title: Fatigue during head-and-neck radiotherapy: prospective study on 117 consecutive patients.
abstract: OBJECTIVE
  Fatigue is an underevaluated cancer-related and treatment-related symptom. We analyzed fatigue in head and neck cancer patients undergoing radiotherapy (RT).
  
  
  METHODS
  A total of 117 patients were enrolled (mean age, 58 years). Radiation therapy (median dose, 66 Gy) was given with either exclusive or postoperative intent in 52 and 65 patients, respectively. Chemotherapy (CT) was added before and/or during RT in 61 patients. The patients completed a 20-item questionnaire (Multidimensional Fatigue Inventory [MFI-20]) before, during (weekly), and after RT. The impact of patient-, tumor-, and treatment-related factors on fatigue was evaluated with unifactorial and multifactorial tests.
  
  
  RESULTS
  Fatigue level increased during RT reaching a maximum at Week 6 and then slowly decreased. In multivariate stepwise regression analysis age (inversely related, p < 0.05), psychologic disorders (p < 0.005), and previous head-and-neck surgery (inversely related, p < 0.005) were correlated with higher pre-RT fatigue level. Pre-RT fatigue score (p < 0.0001), induction and/or concomitant CT (p = 0.035), need of cortisone during RT (p = 0.005), and thyroid disorders (p = 0.032) were correlated with higher during-RT fatigue level. Pre-RT fatigue score (p < 0.0001), induction and/or concomitant CT (p < 0.001), and need of cortisone during RT (p < 0.005) were correlated with higher post-RT fatigue level. No impact of gender, performance status, comorbidities other than psychologic and thyroid, tumor stage/site, RT intent, dose, volume, duration, or toxicity was observed.
  
  
  CONCLUSIONS
  Fatigue affects all patients undergoing RT for head-and-neck cancer, reaches maximum score at the 6th week of RT, and slowly decreases thereafter. Age, thyroid dysfunction, psychologic disorders, pre-RT fatigue score, CT, and cortisone use are correlated with RT-related fatigue levels.
authors.affiliation: Division of Radiotherapy, European Institute of Oncology, Milan, Italy. barbara.fossa@ieo.it
authors.forename: Barbara Alicja
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoro
authors.forename: Daniela
authors.initials: D
authors.lastname: Alterio
authors.forename: Benedetta
authors.initials: B
authors.lastname: Franchi
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Fiore
authors.forename: Piero
authors.initials: P
authors.lastname: Fossati
authors.forename: Anna
authors.initials: A
authors.lastname: Kowalczyk
authors.forename: Paola
authors.initials: P
authors.lastname: Canino
authors.forename: Mohssen
authors.initials: M
authors.lastname: Ansarin
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D011795:Surveys and Questionnaires