Fatigue trajectories during pediatric ALL therapy are associated with fatigue after treatment: a national longitudinal cohort study

Abstract

Objective Fatigue is one of the most prevalent and distressing symptoms reported by survivors of childhood cancer. There is currently a lack of longitudinal studies on cancer-related fatigue, and especially on the relationship between the course of fatigue during treatment and fatigue at follow-up. The purpose of the current study was therefore to investigate if the course of fatigue during treatment, treatment intensity, serious adverse events, sex, or age at diagnosis are associated with cancer-related fatigue after treatment. Methods Participants were 92 children and adolescents diagnosed with acute lymphoblastic leukemia (mean age at diagnosis was 6.26 years). Fatigue was measured with PedsQL multidimensional fatigue scale proxy reports 5 months after diagnosis, 12 months after diagnosis, 24 months after diagnosis, and at follow-up 12 months after end of treatment. The effect of patient and treatment characteristics on fatigue reported at follow-up was tested through logistic regression analyses. Results The course of fatigue during treatment significantly predicted fatigue reported at follow-up for general fatigue (p = .038, OR = 9.20), sleep/rest fatigue (p = .011, OR = 15.48), and cognitive fatigue (p < .001, OR = 10.78). None of the other variables were associated with fatigue at follow-up for any of the subscales. Conclusions The findings demonstrate that fatigue reported during treatment can predict fatigue at follow-up. These results stress the need for longitudinal assessments. Healthcare professionals need to be aware that pediatric patients who are fatigued during treatment need to receive additional attention and timely interventions since cancer-related fatigue will not resolve by itself in the first year after end of treatment.

Neurocognitive outcome and associated factors in long-term, adult survivors of childhood acute lymphoblastic leukemia, treated without cranial radiation therapy

“…It is possible that sex differences previously detected by Cheung et al (2017) are more salient in adolescence, in which females can be particularly vulnerable (Pfeifer & Allen, 2021). Still, our results are consistent with several other studies in the childhood cancer literature, that have reported similar levels of fatigue among males and females (Frederick et al, 2016;Irestorm et al, 2023;Zeller et al, 2014).…”

“…A prevalent (Hamre et al, 2013;van Deuren et al, 2022), distressing (Hamre et al, 2013;Kanellopoulos et al, 2013), and relatively persistent (Irestorm et al, 2023;Zeller et al, 2014) symptom in survivors of childhood ALL is fatigue. Fatigue may be described as "a sense of tiredness and lack of energy, distinct from sadness and weakness" (Krupp et al, 1988).…”

Fatigue in children who have recently completed treatment for acute lymphoblastic leukemia: a longitudinal study

“…This study did not identify any clear risk factors for ongoing fatigue in this patient population at 27-months post treatment. While these findings are in keeping with some earlier evidence indicating no age, sex, or treatment related risk factors to be present 12-months post treatment [31], alternate studies have identified age at diagnosis and female sex to be relevant to fatigue in the childhood cancer survivorship population [13,32,33]. As the current study examined the period directly following treatment completion, as opposed to patients further post-treatment, it seems possible that demographic risk factors go on to emerge further into survivorship.…”

The development of fatigue after treatment for pediatric brain tumors does not differ between tumor locations

“…We previously demonstrated that fatigue reported during treatment for acute lymphoblastic leukemia can predict the level of fatigue experienced after end of treatment. 39 It is possible that this also applies to patients after treatment for a brain tumor, and future studies should therefore investigate fatigue during treatment for this group as well.…”