We thank Drs. Giacalone and Tirelli for their interest in our report.1 They cite Simonelli et al2 in suggesting that the term “cancer survivor” should be applied only to “patients without evidence of disease and free from specific treatment for a period of at least 5 years,” a definition that differs from the one used in our report. We used the definition provided by the National Cancer Institute's Office of Cancer Survivorship, which defines survivorship as beginning at diagnosis and continuing through the balance of the patient's life.3 This definition has been applied to estimate the number of cancer survivors in the United States.3 We focused specifically on the 1-year postdiagnosis time point because it is likely to be an especially stressful time for cancer patients, who face persistent symptom burden, the uncertainty of treatment outcomes, fear of recurrence, and change in socioeconomic status. The goal of our report was to profile symptom burden at this time point and emphasize the necessity of symptom control during early survivorship, which might benefit later survivorship, including survival 5 years posttreatment as mentioned by Drs. Giacalone and Tirelli.
We agree that during the early stage of survivorship, fatigue is associated with cancer and its treatment. Current reports have associated fatigue in both short-term and long-term survivors with cytokine dysregulation, suggesting the similarity of fatigue in patients with active disease and/or treatment and in long-term cancer survivors.4
As Drs. Giacalone and Tirelli suggest, further etiological and pathophysiological studies are needed to address whether fatigue in long-term cancer survivors should be considered a subtype of chronic fatigue syndrome and whether it should be treated differently from cancer-related fatigue. Nevertheless, our point remains: whether the patient has just been diagnosed with cancer, has just finished treatment, or is a long-time survivor, fatigue can be an extremely debilitating problem that should be monitored routinely and addressed appropriately.