Fatigue in head and neck cancer survivors after radiotherapy - prevalence, risk factors, and radiation dose correlates.

Abstract

Purpose: To determine the prevalence of fatigue in head and neck cancer survivors and identify associated factors, including potential associations with radiation dose to cerebral organs at risk (OAR).

Methods: This cross-sectional observational study included survivors treated with curative radiotherapy between 2005 and 2023 at a tertiary cancer center. Fatigue and health-related quality of life (HRQoL) were assessed with the EORTC QLQ-C30. Dosimetric analyses evaluated associations between fatigue and radiation dose to intracranial OAR (brainstem, cerebellum, posterior fossa, medulla, pituitary gland, basal ganglia, hippocampus), including voxel-based analysis (VBA).

Results: One hundred fifty-eight patients were included. The most common tumor site was the oropharynx (38.6%). Median time from radiotherapy completion to study participation was 41 (IQR, 22-61) months. The mean fatigue score was 44.7 (SD, 28.0), exceeding the fatigue levels in the age- and sex-adjusted German general population (29.7); 51.3% of patients showed clinically relevant fatigue (≥ 39 points). Fatigue was inversely associated with HRQoL (ρ = - 0.59, p < 0.001), and positively with distress (ρ = 0.54, p < 0.001) and fear of cancer recurrence (ρ = 0.41, p < 0.001). Higher fatigue was found in patients with impaired performance status and in those with laryngeal and hypopharyngeal cancers. Neither cerebral OAR radiation doses nor skeletal muscle mass index was associated with fatigue, and VBA revealed no relevant subregions.

Conclusions: Clinically relevant fatigue affects about half of head and neck cancer survivors.

Implications for cancer survivors: The absence of a correlation with cerebral OAR doses suggests that other, probably multifactorial somatic, psychological and lifestyle-related factors play a more central role in the genesis of fatigue than the radiation-related brain exposures investigated.