The Efficacy of Web-based, Tailored Program(Health Navigation®) for the Management of Cancer-Related Fatigue in Cancer Survivors
Cancer-related fatigue (CRF) and its impact on patients' quality of life has been increasing
subject of research. Especially, cancer survivors who are complaining of fatigue (moderate -
severe) should be cared.
Multidimensional characteristics of CRF were addressed in the NCCN guideline for CRF, and
NCCN guideline points out the importance of behavioral approaches in managing of CRF.
NCCN guideline in 2008 suggests that 6 strategic areas (1) Energy Conservation, 2) Pain 3)
Sleep disturbance 4) Distress 5) exercise, 6) Nutrition) are important issues in caring CRF
in addition to the medical treatment caring chronic disease or co morbidity.
Behavioral strategy can lead those 6 areas to be effective.
However, to our knowledge, no study has examined the comprehensive fatigue management
The objective of this study is to develop the Web based, tailored program(Health
Navigation®) for disease-free cancer patients to cope with CRF, and then evaluate the
efficacy of the Web-based program(Health Navigation®).
From evidence extracted from a literature review, contents of the program was elaborated,
and tailored from the TTM model. The curriculum is currently being reviewed and validated by
an expert group of palliative care physician, oncologists, nurse, psychologist and health
education scientists. The module will be pretested with a small number of patients,
discussed in terms of feasibility and acceptance.
To determine the efficacy of the program(Health Navigation®), a randomized controlled trial
will be conducted:
After excluding patients with other causes (anemia, thyroid diseases, liver disease, co
morbidities etc), 296 patients will be recruited based on statistical assumption of alpha
(0.05), beta (0.20=power 80%), effect size (0.375) and drop out rate (10%).
First, they will be stratified according to their age (<50 vs. >50) and sex (male vs.
female), cancer type (type 1: stomach cancer & colon cancer, type 2: Cervix & Breast cancer
& Thyroid, type 3 : Lung cancer ), cancer stage (I-III) ; and then allocated to an
intervention or a wait-list control group.
When intervention group participate in the Web-based care program (Health Navigation®), they
can receive various information which is related with the CRF.
And Web-based fatigue care program consists of 6 strategic areas (energy conservation,
nutrition, exercise, sleep disturbance, pain, and distress); three areas (pain, exercise,
sleep disturbance) are based on the transtheoretical model (TTM), and others (energy
conservation, distress, nutrition) are based on psycho-education method or cognitive
behavioral therapy. Cancer survivors who participate in the Web-based care program (Health
Navigation®) will be received tailored EMS/SMS message that notify participants of the next
program's news and the last program's issue etc.
Their assistants (family member or friend) help them change their behaviors. Wait-list
(control) group could not participate in the fatigue-care program (based on the Web based
care program: Health Navigation®).
They could only be treated by usual care and use internet for health information. However,
they can participate in the fatigue care program (Health Navigation®) after 12 weeks.
Data will be collected before randomization, after intervention, and after a follow-up of 6
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
Score of fatigue Severity
BFI and FSS
Youngho Yun, Ph.D
National Cancer Center
Korea: Food and Drug Administration