Fatigue in patients with head-and-neck malignancies receiving radiation therapy and impact on quality of life: A prospective observational study

Abstract

ABSTRACT Background: Cancer-related fatigue is an important but often unrecognized problem in patients with head-and-neck cancer undergoing radiation therapy. Objectives: To assess cancer-related fatigue in patients with head-and-neck cancer undergoing radiation therapy, and to evaluate for any impact on the quality of life (QoL). Materials and Methods: Between Oct 2015 and Dec 2016, we included 120 patients with head-and-neck cancers, who were treated with definitive or post-operative radiotherapy using intensity-modulated radiation therapy (IMRT) or 3-dimensional conformal radiation therapy (3DCRT), with or without concurrent chemotherapy. Fatigue was assessed with the Brief Fatigue Inventory (BFI) questionnaire and the impact of cancer-related fatigue on QoL was assessed by the European Organization for Research and Treatment of Cancer (EORTC) questionnaires (QLQ-C30) and Head and Neck (H&N) 35; these questionnaires were filled at the start, completion, and in the third month after treatment. Based on the BFI score, fatigue was graded as mild (1–3), moderate (4–7), or severe (8–10). A score of 4 or higher on the BFI was considered an indication for some form of intervention. Results: The mean fatigue score before the start of radiation was 2.43; at the completion of treatment, the fatigue score increased to 5.07, and then decreased to 0.53 by the third month of follow-up (P < 0.0001). There was an increase in the score on the EORTC QLQ-H&N35 indicating worsening QoL at the completion of treatment as compared to that before the start of treatment with a subsequent decline in all the scores, except dryness of the mouth, by the third month of follow up. There was an increase in the score for dryness of the mouth from the completion of treatment to the third month of follow-up. Conclusion: Patients undergoing chemoradiation for head-and-neck cancers suffer worsening fatigue at the time of completion of treatment which impacts the QoL, but subsequently improves with time.