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Is long-term fatigue in patients with cancer an infrequent symptom?

TO THE EDITOR: The prospective study by Goldstein et al addresses an interesting ongoing and unresolved debate regarding the effects and prevalence of cancer-related fatigue (CRF) in patients with cancer. In a cohort of women who received adjuvant treatment for early-stage breast cancer, the authors showed that CRF was a common symptom but generally ran a self-limiting course. However, some concerns might affect the generalizability of their findings. First, the reasons for exclusion from the study of 118 patients (84 patients at the time of enrollment and 34 patients after 12 months) were not described. It is possible that, among these patients, some women were too fatigued to accept being enrolled or continuing on and completing the questionnaires. In theory, this effect could explain the surprisingly low numbers of patients who suffered from CRF 1 year after the end of treatment (18 of 218 patients) and 5 years after the end of treatment (26 of 218 patients). In addition, it would be interesting to know whether fatigue was also present before treatment started (ie, were enrolled patients fatigued weeks, months, or years before the diagnosis of cancer?). In other words, it could useful to differentiate patients with fatigue closely related to cancer and/or a cancer diagnosis from patients affected by chronic fatigue and breast cancer. Moreover, the article considered only women with breast cancer. It would be interesting to compare this cohort of patients with both male and female fatigued patients affected by other malignancies like lymphomas. On the basis of these considerations, we question the generalizability of the study by Goldstein et al. If the data were available, we hypothesize that the presence and course of fatigue in this population of patients with cancer could have been underestimated within the study. Additional research is needed on this topic to better define the fatigue experienced by patients with cancer.