Fatigue and radiotherapy: (A) experience in patients undergoing treatment

Abstract

Summary Cancer patients undergoing radiotherapy frequently report fatigue. However, knowledge of the importance of fatigue for these patients and of the factors associated with their fatigue is limited. The aim of the current investigation was to gain more insight into fatigue as related to radiotherapy by answenng the following questions. First. how is the experience of fatigue best described? Secondly, to what extent is fatigue related to sociodemographic, medical (including treatment), physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue after completion of radiotherapy? Patients with different types of cancer receiving radiotherapy with curative intent (n = 250) were interviewed before and within 2 weeks of completion of radiotherapy. During treatment, patients rated their fatigue at 2-weekly intervals. Results indicate a gradual increase in fatigue over the period of radiotherapy and a decrease after completion of treatment. Fatigue scores obtained after radiotherapy were onty slightly, although significantly, higher than pretreatment scores. After treatment, 46% of the patients reported fatigue among the three symptoms that caused them most distress. Significant associations were found between post-treatment fatigue and diagnosis, physical distress, functional disability, quality of sleep, psychological distress and depression. No association was found between fatigue and treatment or personality characteristics. Multivariate regression anatysis demonstrated that the intensity of pretreatment fatigue was the best predictor of fatigue after treatment. In view of this finding, a regression analysis was performed to gain more insight into the variables predicting pretreatment fatigue. The degree of functional disability and impaired quality of sleep were found to explain 38% of the variance in fatigue before starting radiotherapy. Fatigue in disease-free patients 9 months after treatment is described in paper (B) in this issue.

A multidimensional examination of correlates of fatigue during radiotherapy

“…This pattern is consistent with patterns reported in previous research. 36,37 Other treatment sites were not examined individually because of the effects of small sample sizes. Head and neck radiotherapy was associated with a lower level of fatigue at the initiation of treatment but a sharper increase in fatigue during treatment than noted with pelvic radiotherapy.…”

Personality and fatigue in patients with benign or malignant breast disease

“…As was already found in earlier studies [29,30], extraversion and neuroticism were predictors of fatigue. Smets et al [25] suggested that the link between neuroticism and fatigue could be explained by Fig. 1 Course of fatigue over 6 months in women with benign breast problems or cancer the fact that individuals high in negative affect report more symptoms, probably due to their inner fixation and the tendency to interpret symptoms as threatening.…”

“…In general, BC patients are not as severely tired as chronic fatigue syndrome patients [24]: their fatigue is mainly mild to moderate [2]. However, fatigue might distress BC patients [25], reduce their quality of life (QOL) [29], and impair their physical activity [1].…”

“…Physical, cancer-or treatment-related factors such as anemia [7], receiving chemotherapy [16], radiotherapy [25], and/or hormone therapy only partially explain the difference with fatigue in the general population. Regarding the association between fatigue and personality in (breast) cancer patients, inconsistent findings were reported.…”

Cancer related fatigue: A focus on breast cancer and Hodgkin's disease survivors

“…Among breast cancer patients and survivors, fatigue is strongly correlated with psychological distress and depression [11,13,18,19]. Depressed mood, pain, and sleep disturbance were the strongest correlates of fatigue in our large study of breast cancer survivors assessed at 1 Á5 years post diagnosis [13].…”