Radiotherapy-related fatigue: How to assess and how to treat the symptom. A commentary

Acute and chronic radiotherapy-related fatigue occurs in up to 80% and 30%, respectively, of patients undergoing irradiation for cancer. Frequently, t he symptom is not expected by the patients and is underestimated by medical and nursing staff. Fatigue can affect global quality of life more than pai n, sexual dysfunction and other cancer- or treatment-related symptoms. Its etiology and correlates are not clear, Published reports are mainly descrip tive, and in many of them numerous methodological biases are present. One o f the limitations is lack of a standard method of assessment that could sim plify the comparison between different series. In the last decade, modern i nstruments have been designed to measure fatigue. They include uni- and mul tidimensional tools. Use of these specific instruments is highly recommende d for research on radiation-related fatigue. In daily practice when time is limited, simple assessment is necessary. For example, systemic use of plai n and easily understandable questions about fatigue, its level and impact o n daily life could be sufficient and reliable. Therapeutic strategies for r adiotherapy-induced fatigue have not yet been clearly defined, but a few ra ndomized studies have been recently published. Physical exercise, group psy chotherapy and relaxation therapy have been demonstrated to be effective. M oreover, pharmacological treatment of concomitant disturbances (anemia, pai n, insomnia, depression, dehydration, infection, malnutrition) and other ra diotherapy side effects (diarrhea, hormonal insufficiency etc.) should be c onsidered. Further methodologically correct studies are warranted to better define the causes, optimal prevention, assessment and management of this s ymptom.