Time course and predictors for cancer-related fatigue in a series of oropharyngeal cancer patients treated with chemoradiation therapy.

BACKGROUND: Cancer-related fatigue (CRF) is a highly prevalent and underestimated symptom in cancer patients. This study aims to analyze CRF solely in a cohort of oropharyngeal cancer patients who underwent treatment with radiotherapy (RT). METHODS: In January 2008 to June 2010, 87 consecutive oropharyngeal carcinoma patients underwent definitive RT. Concurrent chemotherapy was used for 94% of patients. The median prescription dose to the planning target volume of the gross or clinical tumor volume was 70 Gy for definitive cases (n = 84) and 66 Gy for postoperative cases (n = 3), both delivered over 6.5 weeks. A normalized 12-point numeric rating scale assessed CRF from patient visits before, during, and after RT. RESULTS: The median follow-up of living patients was 14 months. Fatigue peaked 1-2 weeks post-RT and remained higher than baseline for up to 2 years post-RT in 50% of patients. The average fatigue score at the time of completion of therapy or maximum thereafter up to 1 year post-RT was significantly worse than baseline. Patients who experienced pain had a trend toward significance with association for a higher maximum difference in fatigue from baseline. Karnofsky performance status score, weight change, and mood disorders did not correlate with CRF. CONCLUSIONS: Fatigue was a common treatment-related symptom in this uniform cohort of patients with oropharyngeal cancer. RT was highly correlated with worsening of CRF. Pain control has the potential to help mitigate CRF in patients experiencing pain, and will need to be confirmed using larger datasets.

Chronic pain management in cancer survivors.

The problem of pain in cancer survivors is attracting increased attention. Although comprehensive information about the prevalence of persistent pain in the cancer survivor population is currently lacking, it is known to depend on the type of cancer, comorbid conditions, and the initial pain management. Epidemiologic studies generally categorize pain in patients with cancer as either pain directly caused by the neoplastic process or related phenomena, pain occurring as a complication of anticancer treatment, or pain unrelated to the neoplastic process, caused by debility or concurrent disorders. This article focuses on pain syndromes in cancer survivors and the safe use of opioid therapy in this population when its ongoing use is part of the pain management plan. The use of physical therapy, rehabilitation therapy, and cognitive behavioral therapy, which are all extremely important aspects of pain management in the cancer survivor, are briefly mentioned.