Education for cancer-related fatigue: could talking about it make people more likely to report it?

Education-based interventions for cancer-related fatigue have shown promise in adults undergoing radiotherapy. Research on the cancer-related fatigue intervention trial (CAN-FIT) programme found that pre-radiotherapy fatigue information and support (pre-RFES) did not improve levels of fatigue, but was associated with improvements in activity-based outcomes. We aimed to measure whether pre-RFES resulted in greater participant self-ratings of their performance of daily living activities, fatigue, quality of life and distress. Thirty people undergoing radiotherapy and/or chemotherapy were randomly allocated to either a 1-h RFES session from the CAN-FIT programme (delivered individually to participants and modified where necessary for patients undergoing chemotherapy) or standard care. Measures were taken pre- and post-treatment and 6 weeks after completing treatment. There was no significant difference between groups on performance of daily living activities or ratings of distress. Further analysis found a significant difference between the control and treatment groups for EQ-5D health state visual analogue scale (-9.05 [-18.09; -0.018]; p < 0.05) and physical fatigue (2.86 [0.58; 5.14]; p < 0.02) with the treatment group rating their overall health state worse and their physical fatigue higher than the controls. Pre-RFES delivered individually did not significantly improve participants' ratings of their performance of daily occupations and was unexpectedly associated with worse overall health state and higher physical fatigue. Future trials, ideally comparing individual and group education to exercise programmes or cognitive-behavioural approaches, are recommended to examine the broader question of whether discussing fatigue might actually make participants feel worse.