Fatigue during preoperative chemoradiation for resectable rectal cancer

Abstract

BACKGROUND The aim of this study was to evaluate the severity and patterns of fatigue during preoperative chemoradiation therapy for locally advanced rectal cancer and determine whether there are predictors for patients who develop severe fatigue. METHODS Seventy‐two patients with resectable rectal cancer received chemoradiation (total radiation dose, 45 gray/25 fractions to the pelvis; continuous infusion of 5‐fluorouracil [300 mg/m2]). The Brief Fatigue Inventory (BFI), a measure that categorizes fatigue severity on a 0–10 scale, was administered weekly during treatment. Severe fatigue was defined as 7–10 on the “worst level of fatigue” item. Demographics, disease information, toxicities, and blood counts were collected. Descriptive statistics, repeated measure analysis of variance, and multiple regression were used to examine fatigue and its correlates. RESULTS Fatigue increased in 67% of patients during chemoradiation (CTX/XRT). The mean fatigue score increased from 3.16 before treatment to 4.62 at the end of treatment. A significant linear trend suggested that fatigue progressively got worse during CTX/XRT (F = 16.497, P < 0.001). However, 18% of patients experienced severe fatigue before CTX/XRT; this was predicted by uncontrolled pain (r2 = 0.321; F = 16.52; P < 0.001). During CTX/XRT, uncontrolled diarrhea was the only predictor for increased fatigue (r2 = 0.182; F = 7.77; P < 0.01). Approximately one‐third of patients had severe fatigue, which impaired their function at the end of CTX/XRT. CONCLUSIONS Preoperative chemoradiation therapy for patients with rectal cancer was associated with progressive fatigue during therapy. Based on identified predictors for fatigue, more active pain management before CXT/XRT and bowel management during CTX/XRT might reduce cancer‐related fatigue in these patients. Cancer 2001;92:1725–32. © 2001 American Cancer Society.

Cancer fatigue—more data, less information?

“…Another recent study evaluated pain and fatigue in elderly cancer patients and their association with other symptoms [28]. Patients were aged over 65 years, had newly diagnosed cancer of the breast, colon, lung, or prostate, and were followed for 1 year.…”

“…In some studies fatigue has been significantly higher in patients than in a control population, and in other studies no difference was evident [26][27][28][29][30][31]. Many studies test variably constructed groups using different assessment tools, and others have not included control subjects.…”

Fatigue in patients with adjuvant radiation therapy for breast cancer: long-term follow-up

“…In patients with adjuvant irradiation for conservatively operated breast cancer, it might be the only treatment toxicity. Some studies focus on the time course of radiation-induced fatigue during therapy, showing that fatigue intensity peaks during the last weeks of treatment and that it subsides in the weeks following therapy (Ahsberg and Furst 2001;Geinitz et al 2001; Greenberg et al 1992; Greenberg et al 1993; Monga et al 1999;Smets et al 1998a; Wang et al 2001). Little is known about fatigue during long-term follow-up after radiation therapy and its relation to pretreatment fatigue levels (Smets et al 1998b).…”

The impact of fatigue and anemia on functional status in older cancer patients treated with chemotherapy

“…34,35 While there is a consistent association between fatigue and anemia in cancer patients, 6,36-39 anemia is not the only factor responsible for fatigue as there is fatigue in nonanemic patients and there are anemic patients without fatigue. 40 We found that anemia is an independent factor for IADL dependencies. This is a new finding in cancer patients though it has been abundantly demonstrated in geriatric patients.…”