BACKGROUND: Research suggests that cancer rehabilitation reduces fatigue in 
survivors of cancer. To date, it is unclear what type of rehabilitation is most 
beneficial.
OBJECTIVE: This randomized controlled trial compared the effect on 
cancer-related fatigue of physical training combined with cognitive behavioral 
therapy with physical training alone and with no intervention.
DESIGN: In this multicenter randomized controlled trial, 147 survivors of cancer 
were randomly assigned to a group that received physical training combined with 
cognitive-behavioral therapy (PT+CBT group, n=76) or to a group that received 
physical training alone (PT group, n=71). In addition, a nonintervention control 
group (WLC group) consisting of 62 survivors of cancer who were on the waiting 
lists of rehabilitation centers elsewhere was included.
SETTING: The study was conducted at 4 rehabilitation centers in the Netherlands.
PATIENTS: All patients were survivors of cancer.
INTERVENTION: Physical training consisting of 2 hours of individual training and 
group sports took place twice weekly, and cognitive-behavioral therapy took 
place once weekly for 2 hours.
MEASUREMENTS: Fatigue was assessed with the Multidimensional Fatigue Inventory 
before and immediately after intervention (12 weeks after enrollment). The WLC 
group completed questionnaires at the same time points.
RESULTS: Baseline fatigue did not differ significantly among the 3 groups. Over 
time, levels of fatigue significantly decreased in all domains in all groups, 
except in mental fatigue in the WLC group. Analyses of variance of 
postintervention fatigue showed statistically significant group effects on 
general fatigue, on physical and mental fatigue, and on reduced activation but 
not on reduced motivation. Compared with the WLC group, the PT group reported 
significantly greater decline in 4 domains of fatigue, whereas the PT+CBT group 
reported significantly greater decline in physical fatigue only. No significant 
differences in decline in fatigue were found between the PT+CBT and PT groups.
CONCLUSIONS: Physical training combined with cognitive-behavioral therapy and 
physical training alone had significant and beneficial effects on fatigue 
compared with no intervention. Physical training was equally effective as or 
more effective than physical training combined with cognitive-behavioral therapy 
in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy 
did not have additional beneficial effects beyond the benefits of physical 
training.