Prevalence and risk factors of cancer-related fatigue in childhood cancer survivors: A DCCSS LATER study

Abstract

Background: Cancer-related fatigue is a debilitating late effect after treatment for childhood cancer. The prevalence of fatigue in childhood cancer survivors (CCSs) and associated factors for fatigue has varied widely in previous studies. Two important aspects of cancer-related fatigue, its severity and chronicity, are often not assessed. This study investigated the prevalence of, and risk factors for, severe chronic fatigue (CF) in a national cohort of Dutch CCSs.

Methods: In this study, 2810 CCSs (5-year survivors of all childhood malignancies diagnosed between 1963 and 2001 with a current age of 12-65 years) and 1040 sibling controls were included. CF was assessed with the Short Fatigue Questionnaire and was defined as a score ≥ 18 and persistence of fatigue for ≥6 months. Cancer- and treatment-related characteristics, current health problems, and demographic and lifestyle variables were assessed as potential risk factors for CF via multivariable logistic regression analyses.

Results: In adult CCSs and sibling controls (≥18 years old), the prevalence of CF was 26.1% and 14.1%, respectively (P < .001). In adolescent CCSs and sibling controls (<18 years old), the prevalence of CF was 10.9% and 3.2%, respectively. Female gender (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.73-2.62), unemployment (OR, 2.18; 95% CI, 1.67-2.85), having 1 or more health problems (OR for 1-2, 1.48; 95% CI, 1.18-1.87; OR for >2, 2.20; 95% CI, 1.50-3.21), and a central nervous system diagnosis (OR, 1.74; 95% CI, 1.17-2.60) were significantly associated with CF in adult CCSs.

Conclusions: This study shows that CCSs, regardless of their cancer diagnosis, report CF more often than sibling controls. This study provides new evidence for the prevalence of fatigue in CCSs.

Keywords: cancer-related fatigue; childhood cancer survivors; late effects; survivorship.

Figure 1

Flowchart inclusion of CCSs and siblings of CCSs. CCS indicates childhood cancer survivor; DCCSS‐LATER, Dutch Childhood Cancer Survivor Late Effect Study; SFQ, Short Fatigue Questionnaire.

Figure 2

Prevalence of chronic fatigue in CCSs (n = 2810) and siblings (n = 1040) for (Left) all participants and (Right) participants separated by age at assessment (age at assessment < 18 years = adolescents; age at assessment ≥ 18 years = adults). Chronic fatigue was defined as severe (SFQ ≥ 18) and persistent fatigue (duration of complaints > 6 months). *P < .001 (χ² test). CCS indicates childhood cancer survivor; SFQ, Short Fatigue Questionnaire.

Figure 3

Prevalence of chronic fatigue per diagnosis in CCSs. Diagnostic groups were classified according to the third edition of the International Classification of Childhood Cancer. For the comparison between diagnostic groups, survivors of ALL served as the reference group. *P < .05 (χ² test); **P < .001 (χ² test). ^aCompared with siblings, all diagnostic groups except for RB were also found to have a significantly higher risk for chronic fatigue (P values < .05; multivariable logistic regression corrected for gender, age at assessment, employment status, educational level, marital status, number of health problems, current alcohol use, current smoker, and drug use in the past year). ALL indicates acute lymphoblastic leukemia; AML/CML, acute myeloid leukemia and chronic myeloid leukemia (leukemia, not acute lymphoblastic leukemia); BT, bone tumor; CCS, childhood cancer survivor; CNS, central nervous system tumor; GCT, germ cell tumor; HL, Hodgkin lymphoma; HT, hepatic tumor; NB, neuroblastoma; NHL, non‐Hodgkin lymphoma; Other, other and unspecified malignant neoplasm, including severe Langerhans cell histiocytosis; RB, retinoblastoma; RT, renal tumor; STS, soft tissue sarcoma.