@shanm can you get an appointment with palliative care team to implement better pain management protocols? My husband takes HYDROmorphone 2 mg as needed every 4 hours plus a Butrans 10 mcg/hr pain patch of transdermal buprenorphine. For some reason oncologist usually defers to palliative care to manage pain - I think with opioids. The radiation pain and fatigue will slowly improve. Keytruda fatigue waxes & wanes. Hopefully your husband has some good days soon!