In a groundbreaking qualitative study published in BMC Cancer, researchers have shed light on breast cancer patients’ firsthand experiences with a novel therapeutic intervention that combines cognitive behavioural therapy with activity pacing (CBT-AP). This integrated approach addresses the multifaceted challenges faced by patients undergoing treatment, notably cancer-related fatigue and depression, which significantly impair quality of life. While previous clinical trials established the efficacy of CBT-AP in symptom reduction, this latest research delves deeper into the subjective nuances of therapy as perceived directly by patients, offering a rare window into patient-centered care dynamics.
Breast cancer remains one of the most prevalent malignancies worldwide, carrying not only physical burdens but also profound psychological and social repercussions. Fatigue and depression frequently accompany cancer treatment, often diminishing patients’ overall well-being and their ability to engage with daily activities. Traditional cognitive behavioural therapy (CBT) has been a staple in managing these psychological disturbances; however, integrating activity pacing—a structured approach to balancing activity with adequate rest—into CBT is a relatively recent innovation aimed at better aligning therapeutic strategies with patients’ lived realities.
The study involved in-depth interviews with twenty breast cancer patients aged between 24 and 62, all of whom were at various stages of cancer progression and actively receiving chemotherapy. Researchers utilized a rigorous qualitative methodology, ensuring data saturation by conducting comprehensive interviews until no novel themes emerged. Their analytical framework prioritized contextual sensitivity and methodological transparency, providing robust insights into the efficacy and reception of CBT-AP within a real-world clinical setting.
Six key thematic domains emerged from the analysis, reflecting a holistic patient experience: content of the therapy, context of delivery, implementation challenges, perceived benefits, therapeutic approach, and patient-driven recommendations. Patients articulated the integral role of each CBT-AP component, validating its relevance in addressing cancer-specific symptoms. Participants highlighted how the therapy’s content effectively acknowledged and responded to both the physical and emotional tolls of their treatment, thereby fostering a tailored approach to symptom management.
One of the most salient findings revolves around patients’ preference for different delivery modalities. While the majority favored traditional face-to-face sessions, acknowledging the value of direct interpersonal engagement with therapists, a notable subset expressed appreciation for hybrid models incorporating telephone sessions. This preference underscores the need for flexible healthcare delivery mechanisms that can accommodate varying patient circumstances and logistical constraints without compromising therapeutic efficacy.
Crucially, the participant manual accompanying the therapy was praised for its clarity and accessibility, suggesting that well-designed educational materials can empower patients to better understand and engage with therapeutic concepts. This aspect of the intervention addresses a common barrier in healthcare communication—ensuring patient comprehension—thereby enhancing adherence and fostering greater self-efficacy among patients navigating complex treatment regimens.
Beyond the acceptability of the intervention, the participants reported multifaceted benefits spanning physical, psychological, and social health dimensions. Patients described improvements not only in managing fatigue and depressive symptoms but also in reclaiming a sense of agency and social connectedness. Such outcomes highlight the therapeutic synergy achieved by integrating behavioural strategies like activity pacing with cognitive restructuring, thereby enabling patients to better regulate their energy expenditure and emotional responses.
The study also brought to light contextual factors influencing therapy outcomes. Variables such as timing relative to chemotherapy cycles, the emotional climate of the therapeutic setting, and individual differences in coping styles appeared to modulate patients’ engagement and benefit from CBT-AP. These insights underscore the importance of tailoring interventions to the nuanced realities of cancer care, suggesting that a one-size-fits-all approach may be insufficient for optimizing patient outcomes.
From an implementation science perspective, the research illuminates critical considerations regarding the feasibility of incorporating CBT-AP into routine oncology practice. Despite its demonstrated benefits, successful integration requires attention to logistical challenges, including scheduling, therapist training, and resource allocation. Patient feedback pointed towards a desire for more flexible scheduling options and enhanced therapist accessibility, factors essential for sustaining long-term engagement in behavioural interventions.
The therapeutic approach underpinning CBT-AP is characterized by its patient-centeredness—an emphasis on individualized assessment and collaborative goal-setting that respects patients’ lived experiences and preferences. This orientation appeared instrumental in fostering trust, motivation, and adherence, aligning with contemporary paradigms in psychosocial oncology that prioritize empowerment and shared decision-making.
Furthermore, participants offered valuable recommendations for refining the therapy, including enhancing digital resources, tailoring session frequency based on individual fatigue levels, and incorporating family or caregiver involvement to reinforce therapeutic gains. Such patient-informed suggestions provide actionable pathways for optimizing and scaling CBT-AP, hinting at its potential for broader applicability beyond the current study cohort.
In summary, this qualitative exploration affirms that CBT integrated with activity pacing offers a promising, patient-friendly strategy to mitigate the pervasive burden of fatigue and depression among breast cancer patients. By illuminating both the therapeutic mechanisms and contextual factors shaping patient experiences, the study enriches our understanding of how psychobehavioural interventions can be most effectively deployed in oncology settings. Its emphasis on flexibility, clarity, and patient empowerment resonates with emerging healthcare trends geared towards personalized medicine.
The research team concludes that while these findings underscore CBT-AP’s acceptability and potential benefits, further investigations are warranted to evaluate its long-term effectiveness and adaptability across diverse populations and healthcare environments. Future research directions may involve larger-scale randomized controlled trials, integration with digital health platforms, and exploration of cost-effectiveness, with the ultimate goal of embedding CBT-AP as a standard adjunct in comprehensive cancer care.
As cancer care continues to advance technologically and scientifically, this study importantly reminds us of the centrality of patient experience and subjective wellbeing. In representing the voices of those living through cancer treatment, it advocates for therapeutic models that transcend symptom management alone, fostering resilience, functional restoration, and improved quality of life.
Indeed, by bridging cognitive behavioural techniques with activity pacing, this integrative approach models how interdisciplinary collaboration within oncology and psychological sciences can produce innovative, holistic treatments. Such synergy is likely to expand the horizons of survivorship care, transforming cancer from a terminal diagnosis into a manageable chronic condition.
Ultimately, the work not only enriches academic literature but also carries profound clinical implications, reminding healthcare providers, therapists, and policy-makers alike of the vital role that tailored, flexible, and patient-informed interventions play in addressing the complex tapestry of cancer survivorship challenges.
Subject of Research:
Exploration of breast cancer patients’ subjective experiences with cognitive behavioural therapy integrated with activity pacing (CBT-AP) aimed at alleviating cancer-related fatigue and depression.
Article Title:
Patients’ experiences of cognitive behavioural therapy integrated with activity pacing: a qualitative study
Article References:
Getu, M.A., Kaba, M., Addissie, A. et al. Patients’ experiences of cognitive behavioural therapy integrated with activity pacing: a qualitative study. BMC Cancer 25, 670 (2025). https://doi.org/10.1186/s12885-025-13971-x
Image Credits:
Scienmag.com
