Cognitive fatigue in relation to depressive symptoms after treatment for childhood cancer

Abstract

Background: Cognitive fatigue after childhood cancer is frequently overlooked despite guidelines recommending follow-up, and might be mistaken for depression due to overlapping symptoms. Our objectives were: 1) to examine ratings of fatigue in survivors of paediatric brain tumours (BT) and acute lymphoblastic leukaemia (ALL) compared to healthy controls, 2) to examine the relationship between symptoms of depression and cognitive fatigue, and 3) to evaluate parent-child concordance in ratings of cognitive fatigue. Methods: Survivors of BT (n = 30), survivors of ALL (n = 30), and healthy controls (n = 60) aged 8-18 years completed the Pediatric Quality of Life Multidimensional Fatigue Scale and the Beck Youth Inventories. Associations between cognitive fatigue, diagnosis and depression were assessed with general linear modelling. Group differences were analysed using the Kruskal-Wallis test. Parent-child concordance was investigated with internal consistency reliability. Results: Cognitive fatigue was prevalent in 70% of survivors of BT survivors and in 30% of survivors of ALL. Diagnosis was the main predictor of cognitive fatigue (p < .001, η p 2 = 0.178), followed by depression (p = .010, η p 2 = 0.080). Survivors of BT reported significantly more fatigue than healthy controls on all fatigue subscales. While they also expressed more symptoms of depression, we found no evidence for an interaction effect. Parent-child concordance was moderate to good among survivors, but poor for controls. Conclusions: Survivors of BT and ALL suffer from cognitive fatigue, with survivors of BT expressing more problems. Cognitive fatigue and depression should be assessed in survivors of childhood cancer using both self-rated and proxy-rated measures, and appropriate interventions offered.

Can National Tests from the Last Year of Compulsory School Be Used to Obtain More Detailed Information about Academic Performance in Children Treated for Brain Tumours? A Nationwide, Population-Based Study from Sweden

“…National tests are mandatory, and there may be different explanations for the higher frequency of missing information among PBTS. Mental fatigue is a common problem for PBTS [ 24 , 25 ], and this may affect their capacity to participate in the national tests, which are time-consuming and may require substantial effort. Another explanation for the missing information could be that PBTS generally have high school absences [ 26 , 27 , 28 ] and, therefore, happened to be absent at the time of the tests.…”

Cognitive Fatigue and Processing Speed in Children Treated for Brain Tumours

“…Survivors rated themselves to have more cognitive fatigue as compared to general fatigue and sleep/rest fatigue (M = 48.43, SD = 26.80). Cognitive fatigue scores were poor when compared to those reported in healthy controls in Swedish (M = 76.04, SD = 14.75) and Dutch (M = 76.46, SD = 14.53) samples (Gordijn, Cremers, Kaspers, & Gemke, 2011;Irestorm et al, 2020). Impairment on the fatigue subscales was defined as a score below the 10 th percentile of healthy children and adolescents.…”

“…Cognitive fatigue in children has been investigated in relation to multiple sclerosis (Goretti et al, 2012), traumatic brain injuries (de Kloet et al, 2015), cancer (Meeske, Katz, Palmer, Burwinkle, & Varni, 2004;Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002), sickle cell disease (Panepinto et al, 2014), and rheumatic diseases (Varni, Burwinkle, & Szer, 2004). Survivors of paediatric brain tumours have been shown to suffer from more cognitive fatigue compared to survivors of leukaemia (Irestorm, Tonning Olsson, Johansson, & Ora, 2020;Meeske et al, 2004;Mulrooney et al, 2008). While most follow-up protocols after cancer treatment do not yet include measurements of fatigue, there is an increased demand for including it in followup protocols for survivors of both paediatric and adult cancer (Berger, Mitchell, Jacobsen, & Pirl, 2015;Irestorm et al, 2020;Limond et al, 2020;Tomlinson et al, 2013).…”

“…Survivors of paediatric brain tumours have been shown to suffer from more cognitive fatigue compared to survivors of leukaemia (Irestorm, Tonning Olsson, Johansson, & Ora, 2020;Meeske et al, 2004;Mulrooney et al, 2008). While most follow-up protocols after cancer treatment do not yet include measurements of fatigue, there is an increased demand for including it in followup protocols for survivors of both paediatric and adult cancer (Berger, Mitchell, Jacobsen, & Pirl, 2015;Irestorm et al, 2020;Limond et al, 2020;Tomlinson et al, 2013). Cancer-related fatigue has consistently been found to be one of the most prevalent and distressing symptoms in childhood cancer survivors (Kanellopoulos, Hamre, Dahl, Fossa, & Ruud, 2013;Meeske, Patel, Palmer, Nelson, & Parow, 2007;Spathis et al, 2015).…”

Psychopathological outcomes and defence mechanisms in clinically healed adults with a paediatric cancer history: an exploratory study

“…According to the data reported in the meta-analysis by Swartzman et al 6 , cancer survivors seem to have 1.66 times the odds of post-traumatic stress disorder (PTSD) compared with controls who did not have cancer, but it would seem that the prevalence of adjustment disorder among cancer survivors exceeds that of PTSD, with a prevalence equal to 12.4%. 7 Other studies have found an increase in cognitive fatigue and depressive symptoms in childhood cancer survivors 8 and a considerable percentage is affected by suicide ideation decades after having survived cancer. 9 Comparatively, few descriptions exist of positive psychosocial factors after cancer, even though it has been shown that more than 80% of survivors of childhood cancer report at least one positive consequence of this experience.…”