Fatigue is a significant symptom associated with radiotherapy. Affected individuals experience tiredness, weakness, exhaustion, lack of energy, malaise, and impaired ability to concentrate and complete activities of daily living.69
The incidence of moderate to severe fatigue following radiotherapy has been reported at between 32% and 59%.30 The incidence and severity of fatigue is known to fluctuate over the treatment trajectory. The pattern of fatigue following radiotherapy differs depending on the site and disease.
Factors influencing the occurrence of fatigue include:30
- adjuvant therapy - hormone, chemotherapy, recent surgery
- frailty and functional status
- site of radiotherapy
- dosage of treatment
- fractionation regimen
- advanced disease.
It is important to prepare people affected by cancer for the possibility of fatigue related to their radiotherapy. To prevent further anxiety, they should also be prepared for the potential severity and extended duration of fatigue following completion of treatment.30
Assessment is important in managing fatigue, which needs to be differentiated from depression. Anaemia related to disease, radiotherapy or adjuvant therapies also needs to be excluded. Subjective assessment using a 0 to 10 scale is recommended.30
Due to the lack of clear aetiology and mechanism of radiation-induced fatigue, interventions are mainly based on behavioural or psychosocial strategies. It appears that fatigue management needs to be individually tailored. Physical exercise and psychosocial interventions have been associated with positive effects against fatigue both during and after treatment for cancer.70
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Cancer-Related Fatigue Version 1.2013. National Comprehensive Cancer Network. 2013
Summarise evidence based recommendations for the prevention and management of cancer and radiotherapy related fatigue.