title: 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/m(2)]). 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 (r(2) = 0.321; F = 16.52; P < 0.001). During CTX/XRT, uncontrolled diarrhea was the only predictor for increased fatigue (r(2) = 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.
authors.affiliation: Pain Research Group,The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: X S
authors.initials: XS
authors.lastname: Wang
authors.forename: N A
authors.initials: NA
authors.lastname: Janjan
authors.forename: H
authors.initials: H
authors.lastname: Guo
authors.forename: B A
authors.initials: BA
authors.lastname: Johnson
authors.forename: M C
authors.initials: MC
authors.lastname: Engstrom
authors.forename: C H
authors.initials: CH
authors.lastname: Crane
authors.forename: T R
authors.initials: TR
authors.lastname: Mendoza
authors.forename: C S
authors.initials: CS
authors.lastname: Cleeland
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005221:Fatigue / Q000209:etiology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000628:therapy*
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil