Cognitive behavioral therapy for targeted-therapy related fatigue (CBT-TTF) reduced tyrosine kinase inhibitor (TKI)-related fatigue in patients with chronic myeloid leukemia (CML), according to results of a randomized controlled trial published in the Annals of Behavioral Medicine.

One of the most common side effects of TKI therapy is fatigue. To assess whether CBT-TTF may mitigate the associated symptoms of disturbed sleep/cycle, dysregulated activity patterns, and insufficient processing of cancer and fatigue, researchers at the Moffitt Cancer Center recruited patients with CML receiving a TKI. Patients were randomly assigned in a 2:1 ratio to the CBT-TTF (n=22) or waitlist control (n=14) groups.

The intervention comprised an in-person primary consultation and receipt of an iPad followed by 18 weekly virtual sessions of CBT. All participants in the CBT-TTF group received 2 core modules (sleep/wake cycles and activity patterns). Additional modules (cognition, processing, social support, and fear of progression) were assigned based on patients’ concerns expressed on self-report measures or in their initial clinical assessment.

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Patients in the intervention and control groups, respectively, were aged mean 53.7±11.0 and 59.6±12.4 years, 50% and 43% were women, 91% and 79% were White, and time on TKI therapy was mean 2.9±2.7 and 2.6±3.2 years.

Compared with the patients in the waitlist control group, those in the CBT-TTF group had significant improvements in focusing on symptoms, fatigue catastrophizing, self-efficacy, social activity, helplessness, mental activity, and physical activity. Significant improvements were not observed for sleep, processing, social support, or fear of progression.

“Our findings suggest that cognitive factors (e.g., self-efficacy, helplessness, focusing on symptoms) play a central role in mediating the effect of the intervention on patients’ reports of fatigue,” the researchers reported. “Changing maladaptive thought patterns may alter patients’ perceptions and subjective experience of fatigue, thereby altering their reports of the experience of fatigue.”

This study was limited by its lack of diversity among participants.

These data suggested CBT-TTF may help to mitigate some negative impacts of TKI-related fatigue among patients with CML.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Hyland K A, Nelson A M, Eisel S L, et al. Fatigue perpetuating factors as mediators of change in a cognitive behavioral intervention for targeted therapy-related fatigue in chronic myeloid leukemia: a pilot study. Ann Behav Med. Published online May 15, 2021. doi:10.1093/abm/kaab035