The Impact of Cancer-Related Fatigue on HRQOL in Survivors of Childhood Cancer: A DCCSS LATER Study

Abstract

Background: Early detection and management of late effects of treatment and their impact on health-related quality of life (HRQOL) has become a key goal of childhood cancer survivorship care. One of the most prevalent late effects is chronic fatigue (CF). The current study aimed to investigate the association between CF and HRQOL in a nationwide cohort of CCS. Methods: Participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort, a nationwide cohort of CCS. Participants completed the Checklist Individual Strength (CIS) to indicate CF (CIS fatigue severity subscale ≥ 35 and duration of symptoms ≥6 months) and the Short Form-36 (SF-36) and TNO (Netherlands Organization for Applied Scientific Research) and AZL (Leiden University Medical Centre) Adult’s Health-Related Quality of Life questionnaire (TAAQOL) as measures for HRQOL. Differences in mean HRQOL domain scores between CF and non-CF participants were investigated using independent samples t-tests and ANCOVA to adjust for age and sex. The association between CF and impaired HRQOL (scoring ≥ 2 SD below the population norm) was investigated using logistic regression analyses, adjusting for confounders. Results: A total of 1695 participants were included in the study. Mean HRQOL domain scores were significantly lower in participants with CF. In addition, CF was associated with impaired HRQOL on all of the domains (except physical functioning) with adjusted odds ratios ranging from 2.1 (95% CI 1.3–3.4; sexuality domain) to 30.4 (95% CI 16.4–56.2; vitality domain). Conclusions: CF is associated with impaired HRQOL, urging for the screening and regular monitoring of fatigue, and developing possible preventative programs and interventions.

Quality of life of adolescent and adult survivors of childhood cancer in Europe—A systematic review

“…The included articles provided data on a total of 14 342 survivors of childhood cancer. Three articles were based on data from a French cohort of survivors of leukaemia, [37][38][39] two articles were from studies in northern Italy, 19,20 two articles were based on data from a Belgian and French cohort of survivors of hematologic cancers 40,41 and five articles used data from the Dutch LATER registry, [21][22][23][24][25] with overlapping populations. All articles were screened for overlapping populations.…”

“…31 A study in Norway of 285 survivors of childhood acute lymphoblastic leukaemia and lymphoma found medium-sized differences when comparing scores in survivors with that of the general population on PF (mean, 90.1 vs 94.0, P < .001), BP (mean, 72.2 vs 79.0, P < .001), RP (mean, 75.0 vs 87.4, P < .001) and GH (mean, 64.1 vs 80.1, P < .001). 46 The main mental subdomains found to be coherent with worse QoL were SF 22,25,32,34,35,[37][38][39]46,48,51,52 and MH, 20,25,32,34,35,44,46,49,51 but several studies also found that VT 20,22,25,32,34,35,39,46,52 and RE 25,34,[37][38][39]44,48,52 35 In the five studies that reported comparably better QoL 19,40,42,43,45 among survivors of childhood cancer, both physical and mental scor...…”

“…25,31,33,34,38,39,44,46,53 Fewer studies found that the subdomain BP was coherent with worse QoL. 25,32,34,35,39,46 The size of the effect varied by subscale but was generally small, such as in a Swiss study of 1593 survivors of various childhood cancers, who reported poorer PF (mean, 49.0 vs 52.9, P < .001), RP (mean, 49.5 vs 50.4, P = .003) and GH (mean, 53.5 vs 56.6, P < .001) than siblings. 31 A study in Norway of 285 survivors of childhood acute lymphoblastic leukaemia and lymphoma found medium-sized differences when comparing scores in survivors with that of the general population on PF (mean, 90.1 vs 94.0, P < .001), BP (mean, 72.2 vs 79.0, P < .001), RP (mean, 75.0 vs 87.4, P < .001) and GH (mean, 64.1 vs 80.1, P < .001).…”

Psychosocial outcomes in long‐term Dutch adult survivors of childhood cancer: The DCCSS‐LATER 2 psycho‐oncology study

“…Although effects were mostly small, the consistency of the findings across studies may indicate that these are areas of concern for CCS. The findings may reflect that a substantial proportion of CCS experience physical late effects of cancer and its treatment, among which fatigue is common 36,37 . Also, the findings underline that some CCS may experience impaired HRQOL, and of note, fatigue appeared to be associated with impaired HRQOL in the LATER cohort 37 .…”

Auditory Complications among Childhood Cancer Survivors and Health-related Quality of Life: A PanCareLIFE study

“…20 The SF-36 is a widely used instrument; several studies used it to determine HRQoL among CCS. 12,[21][22][23][24] The questionnaire includes 36 items covering different aspects of physical and mental health aggregated into eight health domains: physical functioning (PF, 10 items), role-limitations due to physical problems (RP, 4 items), bodily pain (BP, 2 items), general health (GH, 5 items), vitality (VT, 4 items), social functioning (SF, 2 items), role-limitations due to emotional problems (RE, 3 items) and mental health (MH, 5 items). 20,25 These health domains are further collapsed into summary scores that reflect overall physical and mental health: physical component summary (PCS) and mental component summary (MCS).…”