The effect of combined radiation and hormone therapy on long-term fatigue

This study examined the effect of combined radiation and hormone therapy on long-term fatigue. Researchers reported severe fatigue during and up to 4 years after treatment. Men with increased cancer markers and symptoms were more likely to report higher fatigue levels.

Radiation therapy and hormone therapy are often combined in cases of locally advanced prostate cancer (tumor protruding into nearby tissue). Men with higher PSA levels (prostate specific antigen; a protein elevated in the blood in prostate cancer), higher Gleason score (tissue samples indicating more aggressive cancer cells), or a higher tumor stage may also benefit from combined therapy.

Advances in treatments such as these have increased survival among men at higher risk of cancer recurrence. Monitoring quality of life after treatment has, therefore, become increasingly important. Fatigue is an important clinical symptom that can affect quality of life. The effect that combined radiation and hormone therapy has on long-term fatigue has not been fully investigated.

This study followed 97 men with locally advanced prostate cancer. All men received radiation therapy combined with 30 months of hormone therapy. A questionnaire measuring fatigue and its effect on quality of life was administered before and at various time points after treatment. Patients were followed for an average of 43.9 months.

Fatigue before treatment was significantly higher among men with elevated PSA levels (if PSA was more than 20 ng/ml). Higher Gleason scores (8 or above) and more bothersome cancer symptoms were also associated with higher fatigure levels. Men with a higher education level reported greater fatigue before treatment. Age did not affect fatigure scores.

Overall, the most severe fatigue was noted between 3 and 12 months after the end of radiation therapy. The most notable effect of fatigue interfering with general level of activity occurred from 1 year after the end of radiation therapy to the end of hormone therapy. Mood and the ability to concentrate worsened during the same time period. The most severe effect of fatigue on normal work activity, relations with others, and enjoyment of life was observed after the end of hormonal therapy.

Researchers concluded that men with higher PSA levels, Gleason score, and education levels are more likely to report fatigue interfering with quality of life.