Fatigue During Head-And-Neck Radiotherapy: Prospective Study on 117 Consecutive Patients

Jereczek‐Fossa, Barbara Alicja; Santoro, Luigi; Alterio, Daniela; Franchi, B; Fiore, Maria Rosaria; Fossati, Piero; Kowalczyk, Anna; Canino, Paola; Ansarin, Mohssen; Orecchia, Roberto

doi:10.1016/j.ijrobp.2007.01.024

Cited by 67 publications

(70 citation statements)

References 45 publications

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“…First, it has been reported with all subscales summed to create a total fatigue score. 38 In summing the total scores, fatigue is investigated as 1 summarized construct rather than as reflecting the differences in dimensions of fatigue; thus, potentially significant relations can be missed. When a significant relation may be present between a correlate and 1 subscale only (eg, anxiety and mental fatigue), the significance of this relation may be lost if all subscales are analyzed together.…”

Section: Discussionmentioning

confidence: 99%

A multidimensional examination of correlates of fatigue during radiotherapy

Purcell

Fleming

Bennett

et al. 2009

Cancer

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BACKGROUND: Cancer-related fatigue can be measured as both a unidimensional and a multidimensional construct. Unidimensional fatigue and its symptom correlates have undergone some previous investigation; however, minimal research has considered the differential effect of correlates on individual dimensions of fatigue. The objective of the current study was to investigate cancer-related fatigue in a radiotherapy sample using a multidimensional conceptualization to determine whether correlates of fatigue are consistent across all dimensions or whether each fatigue dimension has its own unique pattern of correlates. METHODS: The study used a prospective cohort design with data collected from radiotherapy patients at 3 time points; before, after, and 6 weeks after radiotherapy treatment. RESULTS: A total of 210 participants were enrolled in the study. Results indicated the following relations. Increased general fatigue was found to be associated with lower performance status, being in a de facto relationship, depression, having treatment to the brain, and reduced vigorous physical activity. Increased physical fatigue was associated with lower performance status, depression, reduced physical activity, reduced productive hours, and nausea. Higher levels of reduced activity were associated with depression, decreased participation in activities of daily living, decreased number of productive hours, and lower performance status. Higher levels of reduced motivation were associated with radiotherapy to the brain, reduced moderate physical activity, and depression. Increased mental fatigue was associated with diagnosis of a brain tumor, anxiety, depression, and sleep problems. CONCLUSIONS: The results of the current study support the recognition of multiple dimensions of fatigue, because each dimension examined had various correlates. These findings further develop our understanding of fatigue and may help clinicians provide more targeted information to people with cancer-related fatigue. Furthermore, these results can guide the development of group or individually tailored interventions that ultimately may reduce the impact of this distressing symptom on people with cancer. Cancer 2010;116:529-37.

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Section: Discussionmentioning

confidence: 99%

A multidimensional examination of correlates of fatigue during radiotherapy

Purcell

Fleming

Bennett

et al. 2009

Cancer

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“…Firstly, fatigue is one of the most common symptoms experienced by patients undergoing chemotherapy or radiation therapy for head and neck cancer. 65,66 Moderate to severe levels of fatigue occur in up to 60% of patients during RT and even greater levels of severity in those receiving concomitant chemotherapy. 66 RT-related fatigue peaks at the completion of treatment and may never return to baseline in some patients.…”

Section: Methodsmentioning

confidence: 99%

“…66 RT-related fatigue peaks at the completion of treatment and may never return to baseline in some patients. 65 Thus, fatigue can be a long-term issue for many LA-HNSCC patients. Additionally, fatigue may be highly correlated with overall QOL during LA-HNSCC treatment.…”

Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Older adults with squamous cell carcinomas of the head and neck (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced (LA) disease, for which combined modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and higher risk for functional impairments remains challenging, and is exacerbated by the paucity of studies involving older adults. The purpose of this paper is to identify knowledge gaps in the evaluation and management of older adults with HNSCC and their caregivers, particularly those undergoing concurrent chemoradiation, through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with LA-HNSCC. Based on our findings, we prioritized these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

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“…By week 5 of radiation therapy, 93% of patients reported fatigue with a mean intensity of greater than 4. Similarly, in a cohort of 117 patients with head and neck cancer undergoing radiation therapy, investigators 32 using the Multidimensional Fatigue Inventory (scale 0–80) noted that the mean level of fatigue increased from a baseline level of 26 to 36 during radiation therapy (p< .0001) and remained elevated six weeks post treatment (p<.0001). Post-treatment fatigue has been shown to correlate with younger age, history of radiation therapy, time since completion of therapy, and depressive symptoms.…”

Section: Introductionmentioning

confidence: 97%

“…Descriptive studies in patients with head and neck cancer suggest that fatigue is common, that it increases during radiation therapy, and that it persists after treatment. 31,32 Hickok et al 31 described the course of fatigue in 372 cancer patients undergoing radiation therapy: of the 23 patients with HNC, 56% reported baseline fatigue with a mean intensity of less than 2 (scale 0–10). By week 5 of radiation therapy, 93% of patients reported fatigue with a mean intensity of greater than 4.…”

Section: Introductionmentioning

confidence: 99%

Caregiver-Reported Neuropsychiatric Symptoms in Patients Undergoing Treatment for Head and Neck Cancer

2014

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Background Patients with cancer experience multiple neuropsychiatric symptoms. While individual symptoms have been studied in patients with head and neck cancer, the broader context of neuropsychiatric symptoms needs to be explored. Objective The aims of this pilot study were: 1) to determine the caregiver-reported prevalence and severity of neuropsychiatric symptoms in patients with head and neck cancer, 2) to determine the associated level of caregiver distress, and 3) to describe the effects of neuropsychiatric symptoms on patients and their caregivers. Methods Twenty-three family caregivers of patients with head and neck cancer completed the Neuropsychiatric Inventory Questionnaire and participated in a semi-structured interview. Results All caregivers reported that patients experienced at least one neuropsychiatric symptom (Mean 7.5; Range 1–12). The most frequently reported symptoms were trouble with appetite and eating (95.7%), altered nighttime behaviors (82.6%), depression/dysphoria (78.3%), decreased alertness (69.6%), inattention (60.9%), apathy/indifference (56.5%), anxiety (56.5%), irritability/lability (52.5%), agitation/aggression (52.2%), and slowed behavior (43.5%). The mean severity rating for nine symptoms was moderate to severe. Most symptoms caused mild to moderate levels of caregiver distress. Qualitative data indicated that neuropsychiatric symptoms negatively affected patients, their caregivers, and other family members. Patients required more caregiver support resulting in increased caregiver burden and distress. Conclusions Neuropsychiatric symptoms are common and troubling in patients with head and neck cancer during treatment. Further investigation of their effects on patients and family caregivers is needed. Implications for Practice Clinicians should monitor for and treat neuropsychiatric symptoms throughout treatment, and provide caregiver and patient education and support.

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Fatigue During Head-And-Neck Radiotherapy: Prospective Study on 117 Consecutive Patients

Cited by 67 publications

References 45 publications

A multidimensional examination of correlates of fatigue during radiotherapy

A multidimensional examination of correlates of fatigue during radiotherapy

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Caregiver-Reported Neuropsychiatric Symptoms in Patients Undergoing Treatment for Head and Neck Cancer

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