Randomized Evaluation of Cognitive-Behavioral Therapy and Graded Exercise Therapy for Post-Cancer Fatigue Carolina X. Sandler, BSc, PhD, David Goldstein,

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Randomized Evaluation of Cognitive-Behavioral Therapy and Graded Exercise Therapy for Post-Cancer Fatigue Carolina X. Sandler, BSc, PhD, David Goldstein, MBBS, MRCP, FRACP, Sarah Horsfield, MPsych(Clin), Barbara K. Bennett, RN, BSc, PhD, MAPS, Michael Friedlander, MBChB (Hons), MRCP, FRACP, PhD, Patricia A. Bastick, FRACP, MBBS(Hons), BMedSci, Craig R. Lewis, MBBS, MMed, FRACP, Eva Segelov, MBBS(Hons), PhD, FRACP, Frances M. Boyle, MBBS, FRACP, PhD, Melvin T.M. Chin, MBBS, FRACP, Kate Webber, BSc(Med), MBBS, FRACP, Benjamin K. Barry, BSc(Hons), PhD, Andrew R. Lloyd, MBBS, PhD, FRACP Journal of Pain and Symptom Management Volume 54, Issue 1, Pages 74-84 (July 2017) DOI: 10.1016/j.jpainsymman.2017.03.015 Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 1 Overview of the cognitive-behavioral therapy (CBT)/GET intervention. The exercise physiologist delivered compulsory modules focused on activity pacing (AP) and graded exercise therapy (GET). The clinical psychologist delivered three compulsory modules in a typical CBT framework, sleep-wake cycle disturbance management, and neurocognitive disturbance management. In addition, three optional modules (dashed line) were applied to patients with significant depression, anxiety, or poor coping. Both clinicians delivered the education module. Journal of Pain and Symptom Management 2017 54, 74-84DOI: (10.1016/j.jpainsymman.2017.03.015) Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 2 CONSORT diagram. SRQ = self-report questionnaire; ITT = intention-to-treat analysis. Journal of Pain and Symptom Management 2017 54, 74-84DOI: (10.1016/j.jpainsymman.2017.03.015) Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 3 a) Fatigue severity and b) physical function at baseline, end treatment, (12 weeks) and follow-up (24 weeks) by intervention. The means and SDs are shown for participants in education (Edu) and intervention (Int) arms. The fatigue severity score was obtained from the somatic fatigue (SOMA) subscale of the Somatic and Psychological HEalth REport questionnaire and physical status from the role limitation due to physical health problems subscale of the 36-Item Short Form Health Survey questionnaire. # = significant difference between groups. Asterisks (*) represent significant differences within the group in reference to baseline. Journal of Pain and Symptom Management 2017 54, 74-84DOI: (10.1016/j.jpainsymman.2017.03.015) Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 4 a) Mood and b) social function at baseline, end treatment (12 weeks), and follow-up (24 weeks) by intervention. The means and SDs are shown for participants in the education (Edu) and intervention (Int) arms. The mood disturbance score was obtained from the PSYCH subscale of the Somatic and Psychological HEalth REport questionnaire and social function from the social functioning subscale of the 36-Item Short Form Health Survey questionnaire. Journal of Pain and Symptom Management 2017 54, 74-84DOI: (10.1016/j.jpainsymman.2017.03.015) Copyright © 2017 American Academy of Hospice and Palliative Medicine Terms and Conditions