The Etiology and management of radiotherapy-induced fatigue

Abstract

Fatigue is one of the most common side-effects accompanying radiotherapy, but arguably the least understood. Radiotherapy-induced fatigue (RIF) is a clinical subtype of cancer treatment-related fatigue. It is described as a pervasive, subjective sense of tiredness persisting over time, interferes with activities of daily living, and is not relieved by adequate rest or sleep. RIF is one of the early side-effects and long-lasting for cancer patients treated with localized radiation. Although the underlying mechanisms of fatigue have been studied in several disease conditions, the etiology, mechanisms, and risk factors of RIF remain elusive, and this symptom remains poorly managed. The purpose of this paper is to review and discuss recent articles that defined, proposed biologic underpinnings and mechanisms to explain the pathobiology of RIF, as well as articles that proposed interventions to manage RIF. Understanding the mechanisms of RIF can describe promising pathways to identify at-risk individuals and identify potential therapeutic targets to alleviate and prevent RIF using a multimodal, multidisciplinary approach.

Fadiga em pacientes com câncer de cabeça e pescoço em tratamento radioterápico: estudo prospectivo

“…In this sense, one can note that the etiology of the symptom is complex, and can be linked not only to the intensity of the radiation received, but also to the consequence of alterations at a cellular level, especially at signaling ways in the tumor microenvironment, as in the exacerbated release of pro-inflammatory cytokines and chemokines, for example 29-30 . Thus, the inflammatory process resulting from radiation therapy may also be one of the possible causes of fatigue 25 , besides issues involving the psychological state, as stress and nutritional changes 8-9,29-30 .…”

“…Fatigue is one of the most cited symptoms in the literature when considering cancer patients, and is also one of the most common side effects accompanying radiation therapy 9 . It affects from 50% to 90% of HNC patients undergoing radiation therapy.…”

Consortium Building for Nurse Scientists Interested in Symptoms Research in the Era of Precision Health

“…From that review, it was concluded that clustering of CRS is linked with immune and inflammatory pathways (Lynch Kelly et al, ). Another review on the etiology of radiation‐induced fatigue highlighted the multi‐mechanism pathobiology of radiation‐induced fatigue, including genetic, metabolic, immune, and inflammatory processes (Hsiao, Daly, & Saligan, ). Several reviews from CRS consortium members are ongoing, including an integrative review on the effects of alternative interventions (i.e., exercise, mindfulness‐based cognitive therapy, auricular point acupressure) on CRS.…”

Quantitative Analysis of Effects of a Single 60Co Gamma Ray Point Exposure on Time-Dependent Change in Locomotor Activity in Rats

“…With fractionated doses of radiation for cancer treatment, radiation-induced fatigue sets in within a few days after start of treatment and decreases after treatment completion [ 7 ]. Although the underlying mechanisms of fatigue have been studied under several disease conditions, an understanding of the etiology, mechanisms, and risk factors of radiation-induced fatigue remains elusive, and this symptom remains poorly managed [ 8 , 9 , 10 ]. Investigating initial radiation-related behavioral changes by using animals might provide important information to aid understanding of the health effects of radiation exposure and clinical features of radiation injury.…”