Chronic fatigue in childhood cancer survivors is associated with lifestyle and psychosocial factors; a DCCSS LATER study

A Penson; I Walraven; E Bronkhorst; M A Grootenhuis; H Maurice-Stam; I de Beijer; M van der Heiden-van der Loo; W J E Tissing; H J H van der Pal; A C H de Vries; D Bresters; C M Ronckers; M M van den Heuvel-Eibrink; S Neggers; B A B Versluys; M Louwerens; S M F Pluijm; N Blijlevens; E van Dulmen-den Broeder; L C M Kremer; H Knoop; J Loonen; Dutch LATER study group

doi:10.1016/j.esmoop.2023.102044

Chronic fatigue in childhood cancer survivors is associated with lifestyle and psychosocial factors; a DCCSS LATER study

ESMO Open. 2023 Dec;8(6):102044. doi: 10.1016/j.esmoop.2023.102044. Epub 2023 Nov 2.

Authors

A Penson¹, I Walraven², E Bronkhorst², M A Grootenhuis³, H Maurice-Stam³, I de Beijer³, M van der Heiden-van der Loo³, W J E Tissing⁴, H J H van der Pal³, A C H de Vries⁵, D Bresters³, C M Ronckers⁶, M M van den Heuvel-Eibrink⁷, S Neggers⁸, B A B Versluys³, M Louwerens⁹, S M F Pluijm³, N Blijlevens¹⁰, E van Dulmen-den Broeder¹¹, L C M Kremer¹², H Knoop¹³, J Loonen¹⁰; Dutch LATER study group

Affiliations

¹ Radboud University Medical Center, Center of Expertise for Cancer Survivorship, Department of Hematology, Nijmegen. Electronic address: adriaan.penson@radboudumc.nl.
² Department for Health Evidence, Radboud University Medical Center, Nijmegen.
³ Princess Máxima Center for Pediatric Oncology, Utrecht.
⁴ Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen.
⁵ Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands.
⁶ Princess Máxima Center for Pediatric Oncology, Utrecht; Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
⁷ Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands; Wilhelmina Children's Hospital, UMCU, Utrecht.
⁸ Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Medicine, Section Endocrinology, Erasmus Medical Center, Rotterdam.
⁹ Leiden University Medical Center, Department of Internal Medicine, Leiden.
¹⁰ Radboud University Medical Center, Center of Expertise for Cancer Survivorship, Department of Hematology, Nijmegen.
¹¹ Department of Pediatric Oncology/Hematology, Amsterdam University Medical Center, Amsterdam.
¹² Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology, Emma Children's Hospital, University of Amsterdam, Amsterdam.
¹³ Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

Abstract

Background: The purpose of this study was to determine factors associated with chronic fatigue (CF) in childhood cancer survivors (CCS).

Patients and methods: Participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort, a nationwide cohort of CCS (≥5 years after diagnosis) and siblings as controls. Fatigue severity was assessed with the 'fatigue severity subscale' of the Checklist Individual Strength ('CIS-fatigue'). CF was defined as scoring ≥35 on the 'CIS-fatigue' and having fatigue symptoms for ≥6 months. Twenty-four parameters were assessed, categorized into assumed fatigue triggering, maintaining and moderating factors. Multivariable logistic regression analyses were carried out to investigate the association of these factors with CF.

Results: A total of 1927 CCS participated in the study (40.7% of invited cohort), of whom 23.6% reported CF (compared with 15.6% in sibling controls, P < 0.001). The following factors were associated with CF: obesity [versus healthy weight, odds ratio (OR) 1.93; 95% confidence interval (CI) 1.30-2.87], moderate physical inactivity (versus physical active, OR 2.36; 95% CI 1.67-3.34), poor sleep (yes versus no, OR 2.03; 95% CI 1.54-2.68), (sub)clinical anxiety (yes versus no, OR 1.55; 95% CI 1.10-2.19), (sub)clinical depression (yes versus no, OR 2.07; 95% CI 1.20-3.59), pain (continuous, OR 1.49; 95% CI 1.33-1.66), self-esteem (continuous, OR 0.95; 95% CI 0.92-0.98), helplessness (continuous, OR 1.13; 95% CI 1.08-1.19), social functioning (continuous, OR 0.98; 95% CI 0.97-0.99) and female sex (versus male sex, OR 1.79; 95% CI 1.36-2.37).

Conclusion: CF is a prevalent symptom in CCS that is associated with several assumed maintaining factors, with lifestyle and psychosocial factors being the most prominent. These are modifiable factors and may therefore be beneficial to prevent or reduce CF in CCS.

Keywords: childhood cancer; chronic fatigue; late effects; survivorship.

MeSH terms

Cancer Survivors*
Child
Depression / epidemiology
Depression / etiology
Fatigue Syndrome, Chronic* / psychology
Female
Humans
Life Style
Male
Neoplasms* / complications
Neoplasms* / epidemiology
Quality of Life
Sleep Wake Disorders*