Lifestyle Clinic

Lifestyle Clinic

Services » Fatigue Clinic

The UNSW Fatigue Clinic is now located at 32 Botany Street Randwick.  Please contact us on 02 9385 8272 or fatigueclinic@unsw.edu.au

The term chronic fatigue syndrome (CFS) is commonly used to describe the illness in general medical practice in which unexplained fatigue is the dominant complaint. Despite the lack of knowledge as to the pathophysiology of CFS and by extension the lack of treatment options targeting the cause(s), a number of interventions have been investigated 1.

To date the most promising results have been achieved with cognitive behavioural therapy (CBT) [2-6] or graded exercise therapy (GET) [4,7,8].

The Fatigue Clinic is an integrated rehabilitation clinic developed in collaboration with Professor Andrew Lloyd - an internationally recognised leader in the study of the pathogenesis and management of medically unexplained fatigue - and the exercise physiologists at the Lifestyle Clinic.

The Fatigue Clinic provides a 12-week intervention which is individualised to each patient and involves primarily ‘home-based’ activity. The program is developed and implemented after a comprehensive assessment of fatigue, mood, sleep disturbance and pain (by a psychologist), as well as an assessment of functional capacity by the exercise physiologist. The treatment program includes both exercise and cognitive-behavioural components aimed at a reduction in fatigue symptoms, as well as an improvement in functional status and mood. Previous studies have suggested that structured multi-disciplinary interventions such as this can have a very positive impact on overcoming this condition.

Patients referred by their GP under the Enhanced Primary Care Plan receive a rebate for five sessions provided by an exercise physiologist, and the GP is also reimbursed. A similar scheme is now available under the GP Mental Health Care Plan for referral for six focussed psychological interventions, based on an initial screening instrument (e.g. SPHERE). The Fatigue Clinic has developed a ‘user-friendly’ template integrating all three of these elements to minimise the administrative burden for GP practices (download below).

Research Trial: Post-Cancer Fatigue (PCF)

At present there is no clear understanding of the biological basis of medically unexplained fatigue persisting after cancer treatment (known as post-cancer fatigue - PCF), and no effective prevention or treatment strategy has been defined [9-10]. This is an increasingly recognised problem following cancer treatment and in some individuals is a major limiting factor in their recovery and return to normal activities [11] .

The Fatigue Clinic is conducting an ongoing outcome-based study for people experiencing post-cancer fatigue. The 12 week treatment model incorporates the multidisciplinary approach implemented in the Fatigue Clinic as outlined above.

Enquiries or further information regarding the research trial may be directed to Professor David Goldstein (medical oncologist and study co-investigator - 02 9382 2577); Dr. Barbara Bennett (psychologist with experience in post-cancer fatigue and study co-investigator – 02 9382 2353) or Chris Tzar (Lifestyle Clinic Manager and Exercise Physiologist - 02 9385 3352).

References

Reid, S., et al. Chronic Fatigue Syndrome. Clinical Evidence. 2006 [cited]; Available from: www.clinicalevidence.com/ceweb/conditionpdf/1101.pdf

Price, J.R. and J. Couper. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cohrane Database of Systematic Reviews. 1998(4): Art. no. CD001027. DOI: 10.1002/14651858.

Deale, A., et al., Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. American Journal of Psychiatry, 1997. 154(3): 408-414.

McCrone, P., et al., Cost-effectiveness of cognitive behavioural therapy, graded exercise and usual care for patients with chronic fatigue in primary care. Psychological Medicine. 2004: 991-999.

Lloyd, A.R., et al. Immunologic and psychological therapy for patients with chronic fatigue syndrome: a double-blind, placebo-controlled trial. American Journal of Medicine, 1993. 94(2): 197-203.

Grice, J.R. and J. Couper. Cognitive behaviour therapy for adults with chronic fatigue syndrome. Cochrane Database of Systematic Reviews [cited 2000; CD001027]

Fulcher, K.Y. and P.D. White. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. BMJ. 1997. 314(7095): 1647-1652.

Edmonds, M., H. McGuire, and J. Price. Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews, 2004(3): p. Art. No. CD003200. DOI. 10.1002/14651858CD003200.pub2.

Bennett B, Goldstein D, Lloyd A, Davenport T, Hickie I: Fatigue and psychological distress - exploring the relationship in women treated for breast cancer. European Journal of Cancer 2004; 40: 1689-1695

Goldstein D, Bennett B, Friedlander M, Davenport T, Hickie I, Lloyd A: Fatigue states after cancer treatment occur both in association with, and independent of, mood disorder: a longitudinal study. BMC Cancer 2006; 6:240

Bennett B, Goldstein D, Friedlander M, Hickie I, Lloyd A: The experience of cancer-related fatigue and chronic fatigue syndrome: a qualitative and comparative study. Journal of Pain and Symptom Management 2007; 34: 126-135