title: Prospective evaluation of the prevalence and severity of fatigue in patients with prostate cancer undergoing radical external beam radiotherapy and neoadjuvant hormone therapy.
abstract: OBJECTIVE
  To prospectively evaluate the prevalence and severity of fatigue and its impact on quality of life (QOL) during and after radical external beam radiotherapy (RT) for prostate cancer.
  
  
  METHODS
  Twenty-eight men with prostate cancer undergoing RT over 6-8 consecutive weeks were prospectively accrued. The Brief Fatigue Inventory (BFI), a validated fatigue assessment tool, was administered at five time points: baseline (week 1), middle of RT (week 3-4), end of RT (last week of RT), and follow-up (median 6.5 weeks after RT). The BFI contained nine questions, each using 0-10 ratings to quantify fatigue severity and interference with six QOL domains. The prevalence of moderate-severe fatigue was plotted as a function of time. Mean sum and subscale scores at each time point were compared to baseline scores using Wilcoxon tests. Linear regression analyses were performed to assess associations between fatigue scores and age, tumor and treatment characteristics.
  
  
  RESULTS
  The median age was 69 years (range 57-84), Gleason score 7 (range 6-10), and presenting PSA 9.0 ng/mL (range 2.5 ng/mL-103.0 ng/mL). Patients were treated once daily to a median dose of 74 Gy (range 60 Gy-78 Gy) over a median of 37 fractions (range 30-39). Hormone therapy was used in all patients (median duration 12.2 months). The prevalence of moderate-severe present fatigue increased from 7% at baseline to 8% at mid-RT and 32% at RT completion. Compared to baseline (mean score 11.5), fatigue increased significantly mid-RT (mean score 14.6, p = 0.03) and peaked at the end of RT (mean score 23.5, p = 0.001). Fatigue significantly interfered with walking ability, normal work, daily chores, and enjoyment of life only at the end of RT. After RT completion, fatigue improved but remained higher compared to baseline at 6.5 weeks of follow-up (mean score 15.0, p = 0.02). On linear regression analysis, age, Gleason score, PSA, T-stage, hormone therapy duration, RT dose and fractions were not significantly associated with mean fatigue scores.
  
  
  CONCLUSIONS
  Patients undergoing 6-8 weeks of RT experienced significant fatigue adversely affecting QOL persisting after therapy completion. Since walking ability was not affected until the end of RT, a walking exercise intervention to combat fatigue is likely feasible and is being investigated.
authors.affiliation: Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, BC, Canada.
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
authors.forename: Eric
authors.initials: E
authors.lastname: Berthelet
authors.forename: Junella C
authors.initials: JC
authors.lastname: Lee
authors.forename: Ross
authors.initials: R
authors.lastname: Petersen
authors.forename: Jan T W
authors.initials: JT
authors.lastname: Lim
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Gaul
authors.forename: Howard
authors.initials: H
authors.lastname: Pai
authors.forename: Paul
authors.initials: P
authors.lastname: Blood
authors.forename: Charles M
authors.initials: CM
authors.lastname: Ludgate
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D003131:Combined Modality Therapy; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009367:Neoplasm Staging; D015995:Prevalence; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016138:Walking
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen