Fatigue and sleep disturbance in adult survivors of childhood cancer: a report from the childhood cancer survivor study (CCSS)

Abstract

Study objective: To examine the prevalence of and risk factors for fatigue and sleep disturbance among adult survivors of childhood cancer.

Design: Retrospective cohort of childhood cancer survivors.

Setting: Twenty-six academic institutions treating childhood cancer.

Participants: Two thousand six hundred forty-five survivors of childhood acute lymphocytic leukemia, central nervous system tumors, Hodgkin lymphoma, soft-tissue sarcomas, or bone tumors diagnosed before age 21, surviving at least 5 years from diagnosis, and a 500-sibling comparison group.

Measurements: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale.

Results: Significant differences were found between survivors and siblings on the Functional Assessment of Chronic Illness Therapy-Fatigue (40.8 vs 42.0, P < 0.02), Pittsburgh Sleep Quality Index (6.1 vs 5.5, P < 0.004), and Epworth Sleepiness Scale (6.2 vs 5.4, P < 0.001). Nineteen percent of survivors were in the most fatigued range, 16.7% reported disrupted sleep, and 14% increased daytime sleepiness. Survivors with a history of radiation therapy were more likely to be fatigued (odds ratio 1.7, 95% confidence interval 1.3-2.3), yet without significantly different mean scores. Female sex, congestive heart failure, pulmonary fibrosis, depression, and being unmarried significantly predicted more fatigue, whereas obesity and an infant in the house predicted more daytime sleepiness. Similar sociodemographic predictors were also identified among the siblings.

Conclusion: Because of the large sample size, we detected more objectively reported fatigue, sleep disturbance, and daytime sleepiness among adult survivors of childhood cancer. However, the clinical significance of these differences is questionable. Predictors of fatigue and poor sleep were similar in both survivors and the siblings.

Figure 1

Mean scores on SF-36 comparing survivors and siblings with and without fatigue, sleep disturbance, and daytime sleepiness.