Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer

Abstract

Background Long-term survivors of childhood cancer are at risk for fatigue, sleep problems, and neurocognitive impairment, though the association between these outcomes has not been previously examined. Methods Outcomes were evaluated in 1426 survivors from the Childhood Cancer Survivor Study using a validated Neurocognitive Questionnaire. Relative risks for neurocognitive impairment were calculated using demographic and treatment factors, and survivors’ report on the FACIT-Fatigue, the Short Form-36 Vitality Scale (SF-36-V), the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS). Results Neurocognitive impairment was identified in over 20% of survivors, using sibling-based norms for comparison. Multivariable logistic regression models revealed that fatigue (RR=1.34, 1.13–1.59), daytime sleepiness (RR=1.68, 1.55–1.83), poor sleep quality (RR=1.23, 1.01–1.49) and decreased vitality (RR=1.75, 95% CI 1.33–2.30) were all associated with impaired task efficiency. Likewise, fatigue (RR=1.77, 1.23–2.55), sleepiness (RR=1.38, 1.14–1.67) and decreased vitality (RR=3.08, 1.98–4.79) were predictive of emotional regulation problems. Diminished organization was associated with increased sleepiness (RR=1.80, 1.31–2.48) and decreased vitality (RR=1.90, 1.37–2.63). Impaired memory was associated with poor sleep quality (RR=1.45, 1.19–1.76), increased sleepiness (RR=2.05, 1.63–2.58), and decreased vitality (RR=2.01, 1.42–2.86). The impact of fatigue, sleepiness, sleep quality and vitality on neurocognitive outcomes was independent of the effects of cranial radiation therapy, steroids and antimetabolite chemotherapy, sex, and current age. Conclusions Neurocognitive function in long-term survivors of childhood cancer appears particularly vulnerable to the effects of fatigue and sleep disruption. These findings suggest sleep hygiene should be emphasized among survivors, as it may provide an additional mechanism for intervention to improve neurocognitive outcomes.

Cognitive and Occupational Function in Survivors of Adolescent Cancer

“…[64][65][66] Results from a study of adult survivors of childhood cancer showed that even many years after diagnosis and therapy, survivors are significantly more likely than siblings to report poor sleep quality and score poorer on neurocognitive functioning tests. 67 …”

Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern Germany

“…Interestingly, a substantial subset of our patients reported such symptoms with no apparent concurring clinical cause. It is therefore tempting to speculate that the number of diagnosed patients and the real number of long-term cancer survivors suffering from GH-deficiency may substantially differ due to a lack of clinical awareness (47) and that at least a proportion of symptoms categorized as 'chronic fatigue syndrome', may result from undiagnosed secondary endocrine disorders (48,49). …”

Sleep complaints in survivors of pediatric brain tumors

“…Significant advances in the diagnosis and medical treatment of childhood cancers have drastically improved the life expectancy of children with brain tumors, and 5-year survival estimates currently range from 25 to 70 % depending on tumor location and histology [3,4]. While neurosurgery, intensive chemotherapy, and cranial radiation therapy (CRT) have substantially improved survival for these children [5,6], it is increasingly evident that the tumor and its treatments can contribute to a range of negative sequelae that adversely impact survivors' quality of life. A review by Rosen et al [2] found neurologic, neurobehavioral, and neuroendocrine complications to be common effects of cancer treatment in both the initial and long-term survival phases.…”