Identifying Patterns of Fatigue in Head and Neck Cancer Patients Post-Curative Intent Treatment

Background: Cancer-related fatigue (CRF) is a frequent and often debilitating symptom experienced by head and neck cancer (HNC) patients from diagnosis to survivorship. The trajectory and treatment of CRF is poorly understood and is inconsistently assessed by providers. Patient-reported outcomes (PRO) are an effective way to assess the progression of this symptom through the illness trajectory.

Objectives: The aim of this project was to explore and describe the characteristics of HNC patients who completed their cancer treatment with curative-intent and to improve understanding of how their reported experience of fatigue changes over time.

Methods: A retrospective, descriptive study was performed on medical records of HNC patients upon completion of curative-intent cancer treatment who were receiving palliative symptom management. Eight subjects met inclusion criteria and completed a total of 23 PRO surveys. Evidence to specifically identify PRO regarding CRF in the HNC patient population is limited, so this initial medical record review with PRO was an innovative approach to understanding the patient experience.

Findings: No discernible pattern related to post-treatment fatigue was identified given the small sample size; however, several themes were revealed, including limited documentation of fatigue discussions, symptom clusters, patient- versus provider-reported Eastern Cooperative Oncology Group (ECOG) scores, and disparities in scores between health domains of interest. Future research on CRF for HNC patients receiving treatment with curative-intent and palliative symptom management could utilize a prospective design with specific time points for survey completion. Additionally, studies could adopt one standard measure of CRF, such as the PROMIS® fatigue scale.