Of all the potential toxicities of cancer therapy, fatigue is the one side effect all patients can expect to encounter. It most recently has been the focus of increasing investigation in cancer survivors.
Because of our expanding knowledge about this phenomenon in this cohort, we now can educate our patients about fatigue being a significant deterrent to work re-entry and overall quality of life. This has been identified most prominently in survivors of hematological malignancies.
Researchers from the German Hodgkin Study Group were interested in learning more about persistent fatigue after treatment completion.1 They analyzed psychometrically-valid fatigue scores in 4,215 Hodgkin lymphoma survivors in the second and fifth year after treatment completion. Excluded were patients with co-morbidity.
A high incidence of severe acute and persistent fatigue in Hodgkin lymphoma survivors was documented which was not associated with stage of disease (i.e., tumor burden) or treatment type. Clinically relevant fatigue was prevalent even before the onset of chemotherapy and the fatigue at baseline was predictive of fatigue after treatment, even up to 5 years out. Advanced age was also associated with persistent fatigue and was a predictor of impaired fatigue recovery.
Finally, successful treatment of the lymphoma did not prevent the development of severe, persistent fatigue. The researchers identified that one in five patients will experience persistent, severe fatigue at 5 years after successful therapy for Hodgkin lymphoma.
Findings validate the need for continued fatigue research as our conventional wisdom about the nature of this symptom has been challenged. Specifically, the following warrants consideration:
- How is the Hodgkin lymphoma disease process associated with the development of fatigue even prior to diagnosis and treatment?
- In the absence of tumor burden as a contributing factor to fatigue, what is the mechanism of fatigue specific to this malignancy?
- What are the physiological age-associated processes that co-exist that make fatigue more problematic with advanced age?
While oncology nurses currently have more knowledge now about fatigue as a prominent symptom during survivorship, the continued need for research prevails. We need to keep appraised of ongoing findings in this realm.
- Kreissl S, Mueller H, Goergen H, et al. Cancer-related fatigue in patients with and survivors of Hodgkin’s lymphoma: A longitudinal study of the Hodgkin Study Group. Lancet Oncol. 2016 Oct;17(10):1453-1462.