Symptom burden in cancer survivors 1 year after diagnosis

We read with interest the article by Shi et al1 in which 1 in 4 cancer survivors—defined as patients within 1 year of diagnosis and on treatment—showed high symptom burden, with fatigue being the main symptom and having the greatest impact on health-related quality of life. We believe that cancer survivors should be defined as patients without evidence of disease and free from specific treatment for a period of at least 5 years.2 In fact, it is conceivable that patients with active disease and/or on treatment may suffer from the fatigue associated with cancer and its treatments as well as other related causes, including anemia, endocrine and metabolic disorders, and cardiovascular and renal dysfunction (i.e., cancer-related fatigue). On the contrary, in long-term cancer survivors, fatigue has been described as a chronic/persistent condition associated with disrupting symptoms3, 4 similar to chronic fatigue syndrome (CFS).5 In fact, in these cancer patients, fatigue may appear years after the cancer diagnosis and the end of treatment. Fatigue is usually associated with postexertional malaise; sore throat; tender cervical or axillary lymph nodes; muscle pain; multijoint pain without joint swelling or redness; headaches of a new type for pattern or severity; unrefreshed sleep; and self-reported impairment of short-term memory or concentration severe enough to have a substantial impact on a patient's occupation, education, or personal activities. For these reasons, we believe that fatigue in long-term cancer survivors must be considered a subtype of CFS, and that it could be defined as CFS/cancer-related fatigue. In conclusion, we believe that in cancer patients, there are 2 kinds of fatigue that require different symptom monitoring and management: one is observed during therapy and should thus be defined as cancer-related fatigue, whereas the other is observed after therapy and thus could be defined CFS/cancer-related fatigue. Further studies should be performed in these settings to better define these 2 entities. The authors made no disclosures.