Not All Cancer Survivors Respond to a 4-Week mHealth Exercise Fatigue Intervention: Who Are the Responders?
by
, , , and
Morgan Emmi
1
,
Myriam Filion
2
,
Yingwei Yao
1,
Anna L. Schwartz
3,
Diana J. Wilkie
1 and
Saunjoo L. Yoon
1,* 1
Department of Biobehavioral Nursing Science, Center for Palliative Care Research and Education, College of Nursing, University of Florida, Gainesville, FL 32610, USA
2
Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
3
Coleman Health LLC., Parks, AZ 86018, USA
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2025, 32(12), 706; https://doi.org/10.3390/curroncol32120706
Submission received: 22 September 2025
/
Revised: 2 December 2025
/
Accepted: 12 December 2025
/
Published: 15 December 2025
Simple Summary
Cancer-related fatigue (CRF) is prevalent and onerous for cancer survivors. However, not all survivors respond equally to interventions. Identifying the different characteristics of responders and non-responders during a study is important to tailoring effective clinical interventions. Responder analysis findings of our exercise intervention trial indicated that responders (CRF reduction ≥2 points) and non-responders in both intervention and usual care groups mainly differed on baseline fatigue. Higher baseline fatigue levels (difference of 5 points) were observed in responders regardless of group assignment. However, the intervention group had a higher number of responders and significantly lower CRF at the end of the study. Findings suggest that those with a greater fatigue burden may have derived more benefit from exercise for CRF. Balancing study groups on baseline CRF levels is essential. CRF levels should be considered in designing effective personalized and precision exercise interventions to improve survivorship quality for all cancer survivors.
Abstract
Cancer-related fatigue (CRF) is prevalent and onerous for cancer survivors. Not all survivors respond equally to interventions, but the characteristics distinguishing responders and non-responders are often unknown. This secondary analysis study compared baseline characteristics for responders (CRF reduction ≥2 points), non-responders, and those lost to follow-up using data from a two-group pre-test/post-test trial of a four-week exercise intervention compared to usual care. Included were 278 adult cancer survivors, with a mean age of 52.2 ± 11.9, 65% (180/278) female, and 90% (250/278) Caucasian. Of these, 77 (28%) were responders, 153 (55%) were non-responders, and 48 (17%) were lost to follow-up. At baseline, participants completed the 6-item Schwartz Cancer Fatigue Scale, with responses from 1 (not at all) to 5 (extremely fatigued) and a total score ranging 6–30. In the intervention group, 35% (49/141) reported decreased fatigue, 24% (34/141) reported increased fatigue, 25% (35/141) had minimal change, and 16% (23/141) were lost to follow-up. In the control group, 20% (28/137) reported decreased fatigue, 39% (53/137) reported increased fatigue, 23% (31/137) had minimal change, and 18% (25/137) were lost to follow-up. Responders in both groups reported higher baseline fatigue than non-responders, with mean differences of 5.2 (95% CI: 3.6–6.8) and 5.4 (95% CI: 3.4–7.3) for intervention and usual care, respectively. Higher baseline fatigue was found in responders compared to non-responders, regardless of group assignment, suggesting that those with a greater fatigue burden may have derived more benefit from exercise for CRF or a regression to the mean effect.
