Fatigue during preoperative chemoradiation for resectable rectal cancer

BACKGROUND. The aim of this study was to evaluate the severity and patterns of fatigue during preoperative chemoradiation therapy for locally advanced rectal cancer and determine whether there are predictors for patients who develop severe fatigue. METHODS. Seventy-two patients with resectable rectal cancer received chemor adiation (total radiation dose, 45 gray/25 fractions to the pelvis; continu ous infusion of 5-fluorouracil [300 mg/m(2)]). The Brief Fatigue Inventory (BFI), a measure that categorizes fatigue severity on a 0-10 scale, was adm inistered weekly during treatment. Severe fatigue was defined as 7-10 on th e "worst level of fatigue" item. Demographics, disease information, toxicit ies, and blood counts were collected. Descriptive statistics, repeated meas ure analysis of variance, and multiple regression were used to examine fati gue and its correlates. RESULTS. Fatigue increased in 67% of patients during chemoradiation (CTX/XR T). The mean fatigue score increased from 3.16 before treatment to 4.62 at the end of treatment. A significant linear trend suggested that fatigue pro gressively got worse during CTX/XRT (F = 16.4911, P < 0.001). However, 18% of patients experienced severe fatigue before CTX/XRT; this was predicted b y uncontrolled pain (r(2) = 0.321; F = 16.52; P < 0.001). During CTX/XRT, u ncontrolled diarrhea was the only predictor for increased fatigue (r(2) = 0 .182; F = 7.77; P < 0.01). Approximately one-third of patients had severe f atigue, which impaired their function at the end of CTX/XRT. CONCLUSIONS. Preoperative chemoradiation therapy for patients with rectal c ancer was associated with progressive fatigue during therapy. Based on iden tified predictors for fatigue, more active pain management before CXT/XRT a nd bowel management during CTX/XRT might reduce cancer-related fatigue in t hese patients. (C) 2001 American Cancer Society.