Co-Occurring Symptoms Contribute to Persistent Fatigue in Prostate Cancer

Abstract

Purpose: Cancer-related fatigue is one of the most debilitating side effects of cancer and cancer therapy. We aimed to investigate co-occurring symptoms associated with persistent fatigue in men receiving external beam radiation therapy (EBRT) for nonmetastatic prostate cancer. Methods: A sample of 47 men with prostate cancer scheduled to receive radiotherapy (RT) were followed at baseline and 1 year after RT. Clinical and demographic data were obtained from chart review. Symptom measurements included urinary dysfunction (American Urological Association symptoms score), fatigue (Functional Assessment of Cancer Therapy – Fatigue questionnaire), sleep disturbance (Patient-Reported Outcomes Measurement Information System – Sleep Disturbance form), pain (physical well-being domain pain item of the Functional Assessment of Cancer Therapy – General), and depressive symptoms (Hamilton Depression Rating Scale). Paired t tests, correlations, general linear models, and logistic regressions were used to determine associations between fatigue and other symptom scores. Results: At 1 year after RT, 34% of subjects continued to experience fatigue. Urinary dysfunction was the best clinical predictor of persistent fatigue. Pain and depressive symptoms further improved the predictive power of the model. A multivariate linear regression model containing all these three clinical variables (urinary dysfunction, pain, and depressive symptoms) explained 74% of total variance associated with persistent fatigue after RT. Conclusions: Persistent fatigue at 1 year after EBRT in prostate cancer survivors is likely related to a cluster of symptoms elicited by chronic inflammation. Therapies that target each of these symptoms will likely reduce fatigue in this patient population.

Cognitive and motor aspects of cancer‐related fatigue

“…We previously showed that CRF during RT and one‐year post‐RT are dissociable in regard to comorbid symptoms and underlying mechanisms . Future studies will focus on discerning the cognitive and physical contributions of different fatigue subtypes.…”

Brain-derived neurotrophic factor polymorphism Val66Met protects against cancer-related fatigue

“…We are actively recruiting patients with various types of cancer to test this hypothesis. Secondly, previous studies have shown that cancer and cancer treatment may lead to fatigue via different mechanisms 39 , 49 , 50 . We only included participants that had confirmed cancer diagnoses before the start of treatment in order to focus on fatigue related to cancer itself instead of cancer treatment.…”

Fatigue prevalence in men treated for prostate cancer: A systematic review and meta-analysis

“…Most studies were of fair[ 8 , 10 , 21 - 26 ] or high[ 7 , 11 - 13 , 27 , 28 ] quality. Only three of these studies had an adequate sample size[ 13 , 27 , 28 ].…”

“…Rather, they found a subset of patients in their cohort who continued to experience fatigue for a year after RT, long after the treatment-associated hematologic toxicities had resolved. These findings suggest that acute and persistent fatigue may be independent phenomena that are mechanistically different; each may be driven by distinct underlying pathogenic processes[ 8 ]. Storey et al [ 13 ] suggested that the presence of post-treatment CRF may be more influenced by the patient’s current medical and psychological comorbidities than by the initial type of treatment received.…”

“…Storey et al [ 13 ] suggested that the presence of post-treatment CRF may be more influenced by the patient’s current medical and psychological comorbidities than by the initial type of treatment received. Most evidence suggests that persistent fatigue is associated with depression, anxiety, urinary symptoms, pain and insomnia[ 8 , 23 ]. Furthermore, while effective treatments for persistent fatigue do not currently exist, targeting each of the fatigue-related symptoms may provide relief for patients suffering from this debilitating condition.…”