Chronic fatigue after first-line therapy for localized prostate cancer

There are few good data on the occurrence of chronic fatigue after first-line treatment of localized prostate cancer.

Kyrdalen et al. have now published data on chronic fatigue post-treatment in > 500 Norwegian patients who were treated with radical prostatectomy (RP) or external beam radiation therapy (EBRT) for localized prostate cancer in 2004. In their study, they defined chronic fatigue (CF) as fatigue lasting for 6 months or longer. Patients who had received hormone therapy were not eligible for inclusion in this study: all patients had to be hormone-naïve.

Data from this study, based on a postal survey conducted in 2006, and including 337 prostate cancer survivors who had been treated with an RP and 184 treated with EBRT, showed that:

  • At 12 to 32 months after treatment, 45/337 RP patients (13.4 percent) and 48/184  EBRT patients (26.1 percent) reported CF.
  • For patients who received either RP or EBRT, the occurrence of CF was inversely associated with pretreatment age.
  • There was a positive association between reporting of CF and  high levels of neuroticism, post-treatment co-morbidity, pain, urinary and intestinal dysfunction, but not sexual dysfunction.

So first let us be clear what is meant by “the occurrence of CF was inversely associated with pretreatment age.” It means that the younger the patient, the greater the likelihood of reporting of chronic fatigue. At first sight, this might seem like an odd finding, but if you think about it harder it starts to make sense. Older patients are more likely to have “slowed down” in their lifestyles. They don’t expect to be able to do as much as they could at 45 or even 60. By contrast, the 45- to 55-year-old patients would consider that they should still be able to do most of what they could do at 25 years of age, so if they got tired more often (which was clearly more common among those receiving radiation therapy) they would be more likely to report this as “chronic fatigue.”

Now we should not over-interpret the data from this study. It does, however, suggest that understanding more about the association between chronic fatigue and prostate cancer treatment would be useful, and it would hardly be difficult to carry out a prospective, multi-survey study of fatigue in patients treated with first-line therapies for prostate cancer, including patient age and other factors, over a period of (say) 3 years, including a baseline, pre-treatment survey, and selective correlation of the survey results with careful patient chart reviews.

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