The recovery journey for cancer survivors can be long, complicated and taxing to the individual – yet the complexity of these effects is often not clearly understood. Cancer-related fatigue (CRF) is common and often reported as the most debilitating adverse effect experienced by cancer survivors during and after cancer treatment. This is why Flinders’ Caring Futures Institute is examining a specific treatment that addresses CRF.  

Dr Andi Agbejule, a radiation therapist and Cancer Care researcher, has been working with a team at Flinders’ Caring Futures Institute to develop and test a new CRF intervention – noting that currently there is no systematic model of care in acute cancer settings that specifically addresses CRF.  

To design a practical and cost-effective care model that incorporates evidence-based interventions for cancer survivors, Flinders researchers partnered with researchers from the world-renowned cancer care institution, MD Anderson Cancer Center at the University of Texas in the US, which is devoted to cancer patient care, research, education and prevention. 

To leverage existing resources and encourage long-term patient engagement, Flinders researchers also partnered with Cancer Council Queensland to run a trial of the new CRF intervention. 

“Nurses in acute hospital settings often don’t have time to deliver a trial intervention, and to effectively manage fatigue, patients need a lot of support,” explains Dr Agbejule. “Patients trying to deal with cancer-related fatigue have to self-manage and undertake behaviours they may not be used to – like increasing physical activity, conserving energy, and improving nutrition– so we reached out to nurses at Cancer Council Queensland who are already doing this type of work.” 

The intervention involved three clinic sessions with a Cancer Council nurse that focused on providing tailored education and coping strategies for fatigue and other symptom management, co-creating a tailored fatigue management plan with up to three goals, and facilitating referrals to exercise specialists and other support services.  

“Having an intervention that is tailored, convenient, and adaptable means that it takes the exercise option out of the too-hard basket and makes it accessible for far more people.” 

This way of approaching CRF management recognises that cancer patients, whose energy levels are so low from dealing with treatment, don’t believe they have the physical or mental resources to combat their fatigue. As a result, fatigue is accepted by them and under-reported.  

“Many cancer patients think that it’s normal for them to feel excessively tired and therefore need more sleep – but this situation can’t be improved with only rest or sleep,” says Dr Agbejule. “Continuing fatigue can lead to compound problems, including memory loss and difficulty with work or daily routines, which can lead to anxiety and depressive symptoms. 

“It almost seems counter-intuitive, but one of the main beneficial interventions for cancer-related fatigue is exercise.” 

The new intervention received a positive reception during the trial, with Dr Agbejule saying it made patients feel they are being seen. “Interviews with participants tell us it made them feel better to know they were not experiencing a deficiency on their part, but that their chronic fatigue is a side-effect of their cancer and treatment,” she says.  

“The intervention also empowered participants with confidence to push themselves further, after they had been given the green light to explore new management approaches and self-manage their symptoms.” 

Importantly, Dr Agbejule says digital telehealth services can provide a helpful, cost-effective solution. The trial used Microsoft Teams to facilitate one-on-one intervention sessions – a system that provides a low-cost set up for health providers to implement the CRF intervention in their clinics. 

“We understand that not every hospital has the resources to deliver an in-person intervention. So the idea was to explore a way for a CRF management intervention to be delivered so that the support can be sustainable, long after the trial is complete. In this trial we have shown we can draw upon existing organisations like Cancer Council, and feasibly use telehealth models”.  

This research, which saw 60 people involved in the pilot trial, is currently being analysed. Preliminary results, which show that the program is feasible and received substantial approval from participants who received the intervention, should be available from October. The Flinders Cancer Survivorship team is looking for this trial to be expanded further across more locations. 

“Ideally, we want the intervention of this trial to implemented as a model of care,” says Dr Agbejule. “We know that fatigue is under-managed, and that it is a very distressing symptom for people who have been diagnosed with cancer. Our challenge now is that while we know the effective management strategies, we have to figure out how to implement them on a wider scale through our existing health care system.”