with fatigue during chemo- and/or radiotherapy.18 In a prospective study, the level of fatigue increased during radiotherapy without accompanying increase in depressive symptoms.19 Fatigue is also a common problem among cancer survivors. Hodgkin’s disease survivors (HDS)20–22 and breast cancer patients treated with adjuvant chemotherapy10,23 have in-creased levels of fatigue. In a recent study, we demonstrated that the prevalence of substan-tial fatigue of duration 6 months or longer was increased among HDS (26%) compared to general population controls (11%).24 Such chronic fatigue was not related to type of pri-mary treatment, and was most commonly found in subjects with disease stage IB/IIB.24 When fatigue persists after cancer cure, so-matic factors related to fatigue during active disease such as pain, nutritional status, or ane-mia are probably negligible. Empirical data on factors related to fatigue after cancer cure are scarce.16 Fobair et al. found that lacking return of energy among HDS was associated with a high score of depression, stage of the disease, and combined chemo- and radiotherapy.20 Broeckel et al. found that fatigue after adju-vant chemotherapy for breast cancer was re-lated to poorer sleep quality and presence of a current psychiatric disorder. They concluded that fatigue probably was not merely a symp-tom of psychiatric disorder.10 We have also demonstrated high levels of anxiety and low levels of depression in the HDS cohort.25 Both post-treatment anxiety and depression were re-lated to psychiatric symptoms experienced be-
fore or during treatment.25