Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update

Priya Patel^{1

2}, Paula D Robinson¹, Patrick van der Torre³, Deborah Tomlinson⁴, Jennifer Seelisch⁵, Sapna Oberoi⁶, Jessica E Morgan^{7

8}, Pamela S Hinds^{9

10}, Miriam Götte¹¹, Faith Gibson^{12

13}, Nathan Duong¹⁴, Hailey Davis¹⁴, S Nicole Culos-Reed¹⁵, Danielle Cataudella¹⁶, Vanessa Miranda^{1

17}, L Lee Dupuis^{2

4

17}, Lillian Sung^{4

18}

Affiliations

¹ Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada.
² Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
³ Sport and Exercise Center, Princess Máxima Center for Pediatric Oncology, Utrecht 3584CS, the Netherlands.
⁴ Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
⁵ Division of Hematology/Oncology, Children's Hospital London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada.
⁶ Department of Pediatrics and Child Health, Max Rady College of Medicine, CancerCare Manitoba, University of Manitoba, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada.
⁷ Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
⁸ Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds LS1 3EX, UK.
⁹ Department of Nursing Science, Professional Practice, and Quality, Children's National Health System, Washington, DC, USA.
¹⁰ Department of Pediatrics, George Washington University, 111 Michigan Ave NW, Washington, DC 20010, USA.
¹¹ University Hospital Essen, West German Cancer Center, Hufelandstraße 55, Essen 45147, Germany.
¹² Centre for Outcomes and Experiences Research in Children's Health, Illness, and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
¹³ School of Health Sciences, University of Surrey, 388 Stag Hill, Guildford GU2 7XH, UK.
¹⁴ Not Applicable (Patient Representative).
¹⁵ Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
¹⁶ Department of Pediatric Psychology, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada.
¹⁷ Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
¹⁸ Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.

PMID: 37609066
PMCID: PMC10440444
DOI: 10.1016/j.eclinm.2023.102147

Review

Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update

Priya Patel et al. EClinicalMedicine. 2023.

. 2023 Aug 10:63:102147.

doi: 10.1016/j.eclinm.2023.102147. eCollection 2023 Sep.

Authors

Affiliations

¹ Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada.
² Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
³ Sport and Exercise Center, Princess Máxima Center for Pediatric Oncology, Utrecht 3584CS, the Netherlands.
⁴ Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
⁵ Division of Hematology/Oncology, Children's Hospital London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada.
⁶ Department of Pediatrics and Child Health, Max Rady College of Medicine, CancerCare Manitoba, University of Manitoba, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada.
⁷ Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
⁸ Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds LS1 3EX, UK.
⁹ Department of Nursing Science, Professional Practice, and Quality, Children's National Health System, Washington, DC, USA.
¹⁰ Department of Pediatrics, George Washington University, 111 Michigan Ave NW, Washington, DC 20010, USA.
¹¹ University Hospital Essen, West German Cancer Center, Hufelandstraße 55, Essen 45147, Germany.
¹² Centre for Outcomes and Experiences Research in Children's Health, Illness, and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
¹³ School of Health Sciences, University of Surrey, 388 Stag Hill, Guildford GU2 7XH, UK.
¹⁴ Not Applicable (Patient Representative).
¹⁵ Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
¹⁶ Department of Pediatric Psychology, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada.
¹⁷ Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
¹⁸ Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.

PMID: 37609066
PMCID: PMC10440444
DOI: 10.1016/j.eclinm.2023.102147

Abstract

Objective was to update a clinical practice guideline (CPG) for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients. We reconvened a multi-disciplinary and multi-national panel. While the previous 2018 CPG evaluated adult and pediatric randomized controlled trials (RCTs) to manage fatigue, this 2023 update revised previous recommendations based only on pediatric RCTs. Twenty RCTs were included in the updated systematic review. Physical activity significantly reduced fatigue (standardized mean difference -0.44, 95% confidence interval -0.64 to -0.24; n = 8 RCTs). Using the 2018 recommendations as a basis, the panel continued to make strong recommendations to use physical activity, and to offer relaxation, mindfulness or both, to manage fatigue in pediatric patients. Cognitive or cognitive behavioral therapies may be offered. Pharmacological approaches should not be routinely used. The panel made a new good practice statement to routinely assess for fatigue, ideally using a validated scale.

Keywords: Fatigue; Pediatric oncology; Practice guideline.

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Conflict of interest statement

PSH received grants or research support from NIH; royalties or licenses from Lippincott; consulting fees from MSKCC and participated on the REACH Board at Nemours, Delaware. SNCR received grants from CIHR, CCS and Kids Cancer Care-IMPACT. LS is supported by the Canada Research Chair in Pediatric Oncology Supportive Care. No other authors declared a conflict of interest.

References

1. Tomlinson D., Baggott C., Dix D., et al. Severely bothersome fatigue in children and adolescents with cancer and hematopoietic stem cell transplant recipients. Support Care Cancer. 2019;27:2665–2671. - PubMed
1. Tomlinson D., Zupanec S., Jones H., O'Sullivan C., Hesser T., Sung L. The lived experience of fatigue in children and adolescents with cancer: a systematic review. Support Care Cancer. 2016;24:3623–3631. - PubMed
1. Dupuis L.L., Johnston D.L., Baggott C., et al. Validation of the symptom screening in pediatrics tool in children receiving cancer treatments. J Natl Cancer Inst. 2018;110:661–668. - PMC - PubMed
1. Oberoi S., Robinson P.D., Cataudella D., et al. Physical activity reduces fatigue in patients with cancer and hematopoietic stem cell transplant recipients: a systematic review and meta-analysis of randomized trials. Crit Rev Oncol Hematol. 2018;122:52–59. - PubMed
1. Duong N., Davis H., Robinson P.D., et al. Mind and body practices for fatigue reduction in patients with cancer and hematopoietic stem cell transplant recipients: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2017;120:210–216. - PubMed

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Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update

Affiliations

Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

LinkOut - more resources

Full Text Sources