# Cognitive behavioural therapy for fatigue and distress

Source: https://onco.cc/technologies/cbt-fatigue-distress/  
OnCo record `cbt-fatigue-distress` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer-related fatigue and anxiety respond to structured talking therapy that targets the thoughts and habits that keep them going. Randomised trials show benefits during treatment and, for persistent fatigue, years afterwards; guidelines recommend it.

## Summary

Cognitive behavioural therapy adapted to cancer addresses unhelpful beliefs about fatigue, irregular sleep and activity patterns, fear of recurrence and low mood. A randomised trial of 112 severely fatigued disease-free survivors (Gielissen et al., JCO 2006) found that a course of CBT produced clinically significant improvement in fatigue in more than half of patients compared with a quarter on the waiting list, with gains maintained at two years. The 2024 SIO-ASCO fatigue guideline recommends CBT for fatigue during and after treatment and the 2023 SIO-ASCO anxiety and depression guideline recommends it for anxiety and depressive symptoms. Delivery by trained psychologists, nurses or online programmes all have trial support. CBT sits within psycho-oncology alongside distress screening and, where needed, medication.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-10
- Tags: complementary; supportive-care; evidence:strong
- Principle: Behavioural activation, graded activity and cognitive restructuring interrupt the cycle in which rest, worry and deconditioning perpetuate fatigue and low mood.
- Strengths: Durable effects at long follow-up; Recommended in SIO-ASCO 2023 and 2024 guidelines; Deliverable remotely
- Limitations: Therapist capacity; Requires engagement over weeks; Trials mostly in survivors rather than advanced disease

## Notes

- Lung cancer: NICE NG122 (1.15.3) says to consider non-pharmacological interventions based on psychosocial support, breathing control and coping strategies for people with breathlessness, and (1.15.4) that they should be delivered by a multidisciplinary group coordinated by a professional with expertise in the techniques, and be available in all care settings rather than only in a breathlessness clinic. Cancer Research UK explains why the psychological part is not optional: anxiety makes breathlessness worse, which makes anxiety worse, and slowing the breathing deliberately is what interrupts it.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
- SIO-ASCO guideline: integrative oncology care of cancer-related fatigue (JCO 2024): https://doi.org/10.1200/JCO.24.00575
- SIO-ASCO guideline: integrative oncology care of anxiety and depression (JCO 2023): https://doi.org/10.1200/JCO.23.00857
- Effects of CBT in severely fatigued disease-free cancer patients, randomised trial (JCO 2006): https://doi.org/10.1200/JCO.2005.04.8270
- Cancer Research UK: coping with breathlessness when you have lung cancer: https://www.cancerresearchuk.org/about-cancer/lung-cancer/living-with/coping-with-breathlessness
- Macmillan: breathlessness: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/breathlessness
- NICE NG122: lung cancer, palliative interventions and supportive and palliative care: https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care

## Connected records

- cancers: [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Skin cancer (all types)](https://onco.cc/cancers/skin-cancer/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Anxiety after cancer, in survivors and in their partners](https://onco.cc/technologies/rejuv-mind-anxiety-after-cancer/), [Depression during and after cancer: the interview-based prevalence, and the care model that works](https://onco.cc/technologies/rejuv-mind-depression-after-cancer/), [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Fatigue after cancer treatment: what actually works](https://onco.cc/technologies/cancer-related-fatigue-management/), [Getting psychological help after cancer: the stepped-care model, and what is actually commissioned](https://onco.cc/technologies/rejuv-mind-access-to-psychological-care/), [Menopause brought on by cancer treatment, and the options for it](https://onco.cc/technologies/menopause-after-cancer-treatment/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Sexual function and intimacy after cancer, for both sexes](https://onco.cc/technologies/sexual-function-after-cancer/), [Thinking and memory after cancer treatment: what is measurable, and what helps](https://onco.cc/technologies/cognitive-impairment-after-cancer-treatment/), [Treating fear of recurrence: the randomised trials, their effect sizes, and where the treatment is available](https://onco.cc/technologies/rejuv-mind-fear-of-recurrence-treatment/)
- terms: [Cancer-related fatigue (tiredness)](https://onco.cc/terms/cancer-related-fatigue/), [Emotional support and helplines (UK)](https://onco.cc/terms/emotional-support-cancer-uk/), [Fatigue after lymphoma treatment, and why it is a symptom to report](https://onco.cc/terms/lymphoma-living-fatigue/), [Menopause symptoms after chemotherapy for breast cancer](https://onco.cc/terms/menopause-after-chemotherapy-breast/), [Quality of life](https://onco.cc/terms/quality-of-life/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline](https://onco.cc/key-papers/paper-carlson-j-clin-oncol/)

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