Fatigue in head and neck cancer patients treated with radiotherapy: a prospective study of patient-reported outcomes and their association with radiation dose to the cerebellum

Abstract

Purpose: Although fatigue is a known side effect in head and neck cancer (HNC) patients receiving radiotherapy, knowledge regarding long-term fatigue and dose-response relationships to organs at risk (OAR) is scarce. The aim of this prospective study was to analyze patient-reported fatigue in HNC patients receiving radiotherapy and to explore any possible association with OAR doses. Materials and Methods: Patients with HNC referred for curative radiotherapy were eligible for inclusion in the study. To assess patient-reported fatigue, quality of life questionnaires (European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-FA-12) were distributed before treatment and 1, 3, 6, 12, 24 and 60 months after start of treatment. Mean dose (Dmean) and near maximum dose (D2%) of the cerebellum and brainstem were evaluated in relation to baseline-adjusted fatigue scores at three months. Results: One-hundred and twenty-six patients treated with intensity-modulated radiotherapy (IMRT) between 2008 and 2010 were available for final analysis. Female gender and age <60 years were associated with higher fatigue at baseline, whereas patients also treated with chemotherapy had reduced physical and emotional fatigue at six months. Physical fatigue (QLQ-FA-12 scale) increased from baseline up to three months (29 vs 59; P < .0001), but showed no difference compared to baseline from one to five years. Emotional fatigue was significantly lower at five years compared to baseline (14 vs 28; P < .0001). Patients with cerebellum Dmean > 3.5 Gy had higher mean physical fatigue scores at three months (38 vs 27; P=0.036). Conclusions: Although there is a significant increase in fatigue scores for HNC patients up to one year after radiotherapy, this study showed a return to baseline levels at five years. A possible association was found between physical fatigue and a higher mean dose to the cerebellum.