Fatigue During Head-And-Neck Radiotherapy: Prospective Study on 117 Consecutive Patients

Jereczek-Fossa, Barbara Alicja; Santoro, Luigi; Alterio, Daniela; Franchi, Benedetta; Fiore, Maria Rosaria; Fossati, Piero; Kowalczyk, Anna; Canino, Paola; Ansarin, Mohssen; Orecchia, Roberto

doi:10.1016/j.ijrobp.2007.01.024

Cited by 77Head and Neck Cancer StudiesCancer survivorship and careOral health in cancer treatment

Fatigue During Head-And-Neck Radiotherapy: Prospective Study on 117 Consecutive Patients

Jereczek-Fossa, Barbara Alicja, Santoro, Luigi, Alterio, Daniela, Franchi, Benedetta, Fiore, Maria Rosaria, Fossati, Piero, Kowalczyk, Anna, Canino, Paola +2 more·2007·International Journal of Radiation Oncology*Biology*Physics

DOI 10.1016/j.ijrobp.2007.01.024

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Abstract

Purpose Fatigue is an underevaluated cancer-related and treatment-related symptom. We analyzed fatigue in head and neck cancer patients undergoing radiotherapy (RT).Methods and materials 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.Conclusion 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.

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Fatigue is one of the most common, debilitating, and distressing side effects of RT reported by cancer patients.
“Fatigue is one of the most common, debilitating, and distressing side effects of RT reported by cancer patients,2-4”
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Differences in morning and evening fatigue in oncology patients and their family caregivers
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“These same characteristics were found to be associated with higher mean fatigue severity scores in several studies (Curt et al., 2000; Dhrupad et al., 2010; Fletcher et al., 2008; Jereczek-Fossa et al., 2007; Miaskowski et al., 2008).”
Background
Associations among human papillomavirus, inflammation, and fatigue in patients with head and neck cancer
Xiao, C., Beitler, J. J., Higgins, K. A., Glazer, T., Huynh, L. K., Paul, S., Felger, J. C., Wommack, E. C., Saba, N. F., Shin, D. M., et al. (2018) · Cancer · doi:10.1002/cncr.31537 · Cited by 34 · see citing works
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Effect of Processed Honey and Royal Jelly on Cancer-Related Fatigue: A Double-Blind Randomized Clinical Trial
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Background
Time Course and Predictors for Cancer-Related Fatigue in a Series of Oropharyngeal Cancer Patients Treated with Chemoradiation Therapy
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Pilot study of combined aerobic and resistance exercise on fatigue for patients with head and neck cancer: Inflammatory and epigenetic changes
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Impact of patient symptoms and caregiving tasks on psychological distress in caregivers for head and neck cancer (HNC)
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Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy
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A randomized, double-blind, placebo controlled, phase II study to evaluate the efficacy of ginseng in reducing fatigue in patients treated for head and neck cancer
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Cognitive function, depression, fatigue and quality of life among long-term survivors of head and neck cancer
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Cancer-related fatigue: a review
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“Specifically in patients with head and neck cancer (HNC), fatigue has been described as an acute complication to radiation therapy and has also been reported in a few studies to have a strong association with overall quality of life.(3,4) Apart from being an acute side effect of treatment, there is growing evidence of…”
Background
Cancer-Related Fatigue: A Review and a Conceptual Framework to Guide Therapists' Understanding
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Shoulder function after neck dissection: Assessment via a shoulder-specific quality-of-life questionnaire and active shoulder abduction
Imai, T., Sato, Y., Abe, J., Kumagai, J., Morita, S., Saijo, S., Yamazaki, T., Asada, Y., & Matsuura, K. (2020) · Auris Nasus Larynx · doi:10.1016/j.anl.2020.06.013 · Cited by 18 · see citing works
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Cancer related fatigue and cancer cachexia are the consequence of endocrine failure caused by persistent stress
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Effectiveness of Comprehensive Intervention Programme on Quality of life, fatigue, self-efficacy, and psychosocial distress among head and neck cancer patients receiving radiotherapy
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“Fossa et al.6 (n = 117) reported an association between previous surgery and fatigue among HNC scheduled for radiotherapy.”
BackgroundInfluential
Evaluation of fatigue in head and neck cancer patients undergoing (intensity modulated radiation therapy) radiotherapy: A prospective study
Nautiyal, V., Lal, P., Verma, M., Yadav, R., Singh, N., & Kumar, S. (2015) · Asian Journal of Oncology · doi:10.4103/2454-6798.165111 · Cited by 6 · see citing works
“Age and decreased thyroid function have also been correlated with increasing fatigue during treatment.[20] We did not find any correlation with age in the present study, and thyroid function assessment was not carried out before or after treatment in these patients.”
Background
Implementation Readiness and Initial Effects of a Brief Mindfulness Audio Intervention Compared With a Brief Music Control During Daily Radiation Therapy for Prostate Cancer: A Randomized Pilot Study.
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“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].”
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Doc, I feel tired… oh really, so how‘s your mucositis?
Kober, K. M., & Yom, S. S. (2021) · Cancer · doi:10.1002/cncr.33640 · Cited by 4 · see citing works
Identification of distinct fatigue trajectories in patients with nasopharyngeal carcinoma undergoing radiotherapy: an observational longitudinal study
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“Similar results were reported in earlier observational studies of patients with head and neck cancer [27].”
Unterschätztes Symptom: Häufiger und belastender als Schmerzen
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Fatigue in patients with head-and-neck malignancies receiving radiation therapy and impact on quality of life: A prospective observational study
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Assessing Honey Jell® as a Treatment for Reducing Cancer-Related Fatigue in Breast Cancer Patients Undergoing Radiotherapy: Double Blind Phase III Clinical Trial
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“3: 358-363 359 It involves both subjective and objective parts leading to physical signs, pain, depression, and other social and cognitive problems.(3,4) The prevalence of Cancer Related Fatigue (CRF) is relatively high, and it has been reported to be between 50-90% in different studies.”
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LIVING WITH HEAD AND NECK CANCER: A HEALTH PROMOTION PERSPECTIVE – A Qualitative Study
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Fadiga relacionada ao câncer: uma revisão
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Identifying Patterns of Fatigue in Head and Neck Cancer Patients Post-Curative Intent Treatment
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Survivorship and Quality of Life in Head and Neck Cancer
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Patient-reported outcomes after ipsilateral radiation therapy for N2b tonsillar squamous cell carcinoma
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Obstructive Sleep Apnea Following Head and Neck Chemoradiation: A Scoping Review With Exploratory Meta‐Analysis
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From recognition of malnutrition to improvement of dietary counseling for patients with head and neck cancer
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Age, clinical and psychological associations with fatigue following radiotherapy for early breast cancer – Results from 2208 women in the UK Standardisation of Breast Radiotherapy Trials (START) on behalf of the START Trial Management Group
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Fatigue in Patients With Head and Neck Cancer Treated With Radiation Therapy: A Prospective Study of Patient-Reported Outcomes and Their Association With Radiation Dose to the Cerebellum
Abel, E., Silander, E. M., Nordström, F., Olsson, C., Brodin, N. P., Nyman, J., Björk‐Eriksson, T., & Hammerlid, E. B. (2022) · Advances in Radiation Oncology · doi:10.1016/j.adro.2022.100960 · Cited by 19 · see citing works
Fatigue in head and neck cancer survivors after radiotherapy – prevalence, risk factors, and radiation dose correlates
Magnus, V., Schafer, S. A., Tyyger, M., Iyizoba-Ebozue, Z., Unger, D., Tews, A.-M., Boide, A., Mehnert, A., Seidel, C., Moustakis, C., et al. (2026) · Journal of Cancer Survivorship · doi:10.1007/s11764-026-02143-w

Authors: Jereczek-Fossa, B. A., Santoro, L., Alterio, D., Franchi, B., Fiore, M. R., Fossati, P., Kowalczyk, A., Canino, P., Ansarin, M., & Orecchia, R.
Affiliations: European Institute of Oncology (IT)
Gdańsk Medical University (PL)
University of Milan (IT)
ORCID: Santoro, Luigi
Alterio, Daniela
Fossati, Piero
Kowalczyk, Anna
Ansarin, Mohssen
Orecchia, Roberto
Venue: International Journal of Radiation Oncology*Biology*Physics
Publisher: Elsevier BV
Published: 2007-06
Volume: 68
Issue: 2
Pages: 403-415
ISSN: 0360-3016 (ISSN-L)
DOI: 10.1016/j.ijrobp.2007.01.024
OpenAlex: W2047523185
Cited by: 77
References: 54
Citations by year: 2026: 1 · 2025: 3 · 2024: 3 · 2023: 1 · 2022: 6 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 8 · 2017: 5 · 2016: 2 · 2015: 4 · 2014: 4 · 2013: 5 · 2012: 5
FWCI: 3.61
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: International Journal of Radiation Oncology*Biology*Physics (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Oral health in cancer treatment
Keywords: fatigue, head and neck cancer, radiotherapy, treatment-related fatigue, Multidimensional Fatigue Inventory, chemotherapy, corticosteroids, thyroid dysfunction, mental illness, risk factors for fatigue
MeSH terms: Adult, Aged, Aged, 80 and over, Fatigue, Female, Head and Neck Neoplasms, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Radiotherapy, Radiotherapy Dosage, Regression Analysis

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Fatigue During Head-And-Neck Radiotherapy: Prospective Study on 117 Consecutive Patients

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