Fatigue in Long-Term Head and Neck Cancer Survivors From Diagnosis Until Five Years After Treatment

Return to work of head and neck cancer patients after curative radiotherapy

Background

Our objective was to evaluate the rate of reemployment after having curative radiotherapy for head and neck cancer and to identify the barriers of successful return to work in this patient population.

Methods

The study was retrospective, cross-sectional, analytical and cohort type, it included 52 consecutive patients attending follow-up visits after curative radiotherapy for head and neck cancer at a single tertiary center. Participants completed a survey to assess demographics, tumor characteristics, lifestyle choices and quality of life questionnaires. We analyzed the rate of reemployment and the association with different parameters.

Results

At the time of the survey, the successful return to work rate among head and neck cancer survivors was 55.8%. Most of the returners, 93%, started to work within 14 months from the time of the diagnosis. Educational level, work type and tumor stage were predictive for successful return to work. The main barriers for reemployment were physical symptoms such as fatigue, speech disorders and eating problems.

Conclusions

Head and neck cancer survivors who manage to return to work have a better quality of life and global health status than those who could not return. The most vulnerable patients are those with lower education, doing manual work and with advanced stage cancer. Optimized radiotherapy planning to reduce radiation induced late effects in conjunction with coordinated rehabilitation programs are needed to facilitate head and neck cancer survivors' reemployment.

Identification of distinct fatigue trajectories in patients with nasopharyngeal carcinoma undergoing radiotherapy: an observational longitudinal study

PURPOSE

To investigate the fatigue trajectory types and various influencing factors during intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC).

METHODS

Longitudinal data of cancer-related fatigue from 182 participants with NPC were assessed at baseline (T0) and weekly (T1-T7) during radiotherapy via the revised Piper Fatigue Scale. Patient-generated data from the Subjective Global Assessment (PG-SGA) and the Hospital Anxiety and Depression Scale were collected at baseline. Latent growth curve models (LGCM) and latent class growth models (LCGM) were used to explore fatigue trajectories and heterogeneity among fatigue trajectories, respectively. The influencing factors of different trajectories were assessed via multivariate logistic regression analysis.

RESULTS

The overall fatigue level during IMRT tended to increase but then decreased, as indicated by the LGCM results (S = 0.985, P < 0.001), and peaked in the fifth week. The LCGM results fit the following three fatigue trajectories: "mild fatigue persistence" (n = 54, 29.7%), "mild fatigue growth" (n = 95, 52.2%), and "moderate fatigue persistence" (n = 33, 18.1%). PG-SGA score and being married were risk factors for the "mild fatigue growth" group. The risk factors for the "moderate fatigue persistence" group were PG-SGA, anxiety, and being married, whereas a family income < 3000 Y/month was a protective factor.

CONCLUSIONS

Three types of fatigue trajectories are observed during IMRT in patients with NPC. PG-SGA score, marital status, anxiety, and family income may influence the type of fatigue trajectory in patients, so preventive measures should be taken on the basis of specific circumstances.

Effectiveness of Exercise-Based Interventions on Fatigue among Head and Neck Cancer Patients on Radiotherapy: Systematic Review with Meta-Analysis

OBJECTIVES

Fatigue is a significant challenge among head and neck cancer patients undergoing radiotherapy, impacting their well-being and daily functioning. Exercise-based interventions hold promise in alleviating this fatigue burden. This systematic review aims to evaluate the effectiveness of exercise-based interventions on fatigue among patients with head and neck cancer receiving radiotherapy.

METHODS

We systematically searched for the studies in Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane Library Database, MEDLINE, and Google Scholar in the English language from 2000 to 2023. Two reviewers independently identified the articles using key thesaurus and free text terms based on the inclusion criteria. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Meta-analysis was done by using RevMan 5.3 software.

RESULTS

The systematic review included nine trials encompassing 647 participants, out of which five were randomized control trials and were selected for meta-analysis. Pooled data from randomized control trials showed that exercise-based interventions were effective in reducing few dimensions of fatigue such as general fatigue, physical fatigue, emotional fatigue significantly (P < .001) among Head and Neck Cancer patients receiving radiotherapy.

CONCLUSION

Preliminary evidence from the review suggests that engaging in exercise-based interventions may reduce fatigue among patients with head and neck cancer receiving radiotherapy. However, future research is necessary, as most of the articles in current review were either pilot studies or feasibility trials.

IMPLICATIONS FOR NURSING PRACTICE

This systematic review and meta-analysis protocol was registered in PROSPERO with the register number CRD42023428284.

Fatigue following head and neck cancer radiotherapy: a systematic review of dose correlates

INTRODUCTIONS

Radical radiotherapy (RT) is the cornerstone of Head and Neck (H&N) cancer treatment, but it often leads to fatigue due to irradiation of brain structures, impacting patient quality of life.

OBJECTIVE

This study aimed to systematically investigate the dose correlates of fatigue after H&N RT in brain structures.

METHODS

The systematic review included studies that examined the correlation between fatigue outcomes in H&N cancer patients undergoing RT at different time intervals and brain structures. PubMed, Scopus, and WOS databases were used in the systematic review. A methodological quality assessment of the included studies was conducted following the PRISMA guidelines. After RT, the cohort of H&N cancer patients was analyzed for dose correlations with brain structures and substructures, such as the posterior fossa, brainstem, cerebellum, pituitary gland, medulla, and basal ganglia.

RESULT

Thirteen studies meeting the inclusion criteria were identified in the search. These studies evaluated the correlation between fatigue and RT dose following H&N RT. The RT dose ranged from 40 Gy to 70 Gy. Most of the studies indicated a correlation between the trajectory of fatigue and the dose effect, with higher levels of fatigue associated with increasing doses. Furthermore, five studies found that acute and late fatigue was associated with dose volume in specific brain structures, such as the brain stem, posterior fossa, cerebellum, pituitary gland, hippocampus, and basal ganglia.

CONCLUSION

Fatigue in H&N RT patients is related to the radiation dose received in specific brain areas, particularly in the posterior fossa, brain stem, cerebellum, pituitary gland, medulla, and basal ganglia. Dose reduction in these areas may help alleviate fatigue. Monitoring fatigue in high-risk patients after radiation therapy could be beneficial, especially for those experiencing late fatigue.

Chronic fatigue in long-term survivors of head and neck cancer treated with radiotherapy

BACKGROUND

There is lack of evidence on chronic fatigue (CF) following radiotherapy (RT) in survivors of head and neck cancer (HNC). We aimed to compare CF in HNC survivors > 5 years post-RT with a reference population and investigate factors associated with CF and the possible impact of CF on health-related quality of life (HRQoL).

MATERIAL AND METHODS

In this cross-sectional study we included HNC survivors treated in 2007-2013. Participants filled in patient-reported outcome measures and attended a one-day examination. CF was measured with the Fatigue Questionnaire and compared with a matched reference population using t-tests and Cohen's effect size. Associations between CF, clinical and RT-related factors were investigated using logistic regression. HRQoL was measured with the EORTC Quality of Life core questionnaire.

RESULTS

The median age of the 227 HNC survivors was 65 years and median time to follow-up was 8.5 years post-RT. CF was twice more prevalent in HNC survivors compared to a reference population. In multivariable analyses, female sex (OR 3.39, 95 % CI 1.82-6.31), comorbidity (OR 2.17, 95 % CI 1.20-3.94) and treatment with intensity-modulated RT (OR 2.13, 95 % CI 1.16-3.91) were associated with CF, while RT dose parameters were not. Survivors with CF compared to those without, had significantly worse HRQoL.

CONCLUSIONS

CF in HNC survivors is particularly important for female patients, while specific factors associated with RT appear not to play a role. The high CF prevalence in long-term HNC survivors associated with impaired HRQoL is important information beneficial for clinicians and patients to improve patient follow-up.

"Why am I still suffering?": Experience of long-term fatigue and neurocognitive changes in oropharyngeal cancer survivors following (chemo)radiotherapy

Background

Late effects of cancer treatment, such as neurocognitive deficits and fatigue, can be debilitating. Other than head and neck-specific functional deficits such as impairments in swallowing and speech, little is known about survivorship after oropharyngeal cancer. This study examines the lived experience of fatigue and neurocognitive deficits in survivors of oropharyngeal squamous cell cancer and impact on their daily lives.

Methods

This work is part of the multicentre mixed method ROC-oN study (Radiotherapy for Oropharyngeal Cancer and impact on Neurocognition), evaluating fatigue and neurocognitive function in patients following radiotherapy +/- chemotherapy for oropharyngeal cancer and impact on quality of life. Semi-structured interviews were conducted in adults treated with radiotherapy (+/-chemotherapy) for oropharyngeal squamous cell carcinoma >/=24 months from completing treatment. Reflexive thematic analysis performed.

Results

21 interviews (11 men and 10 women; median age 58 years and median time post-treatment 5 years) were conducted and analysed, yielding six themes: (1) unexpected burden of fatigue, (2) noticing changes in neurocognitive function, (3) the new normal, (4) navigating changes, (5)insufficient awareness and (6)required support. Participants described fatigue that persisted beyond the acute post-treatment period and changes in neurocognitive abilities across several domains. Paid and unpaid work, emotions and mood were impacted. Participants described navigating the new normal by adopting self-management strategies and accepting external support. They reported lack of recognition of these late effects, being poorly informed and being unprepared. Follow-up services were thought to be inadequate.

Conclusions

Fatigue and neurocognitive impairment were frequently experienced by survivors of oropharyngeal cancer, at least two years after treatment. Patients felt ill-prepared for these late sequelae, highlighting opportunities for improvement of patient information and support services.

Comprehensive Geriatric Assessment and Quality of Life Aspects in Patients with Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC)

To define frailty in older cancer patients, the aim of this study was to assess the geriatric status and quality of life (QoL) aspects in patients suffering from recurrent/metastatic head and neck squamous cell carcinoma (r/m HNSCC) under palliative treatment. A comprehensive geriatric assessment (CGA) was performed on 21 r/m HNSCC patients at two defined assessments, and the QoL aspects and the impact of descriptive data were evaluated. The Kolmogorov-Smirnov test, Spearman's rho correlation, and two-way mixed ANOVA were used for statistical analysis. All patients were found to be "frail". Pain, fatigue, and the burden of illness were the highest-rated symptoms. Oral function and orofacial appearance were highly impaired. A significant impact of descriptive data on the CGA and QoL results was found (all p ≤ 0.05). Thus, the CGA results revealed high frailty, severe comorbidities, and high impairments in QoL aspects. The CGA and QoL results were negatively affected by the primary HNSCC treatment approach, the need for prosthetic treatment, and worse oral functional capacity. Therefore, frailty in r/m HNSCC patients seems to be multidimensional. The evaluation of the CGA and QoL aspects in r/m HNSCC patients can be recommended to detect special needs, organize aftercare, and improve the support for frail and vulnerable cancer patients to create a multidisciplinary treatment approach.