Behavioral Activation for Cancer-Related Fatigue After Breast Cancer Surgery

This was a single‐center, assessor‐blinded, parallel‐group randomized controlled trialconducted at Shenzhen Hospital of Southern Medical University. Eligible participants werewomen aged 18‐65 years with pathologically confirmed stage I‐III primary breast cancerwho had completed breast cancer surgery, were clinically stable, had a KarnofskyPerformance Status score of at least 80, and were able to complete study questionnairesand heart rate variability assessments. Participants could be receiving or have completedadjuvant chemotherapy, radiotherapy, and/or endocrine therapy at enrollment.Participants assigned to the experimental arm received structured behavioral activationin addition to care as usual. The program comprised eight weekly individual sessions,each lasting approximately 15‐30 minutes. Core components included activity monitoring,identification of inactivity and avoidance patterns, values‐based goal setting, gradedactivity scheduling, review of barriers, and maintenance planning. The first session wasdelivered face to face; subsequent sessions could be delivered face to face, by WeChataudio/video, or by telephone according to clinical and logistical needs.Participants in the comparator arm received routine oncology care and health educationwithout structured behavioral activation or standardized psychotherapy. Patient‐reportedoutcomes, heart rate variability, and prespecified complete blood count‐derivedinflammatory indices were assessed longitudinally at baseline, Week 4, and Week 8.