Lymphoma Survivors Find Fatigue Relief From Multidisciplinary Intervention

Lymphoma survivors with chronic fatigue participating in a multidisciplinary intervention program experienced a beneficial effect on fatigue and on some aspects of health-related quality of life (HRQoL), according to study results presented at the 2025 ESMO Congress in Berlin.

Findings from the REFUEL trial were presented by Synne-Kristin Bøhn of the department of oncology at The Norwegian Radium Hospital, Oslo University Hospital in Oslo, Norway.

Three months after randomization, patients in the intervention group reported significantly less fatigue than those in the usual care arm. In addition, physical fatigue, mental fatigue, physical functioning, role functioning, emotional functioning and global quality of life also showed improvements in the intervention group compared to patients who received usual care.

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

Patients eligible for the REFUEL trial were lymphoma survivors who were two to 12 years post treatment, who were 18 to 70 years old and who 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 three months after randomization, with secondary outcomes including mental and physical fatigue assessed by FQ and HRQoL assed by the European Organization for Research and Treatment of Cancer QLQ-C30, with outcomes assessed at baseline and three, six and nine months post-randomization.

While speaking at the congress, Bøhn stated that improvements to physical fatigue, subjective vitality and adherence to dietary guidelines were seen at six months, and improvements in oxygen uptake and adherence to dietary guidelines were seen at nine months.

“Twelve-week multidisciplinary intervention improved fatigue, aspects of health-related quality of life, oxygen uptake and diet in lymphoma survivors with chronic fatigue, but most of these effects do not sustain beyond six 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 Information 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 years, and 54% were female. Patients were a median of seven years from diagnosis; 48% had non-Hodgkin lymphoma and 52% had Hodgkin lymphoma. The majority of patients (73%) had received more than four 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.

“We found a statistically significant effects on total fatigue at three months and six months post randomization, and the result at three months can also be considered a clinically relevant effect. … We also found a statistically significant effect on global health status and quality of life. We also found several effects on secondary outcomes, and some even sustained to nine months post randomization, [such as] oxygen uptake and also the diet quality,” Bøhn said.

Reference

“Effect of a multidisciplinary intervention on fatigue in lymphoma survivors with chronic fatigue- a randomized controlled trial (REFUEL),” by Synne-Kristin Bøhn, et al., presented at: 2025 ESMO Congress; October 17-21, 2025; Berlin, Germany. 2806MO.

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