TY - JOUR
T1 - Longitudinal development of fatigue after treatment for childhood cancer
T2 - a national cohort study
AU - Irestorm, Elin
AU - van Gorp, Marloes
AU - Twisk, Jos
AU - Nijhof, Sanne
AU - de Bont, Judith
AU - Grootenhuis, Martha
AU - van Litsenburg, Raphaele
N1 - Funding Information: Dr Elin Irestorm is the receiver of a grant from the Swedish Research Council [grant number 2021-00328]. The study was funded by the Children Cancer Free Foundation [grant number 416]. We acknowledge the efforts of the KLIK-team at the Princess Máxima Centrum for Childhood Oncology, for their dedicated work with implementing KLIK in clinical practice. Publisher Copyright: © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2023
Y1 - 2023
N2 - Background: Fatigue is a distressing and prevalent long-term sequela of treatment for childhood cancer, and there is a need for longitudinal studies to investigate the development of fatigue over time. The objective of this study was to calculate growth-curves for the longitudinal development of fatigue after treatment for childhood cancer, and to investigate the effects of biopsychosocial predictors. Materials and methods: Participants were recruited from a patient monitoring program and data extracted from medical records. Parent-proxy and self-report versions of PedsQL TM Multidimensional Fatigue Scale were used to repeatedly assess fatigue up to 5 years after the end of treatment for childhood cancer. Fatigue was assessed 2440 times for 761 participants (median:3) with proxy-reports (age 2–8 years) and 2657 times for 990 participants with self-reports (above 8 years) (median:2). Mixed models were used to establish growth-curves and to analyze the effect of predictors separately for participants with solid tumors (ST), hemato-oncological malignancies and central nervous system-tumors (CNS). Results: CNS-tumors were associated with more cognitive fatigue than ST at the end of treatment, for both proxy-reports (−11.30, p<.001) and self-reports (−6.78, p=.002), and for proxy-reports of general fatigue (−6.78, p=.002). The only significant difference in change over time was for self-reports of sleep-rest fatigue. The raw scores for the CNS-group decreased with −0.87 per year (95% CI −1.64; −0.81, p=.031) compared to the ST-group. Parental distress was overall the variable most associated with increased fatigue, while immunotherapy was the most frequent medical predictor. National centralization of childhood cancer care decreased fatigue for the CNS-group, but not for other diagnoses. Discussion: Children and adolescents treated for CNS-tumors reported more fatigue than other participants after the end of treatment, and this difference remained over time. Results from this study may help to facilitate the early recognition of children with insufficient recovery of fatigue symptoms.
AB - Background: Fatigue is a distressing and prevalent long-term sequela of treatment for childhood cancer, and there is a need for longitudinal studies to investigate the development of fatigue over time. The objective of this study was to calculate growth-curves for the longitudinal development of fatigue after treatment for childhood cancer, and to investigate the effects of biopsychosocial predictors. Materials and methods: Participants were recruited from a patient monitoring program and data extracted from medical records. Parent-proxy and self-report versions of PedsQL TM Multidimensional Fatigue Scale were used to repeatedly assess fatigue up to 5 years after the end of treatment for childhood cancer. Fatigue was assessed 2440 times for 761 participants (median:3) with proxy-reports (age 2–8 years) and 2657 times for 990 participants with self-reports (above 8 years) (median:2). Mixed models were used to establish growth-curves and to analyze the effect of predictors separately for participants with solid tumors (ST), hemato-oncological malignancies and central nervous system-tumors (CNS). Results: CNS-tumors were associated with more cognitive fatigue than ST at the end of treatment, for both proxy-reports (−11.30, p<.001) and self-reports (−6.78, p=.002), and for proxy-reports of general fatigue (−6.78, p=.002). The only significant difference in change over time was for self-reports of sleep-rest fatigue. The raw scores for the CNS-group decreased with −0.87 per year (95% CI −1.64; −0.81, p=.031) compared to the ST-group. Parental distress was overall the variable most associated with increased fatigue, while immunotherapy was the most frequent medical predictor. National centralization of childhood cancer care decreased fatigue for the CNS-group, but not for other diagnoses. Discussion: Children and adolescents treated for CNS-tumors reported more fatigue than other participants after the end of treatment, and this difference remained over time. Results from this study may help to facilitate the early recognition of children with insufficient recovery of fatigue symptoms.
KW - Childhood cancer
KW - fatigue
KW - long-term effects
KW - longitudinal
KW - patient reported-outcomes
UR - http://www.scopus.com/inward/record.url?scp=85169902245&partnerID=8YFLogxK
U2 - https://doi.org/10.1080/0284186X.2023.2254477
DO - https://doi.org/10.1080/0284186X.2023.2254477
M3 - Article
C2 - 37676687
SN - 0284-186X
VL - 62
SP - 1309
EP - 1321
JO - Acta Oncologica
JF - Acta Oncologica
IS - 10
ER -