Multidisciplinary Intervention Addresses Fatigue Among Lymphoma Survivors

Among lymphoma survivors experiencing chronic fatigue, a multidisciplinary intervention program has been found to have a beneficial effect on fatigue and some aspects of health-related quality of life (HRQOL), according to study results presented at the 2025 European Society for Medical Oncology Congress in Berlin, Germany.

Findings from the REFUEL trial (NCT05130099) were presented by Synne-Kristin Bøhn, PhD, of the Department of Oncology at the Norwegian Radium Hospital, Oslo University Hospital in Norway.

Three months after randomization, patients in the intervention group reported significantly less fatigue than those in the usual care arm (–3.5; 95% CI, –5.4 to –1.6; P < .001). In addition, physical fatigue (–2.4; 95% CI, –3.8 to –1.0), mental fatigue (–1.1; 95% CI, –1.7 to –0.4), physical functioning (3.8; 95% CI, 0.2-7.3), role functioning (9.2; 95% CI, 0.8-17.5), emotional functioning (5.6; 95% CI, 0.0-11.3), and global QOL (9.5; 95% CI, 3.5-15.4) also showed improvement in the intervention group compared with usual care.

The 150 participating patients were randomly assigned 1:1 to either usual care or a 12-week intervention that included 1 digital patient education session, twice-weekly physical exercise sessions, 6 digital cognitive behavioral therapy-based group sessions, and 3 individual digital nutritional counseling sessions.

Patients eligible for the REFUEL trial were lymphoma survivors who were 2 to 12 years post treatment, aged 18 to 70 years, and met the criteria for chronic fatigue according to the Chalder Fatigue Questionnaire (FQ).

The primary outcome of the study was total fatigue as assessed by FQ immediately following the intervention 3 months after randomization, with secondary outcomes including mental and physical fatigue assessed by FQ and HRQOL assessed by the European Organization for Research and Treatment of Cancer QLQ-C30, with outcomes assessed at baseline and 3, 6, and 9 months post randomization.

Speaking at the congress, Bøhn stated that improvements in the amount of physical fatigue, subjective vitality and adherence to dietary guidelines were seen at 6 months, and improvements in oxygen uptake and adherence to dietary guidelines were seen at 9 months.

“Twelve-week multidisciplinary intervention improved fatigue, aspects of [HRQOL], oxygen uptake, and diet in lymphoma survivors with chronic fatigue, but most of these effects do not sustain beyond 6 months,” Bøhn said during her presentation. “Our findings therefore support a multidisciplinary approach when treating cancer survivors with chronic fatigue, but a longer intervention period might be necessary to preserve effects over time.”

More on the REFUEL Study

“Persistent fatigue is a highly prevalent, complex, and very distressing late effect after cancer,” Bøhn stated. “We know that psychological interventions and exercise can help to relieve fatigue, but there are few studies that have included populations that actually are screened for fatigue at study inclusion. [There] is also a lack of studies that investigate the effects of multidisciplinary interventions.”

The patients’ median age at the time of inclusion was 47 (range, 23-70) years, and 54% were female. Patients were a median of 7 (range, 2-13) years from diagnosis, 48% had non-Hodgkin lymphoma, and 52% had Hodgkin lymphoma. The majority of patients (73%) had received more than 4 cycles of chemotherapy, 43% had been treated with radiotherapy, and 7% had undergone high-dose therapy and autologous stem cell transplant for disease progression/relapse.

Reference

Bøhn SKH, Kiserud CE, Skaali T, et al. Effect of a multidisciplinary intervention on fatigue in lymphoma survivors with chronic fatigue - a randomized controlled trial (REFUEL). Presented at: 2025 European Society for Medical Oncology Congress; October 17-21, 2025; Berlin, Germany. 2806MO.