(Cristensen, 1989).To date there are few studies which systematically register how many cancer patients experience fatigue, in which stage of the disease process and to what extent. To give an indication, a literature-search using MEDLINE with CD-ROM over the period 1980 to 1991 yielded nine references in which 'fatigue' was included in the title and 'cancer' was included in title, keyword or abstract. Eight of these references pertained to nursing research.An appraisal of the research literature concerning fatigue in cancer is presented in this paper to give an overview of what is currently known. Literature, other than obtained using the MEDLINE-procedure, was gathered either by searching for studies in which fatigue was assessed as part of patient functioning or through references of the papers obtained. This procedure does evidently not lead to an exhaustive list of all the studies which included fatigue as an outcome-variable. However, we think to have obtained a representative sample. Topics that will be discussed are: the conceptualisation of fatigue and its measurement, prevalence rates of fatigue during and after treatment and somatic and psychological correlates of fatigue. Finally, considerations with regard to research and interventions will be discussed.

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.

Summary Little is known regarding the prevalence and course of fatigue in cancer patients after treatment has ended and no recurrence found. The present study examines fatigue in disease-free cancer patients after being treated with radiotherapy (n = 154). The (Breij and Visser. 1990). 61%7 of the subjects reported fatigue that w-as described as 'moderate to quite bad'. Treatment had ended more than 2 vears before the sunrey in 60%e of the sample. Lastly.

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These results suggest that testosterone therapy in young men with raised LH levels and low/normal testosterone levels does not result in significant changes in BMD, body composition, lipids or quality of life, apart from a reduction in physical fatigue and a small reduction in LDL cholesterol. This implies that mild hypogonadism defined on this basis is not of clinical importance in the majority of men, and that androgen replacement cannot be recommended for routine use in these patients.