Prof. Robbert Sanderman, Simon Spahrkäs, MSc., Dr. Anne Looijmans, and Prof. Mariët Hagedoorn
What is cancer-related fatigue?
A common and distressing long-term side effect of cancer and its treatment is cancer-related fatigue (CRF). CRF is a persistent subjective sense of physical, emotional, and cognitive tiredness related to cancer or cancer treatment that is not proportional to recent activity. In-person psychosocial treatments based on cognitive behavior therapy (CBT), mindfulness-based stress reduction (MBSR), psycho-education, and physical exercises have been found to reduce symptoms of fatigue effectively but are limited in reach, as one therapist can only treat one patient or group at a time.
The Untire app
Inspired by academic research and clinical practice, Tired of Cancer BV (Utrecht, The Netherlands) developed the Untire app, intending to deliver an effective self-management app to improve CRF and quality of life of patients and survivors of cancer who feel fatigued.
The app is based on the successful elements of face-to-face therapy for CRF, such as energy conservation, activity management, optimising restful sleep, MBSR, psychosocial support, CBT, and physical activity exercises. The app aims to create awareness by providing psychoeducation, insight into energy levels, thoughts and behaviors about fatigue; the app, which is available in Dutch, German and English, also helps users challenge unhelpful thoughts (e.g., catastrophising thoughts) and behaviors (e.g., increase physical activity) through exercises.
Outcomes in patients
The research team of the Health Psychology Section, consisting of Simon Spahrkäs, MSc., Dr. Anne Looijmans, Prof. Robbert Sanderman, and Prof. Mariët Hagedoorn, tested the Untire app developed by the company Tired of Cancer BV.
The research team set up a large-scale waiting-list randomised controlled trial (RCT, N=799) targeting cancer patients and survivors who experienced moderate to severe fatigue across 4 English-speaking countries (Australia, Canada, the United Kingdom, and the United States). This RCT showed that after 12 weeks of access to the Untire app, the levels of fatigue decreased and quality of life on average improved in the intervention group as compared to the control group that did not have access to the Untire app. This study showed that a self-management app can support cancer patients and survivors in managing their fatigue and quality of life, and suggests that besides existing face-to-face therapy or therapist-guided online interventions, also a low-threshold mHealth app can be an effective treatment solution. (Spahrkäs, S. S., Looijmans, A., Sanderman, R., & Hagedoorn, M. (2020). Beating cancer-related fatigue with the Untire mobile app: Results from a waiting-list randomized controlled trial. Psycho-oncology, 29(11), 1823-1834. https://doi.org/10.1002/pon.5492)
Implementation in society
This project shows the collaboration between a company developing an app and a research team independently examining the app’s effectiveness. From the launch of the Untire app in English (March 2018), Dutch (October 2018), and German (May 2020), the app has been downloaded 30.000 times.
The app is available to all users who feel that they might benefit from the app. Tired of Cancer BV is continuously busy with bringing the Untire app to the public of cancer patients and survivors on the one hand, and to health care professionals on the other hand. Tired of Cancer BV is also in touch with insurance companies so that users can receive a reimbursement for using the Untire app from their health insurance.
The Untire app presents a scalable opportunity in supporting people worldwide experiencing disabling fatigue.