For the past 40 years, 1 cancer-related fatigue (CRF) has been the subject of intense but sequestered investigation. CRF is commonly defined as a subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or its treatment that is distressing, persistent, not proportional to recent activity, and which interferes with the patient's usual functioning. 2 Excess CRF is known to occur in virtually all patients with head and neck cancer (HNC) who receive chemoradiation, 3 and one-half of these patients have sustained elevations in fatigue as long as 2 years later. 4 CRF has significant affects in terms of lost productivity, lost days from work, and decreased quality of life. 5 In addition, CRF may be associated with decreased survival. 6 However, despite its high prevalence rate and negative effects on patients and society, 5 limited progress has been made in clinical assessment and treatment.In the day-to-day whirlwind of clinical oncology practice, the assessment of CRF is usually not perceived as a priority, particularly among patients with HNC. Patients' frequent reporting of this symptom is simply lost in the busy shuffle of handling their many other severe and complex medical problems. The reasons for this lack of attention are multifactorial. They may include a de-prioritization of what is perceived as a primarily subjective concern, a generally poor medical and clinical understanding of CRF in the oncology community, a lack of training in standardized assessment or treatment options for CRF, or a perception that CRF has little meaningful bearing on patients' oncologic outcomes. In addition, a comprehensive treatment plan for CRF may require multidimensional assessment and multiple routes of intervention, with no rapidly delivered magic bullet. For these reasons, CRF has been called the forgotten symptom in oncology. 7 It is fair to say that the underlying mechanisms for CRF remain under investigation. 8 The most commonly cited of these include interacting alterations in: immune function or inflammation, energy metabolism, neurotransmission, anemia, and circadian rhythm. Variations in genotype, gene expression levels, and methylation patterns related to inflammatory mechanisms are associated with CRF severity in patients treated with chemotherapy and radiation. 5 However, the lack of a clinically applicable risk prediction model is a barrier hindering any impetus to develop more effective management. 9 A widely accepted and accurate risk prediction model could assist clinicians in identifying high-risk patients who could be targeted for interventions to prevent or reduce CRF.The study by Xiao and colleagues in this issue of Cancer 10 provides a clinically accessible demonstration of the importance of assessing and treating CRF in the context of treating HNC. This research maps out the relative contributions of chemotherapy and/or radiation to CRF and CRF's associations with elevated measures of epigenetic aging and chronic inflammation in this specific population of patien...