Evaluation of fatigue in head and neck cancer patients undergoing (intensity modulated radiation therapy) radiotherapy: A prospective study

Introduction: Fatigue is a common symptom in cancer patients and persists after the completion of cancer-directed treatment. We attempted to study temporal variation in fatigue levels in head and neck cancer (HNC) patients when they were treated by radiotherapy (RT) using intensity modulated radiation therapy techniques. Materials and Methods: Histologically proven HNC patients (AJCC stage II and III with Karnofsky performance status [KPS] ≥80) receiving RT between August 2009 and October 2011 were included. Fatigue was assessed before, during and at 3, 6, and 12 months following RT and compared with age-matched healthy controls by using EORTC QOLQ C30 (using question number 10, 12, and 18). Results: Twenty-six patients were evaluated, whose baseline average fatigue score was 22.4, which was significantly higher as compared to controls (average fatigue score = 12.8; P = 0.04). During RT, average fatigue score increased to 30 by 3 weeks (P = 0.02) and rising to 33.2 (P = 0.029) towards the end of RT. Three months following RT, average fatigue score decreased to 22.8 and remained between 23 and 20 at 6 and 12 months respectively. Significant higher fatigue scores were observed in patients with advanced stage (P = 0.000). Lower KPS score did not show significantly higher fatigue scores (P = 0.5).Conclusion: Our study shows that HNC patients suffer greater fatigue than age-matched healthy individuals which is further aggravated by RT. It gradually comes back to the pretreatment level by 3 months following treatment, but does not reach to a normal healthy level even at 12 months following treatment