Abstract:Cancer‐related fatigue (CRF) is a symptom associated with cancer and cancer treatment. The incidence of CRF during radiotherapy is extremely high and severely affects the quality of life and treatment compliance of patients. Although more and more studies on CRF have been carried out, the pathogenesis of CRF caused by radiotherapy is still not well understood, and systemic interventions remain to be improved. In this article, the pathogenesis, influencing factors, and interventions of CRF caused by radiotherapy were reviewed, aiming to provide reference for optimizing treatment options in clinical practice.
Mao Yuxin,Huang Xu,Wang Chunbo. Research progress on cancer‐related fatigue induced by radiotherapy[J]. Chinese Journal of Radiation Oncology, 2023, 32(3): 276-280.
[1] Berger AM, Mooney K, Alvarez-Perez A, et al.Cancer-related fatigue, version 2.2015[J]. Natl Compr Canc Netw, 2015,13(8):1012-1039. DOI:10.6004/jnccn.2015.0122. [2] O'Higgins CM, Brady B, O'Connor B, et al. The pathophysiology of cancer-related fatigue: current controversies[J]. Support Care Cancer, 2018,26(10):3353-3364. DOI: 10.1007/s00520-018-4318-7. [3] Xiao CH, Beitler JJ, Higgins KA, et al.Fatigue is associated with inflammation in patients with head and neck cancer before and after intensity-modulated radiation therapy[J]. Brain Behav Immun, 2016,52:145-152. DOI: 10.1016/j.bbi.2015.10.016. [4] Xiao C, Miller AH, Felger J, et al.Depressive symptoms and inflammation are independent risk factors of fatigue in breast cancer survivors[J]. Psychol Med, 2017,47(10):1733-1743. DOI: 10.1017/S0033291717000150. [5] Wang XS, Shi Q, Williams LA, et al.Inflammatory cytokines are associated with the development of symptom burden in patients with NSCLC undergoing concurrent chemoradiation therapy[J]. Brain Behav Immun, 2010,24(6):968-974. DOI: 10.1016/j.bbi.2010.03.009. [6] Bower JE, Ganz PA, Irwin MR, et al.Fatigue and gene expression in human leukocytes: increased NF-κB and decreased glucocorticoid signaling in breast cancer survivors with persistent fatigue[J]. Brain Behav Immun, 2011,25(1):147-150. DOI: 10.1016/j.bbi.2010.09.010. [7] Feng LR, Fernández-Martínez JL, Zaal K, et al.mGluR5 mediates post-radiotherapy fatigue development in cancer patients[J]. Transl Psychiatry, 2018,8(1):110. DOI: 10.1038/s41398-018-0161-3. [8] Feng LR, Suy S, Collins SP, et al.The role of TRAIL in fatigue induced by repeated stress from radiotherapy[J]. J Psychiatr Res, 2017,91:130-138. DOI: 10.1016/j.jpsychires.2017.03.012. [9] Bower JE, Ganz PA, Aziz N, et al.T-cell homeostasis in breast cancer survivors with persistent fatigue[J]. J Natl Cancer Inst, 2003,95(15):1165-1168. DOI: 10.1093/jnci/djg0019. [10] Xiao C, Beitler JJ, Higgins KA, et al.Associations among human papillomavirus, inflammation, and fatigue in patients with head and neck cancer[J]. Cancer, 2018,124(15):3163-3170. DOI: 10.1002/cncr.31537. [11] Black DS, Cole SW, Christodoulou G, et al.Genomic mechanisms of fatigue in survivors of colorectal cancer[J]. Cancer, 2018,124(12):2637-2644. DOI: 10.1002/cncr.31356. [12] Fukushima T, Nakano J, Ishii S, et al.Influence of hemoglobin level on muscle and physical functions, activities of daily living, and quality of life in patients with hematological malignancies[J]. Integr Cancer Ther, 2019,18:1534735419842196. DOI: 10.1177/1534735419842196. [13] Yang SW, Chu SF, Gao Y, et al. A narrative review of cancer-related fatigue (CRF) andits possible pathogenesis[J]. Cells, 2019,8(7)DOI: 10.3390/cells8070738. [14] Feng LR, Wolff BS, Liwang J, et al.Cancer-related fatigue during combined treatment of androgen deprivation therapy and radiotherapy is associated with mitochondrial dysfunction[J]. Int J Mol Med, 2020,45(2):485-496. DOI: 10.3892/ijmm.2019.4435. [15] Hsiao CP, Araneta M, Wang XM, et al.The association of IFI27 expression and fatigue intensification during localized radiation therapy: implication of a para-inflammatory bystander response[J]. Int J Mol Sci, 2013,14(8):16943-16957. DOI: 10.3390/ijms140816943. [16] 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 German Hodgkin Study Group[J]. Lancet Oncol, 2016,17(10):1453-1462. DOI: 10.1016/S1470-2045(16)30093-6. [17] 中华医学会肿瘤学分会肿瘤支持康复治疗学组.中国癌症相关性疲乏临床实践诊疗指南(2021年版)[J]. 中国癌症杂志,2021,31(9):852-872. DOI: 10.19401/j.cnki.1007-3639.2021.09.012. Tumor Support and Rehabilitation Therapy Group, the Oncology Committee of Chinese Medical Association. Clinical practice guidelines for cancer-related fatigue in China (2021 edition)[J]. China Oncology, 2021, 31(9): 852-872. DOI: 10.19401/j.cnki.1007-3639.2021.09.012. [18] Taunk NK, Haffty BG, Chen S, et al.Comparison of radiation-induced fatigue across 3 different radiotherapeutic methods for early stage breast cancer[J]. Cancer, 2011,117(18):4116-4124. DOI: 10.1002/cncr.26013. [19] Andrykowski MA, Donovan KA, Laronga C, et al.Prevalence, predictors, and characteristics of off-treatment fatigue in breast cancer survivors[J]. Cancer, 2010,116(24):5740-5748. DOI: 10.1002/cncr.25294. [20] MD Anderson Head Neck Cancer Symptom Working Group. Fatigue following radiation therapy in nasopharyngeal cancer survivors: a dosimetric analysis incorporating patient report and observer rating[J]. Radiother Oncol, 2019,133:35-42. DOI: 10.1016/j.radonc.2018.12.023. [21] LaRiviere MJ, Chao HH, Doucette A, et al. Factors associated with fatigue in patients with breast cancer undergoing external beam radiation therapy[J]. Pract Radiat Oncol, 2020,10(6):409-422. DOI: 10.1016/j.prro.2020.05.011. [22] Reidunsdatter RJ, Rannestad T, Frengen J, et al.Early effects of contemporary breast radiation on health-related quality of life -predictors of radiotherapy-related fatigue[J]. Acta Oncol, 2011,50(8):1175-1182. DOI: 10.3109/0284186X.2011.604345. [23] Bower JE.The role of neuro-immune interactions in cancer-related fatigue: Biobehavioral risk factors and mechanisms[J]. Cancer, 2019,125(3):353-364. DOI: 10.1002/cncr.31790. [24] Mustian KM, Alfano CM, Heckler C, et al.Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis[J]. JAMA Oncol, 2017,3(7):961-968. DOI: 10.1001/jamaoncol.2016.6914. [25] Hilfiker R, Meichtry A, Eicher M, et al.Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis[J]. Br J Sports Med, 2018,52(10):651-658. DOI: 10.1136/bjsports-2016-096422. [26] Lipsett A, Barrett S, Haruna F, et al.The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: a systematic review and meta-analysis[J]. Breast, 2017,32:144-155. DOI: 10.1016/j.breast.2017.02.002. [27] Huang X, Zhang QY, Kang XM, et al.Factors associated with cancer-related fatigue in breast cancer patients undergoing endocrine therapy in an urban setting: a cross-sectional study[J]. BMC Cancer, 2010,10:453. DOI: 10.1186/1471-2407-10-453. [28] Schmidt ME, Meynköhn A, Habermann N, et al.Resistance exercise and inflammation in breast cancer patients undergoing adjuvant radiation therapy: mediation analysis from a randomized, controlled intervention trial[J]. Int J Radiat Oncol Biol Phys, 2016,94(2):329-337. DOI: 10.1016/j.ijrobp.2015.10.058. [29] Dong B, Xie CY, Jing XC, et al.Yoga has a solid effect on cancer-related fatigue in patients with breast cancer: a meta-analysis[J]. Breast Cancer Res Treat, 2019,177(1):5-16. DOI: 10.1007/s10549-019-05278-w. [30] Chandwani KD, Perkins G, Nagendra HR, et al.Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy[J]. J Clin Oncol, 2014,32(10):1058-1065. DOI: 10.1200/JCO.2012.48.2752. [31] Ben-Josef AM, Chen J, Wileyto P, et al.Effect of Eischens yoga during radiation therapy on prostate cancer patient symptoms and quality of life: a randomized phase II trial[J]. Int J Radiat Oncol Biol Phys, 2017,98(5):1036-1044. DOI: 10.1016/j.ijrobp.2017.03.043. [32] Lopez G, Liu WL, Milbury K, et al.The effects of oncology massage on symptom self-report for cancer patients and their caregivers[J]. Support Care Cancer, 2017,25(12):3645-3650. DOI: 10.1007/s00520-017-3784-7. [33] Tomlinson D, Robinson PD, Oberoi S, et al.Pharmacologic interventions for fatigue in cancer and transplantation: a meta-analysis[J]. Curr Oncol, 2018,25(2):e152-e167. DOI: 10.3747/co.25.3883. [34] Chow R, Bruera E, Sanatani M, et al.Cancer-related fatigue-pharmacological interventions: systematic review and network meta-analysis[J]. BMJ Support Palliat Care, 2021,DOI: 10.1136/bmjspcare-2021-003244. [35] Thekdi SM, Trinidad A, Roth A.Psychopharmacology in cancer[J]. Curr Psychiatry Rep, 2015,17(1):529. DOI: 10.1007/s11920-014-0529-x. [36] Yennurajalingam S, Frisbee-Hume S, Palmer JL, et al.Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer[J]. J Clin Oncol, 2013,31(25):3076-3082. DOI: 10.1200/JCO.2012.44.4661.