently no clear understanding of the aetiological basis of PCF exists and no effective prevention or treatment strategy has been defined, a pragmatic approach to intervention is required based on existing evidence for management of patients with chronic fatigue syndromes. It’s likely that cognitive-behavioural therapy (CBT)2,coupled with graded exercise therapy (GET)3 will improve functional outcomes. A randomised control trial - Treatment of Post-cancer fatigue Study has been developed assigning patients to receiving either an education intervention (n=50), or a 12-week supervised (by exercise physiologist and clinical psychologist), GET and CBT intervention (n=50). The intervention arm is based on the successful Fatigue Clinic program developed by the Lifestyle Clinic. Potential subjects are screened for clinically-significant fatigue at 3 months post successful-treatment for breast or bowel cancer.

Protocols and ethics applications have been established. Recruitment began recently with 83 potential participants approached. Current recruitment sites include Prince of Wales public (n=33) and private hospitals (n=23), St George public and private hospitals (n=5), Register4 website (n=9) and various private consulting rooms (n=13). 43 patients have been screen with 16 (37%) eligible and 8 enrolled most of whom are female (n=15) with breast cancer (n=15). Of the 27 (63%) ineligible patients mostly with breast cancer (n=20) and female (n=22), major reason for exclusion was reporting not clinically significant fatigue (44%). 36 patients remain to be screened and 4 have been lost to follow-up. The limitations with recruitment numbers to date reflect recent findings that the rate of post-cancer fatigue is not as high as previously thought. Focusing on identification of patients who are at higher risk of sustained fatigue may be beneficial.4

  1. Goldstein D, Bennett B, Friedlander M, Davenport T, Hickie I, Lloyd A. Fatigue states after cancer treatment occur both in association with, and independent of, mood disorder: a longitudinal study. BMC Cancer 2006;6:240.
  2. Gielissen MF, Verhagen S, Witjes F, Bleijenberg G. Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2006;24(30):4882-7
  3. Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008(2):CD006145
  4. Goldstein D, Bennett BK, Webber K, Boyle F, de Souza PL, Wilcken NR, et al. Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2012;30(15):1805-12