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A cross-sectional study of carnitine deficiency and fatigue in pediatric cancer patients

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Abstract

Purpose

Carnitine deficiency has been found in cancer patients and has been associated with fatigue. This study aimed to explore the prevalence of carnitine deficiency in pediatric cancer patients and its relationship with fatigue and other potential contributing factors.

Methods

Children with cancer or Langerhans cell histiocytosis who were receiving treatment or had completed therapy were eligible. Patients completed the Pediatric Functional Assessment of Chronic Illness-Fatigue, the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, a numeric fatigue rating, and had carnitine levels obtained. Carnitine deficiency was defined as a total and/or free carnitine level less than normal for age or an acylcarnitine value higher than normal for age.

Results

Data from 142 children aged 8–17 were analyzed. Twenty-eight of 142 (19.7 %) had decreased total and 42.8 % (12/28) had decreased free carnitine levels. No patients had elevated acylcarnitine levels or elevated ratios. Patients with versus without carnitine deficiency differed by age (p = 0.043), treatment (p = 0.037), duration since last chemotherapy (p = 0.020), and body mass index (p = 0.010), but not fatigue, when all data were analyzed together. Yet, a negative relationship between fatigue and carnitine levels was found on a subgroup (off-therapy; fatigue worse than the norm).

Conclusion

No significant association between fatigue and carnitine level was demonstrated when data from all patients were analyzed together; however, a significant yet unexpected relationship was found for patients who completed therapy and reported elevated fatigue. Given the small sample size, these results should be interpreted with caution. Future studies to explore impact upon excessive carnitine levels are warranted.

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References

  1. Henry D, Viswanathan HN, Elkin E, Traina S, Wade S, Cella D (2008) Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer 16:791–801

    Article  PubMed  Google Scholar 

  2. Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR (2007) Cancer-related fatigue: the scale of the problem. Oncologist 12:4–10

    Article  PubMed  Google Scholar 

  3. Minton O, Richardson A, Sharpe M, Hotopf M, Stone P (2008) A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst 100:1155–1166

    Article  CAS  PubMed  Google Scholar 

  4. Morrow GR (2007) Cancer-related fatigue: causes, consequences, and management. Oncologist 12:1–3

    Article  PubMed  Google Scholar 

  5. Ryan JL, Carroll JK, Ryan EP, Mustian KM, Fiscella K, Morrow GR (2007) Mechanisms of cancer-related fatigue. Oncologist 12:22–34

    Article  CAS  PubMed  Google Scholar 

  6. Perdikaris P, Merkouris A, Patiraki E, Tsoumakas K, Vasilatou-Kosmidis E, Matziou V (2009) Evaluating cancer related fatigue during treatment according to children’s, adolescents’ and parents’ perspectives in a sample of Greek young patients. Eur J Oncol Nurs 13:399–408

    Article  PubMed  Google Scholar 

  7. Dupuis LL, Milne-Wren C, Cassidy M, Barrera M, Portwine C, Johnston DL, Silva MP, Sibbald C, Leaker M, Routh S (2010) Symptom assessment in children receiving cancer therapy: the parents’ perspective. Support Care Cancer 18:281–299

    Article  PubMed  Google Scholar 

  8. Collins JJ, Byrnes ME, Dunkel IJ, Lapin J, Nadel T, Thaler HT, Polyak T, Rapkin B, Portenoy RK (2000) The measurement of symptoms in children with cancer. J Pain Symptom Manag 19:363–377

    Article  CAS  Google Scholar 

  9. Hedayati SS (2006) Dialysis-related carnitine disorder. Semin Dial 19:323–328

    Article  PubMed  Google Scholar 

  10. Malaguarnera M (2012) Carnitine derivatives: clinical usefulness. Curr Opin Gastroenterol 28:166–176

    Article  CAS  PubMed  Google Scholar 

  11. Reuter S, Evans A (2011) Long-chain acylcarnitine deficiency in patients with chronic fatigue syndrome. Potential involvement of altered carnitine palmitoyltransferase-I activity. J Intern Med 270:76–84

    Article  CAS  PubMed  Google Scholar 

  12. Tejani A, Wasdell M, Spiwak R, Rowell G, Nathwani S (2011) Carnitine for fatigue in multiple sclerosis. Cochrane Database Syst Rev 5:CD007280–CD007280

    Google Scholar 

  13. Cruciani RA, Dvorkin E, Homel P, Malamud S, Culliney B, Lapin J, Portenoy RK, Esteban-Cruciani N (2006) Safety, tolerability and symptom outcomes associated with L-carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: a phase I/II study. J Pain Symptom Manag 32:551–559

    Article  CAS  Google Scholar 

  14. Cruciani R, Dvorkin E, Homel P, Culliney B, Malamud S, Shaiova L, Fleishman S, Lapin J, Klein E, Lesage P (2004) l-carnitine supplementation for the treatment of fatigue and depressed mood in cancer patients with carnitine deficiency: a preliminary analysis. Ann N Y Acad Sci 1033:168–176

    Article  CAS  PubMed  Google Scholar 

  15. Graziano F, Bisonni R, Catalano V, Silva R, Rovidati S, Mencarini E, Ferraro B, Canestrari F, Baldelli AM, De Gaetano A, Giordani P, Testa E, Lai V (2002) Potential role of levocarnitine supplementation for the treatment of chemotherapy-induced fatigue in non-anaemic cancer patients. Br J Cancer 86:1854–1857

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Gramignano G, Lusso MR, Madeddu C, Massa E, Serpe R, Deiana L, Lamonica G, Dessì M, Spiga C, Astara G (2006) Efficacy of l-carnitine administration on fatigue, nutritional status, oxidative stress, and related quality of life in 12 advanced cancer patients undergoing anticancer therapy. Nutrition 22:136–145

    Article  CAS  PubMed  Google Scholar 

  17. Cruciani RA, Dvorkin E, Homel P, Culliney B, Malamud S, Lapin J, Portenoy RK, Esteban-Cruciani N (2009) L-carnitine supplementation in patients with advanced cancer and carnitine deficiency: a double-blind, placebo-controlled study. J Pain Symptom Manag 37:622–631

    Article  CAS  Google Scholar 

  18. Hockenberry MJ, Hooke MC, Gregurich M, McCarthy K (2009) Carnitine plasma levels and fatigue in children/adolescents receiving cisplatin, ifosfamide, or doxorubicin. J Pediatr Hematol Oncol 31:664–669

    Article  CAS  PubMed  Google Scholar 

  19. Rogalidou M, Evangeliou A, Stiakaki E, Giahnakis E, Kalmanti M (2010) Serum carnitine levels in childhood leukemia. J Pediatr Hematol Oncol 32:e61–e69

    Article  CAS  PubMed  Google Scholar 

  20. Yaris N, Akyüz C, Coskun T, Büyükpamukçu M (2002) Serum carnitine levels of pediatric cancer patients. Pediatr Hematol Oncol 19:1–8

    Article  CAS  PubMed  Google Scholar 

  21. Lai JS, Cella D, Kupst MJ, Holm S, Kelly ME, Bode RK, Goldman S (2007) Measuring fatigue for children with cancer: development and validation of the pediatric functional assessment of chronic illness therapy-fatigue (pedsFACIT-F). J Pediatr Hematol Oncol 29:471–479

    Article  PubMed  Google Scholar 

  22. Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P (2002) The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module. Cancer 94:2090–2106

    Article  PubMed  Google Scholar 

  23. National Comprehensive Cancer Network (2010) NCCN Practice Guildlines in Oncology: Cancer-Related Fatigue v.1. www.nccn.org Accessed Date Accessed 2010 Accessed

  24. Armenian SH, Gelehrter SK, Vase T, Venkatramani R, Landier W, Wilson KD, Herrera C, Reichman L, Menteer J-D, Mascarenhas L (2014) Carnitine and cardiac dysfunction in childhood cancer survivors treated with anthracyclines. Cancer Epidemiol Biomark Prev 23:1109–1114

    Article  CAS  Google Scholar 

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Acknowledgments

Dr. Haertling’s efforts were supported by a grant from the SurvivorVision when she was on fellowship at Ann & Robert H. Lurie Children’s Hospital of Chicago. We also thank Kara Halligan, RN, for her assistance in patient recruitment and enrollment.

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Authors and Affiliations

  1. Department of Medical Social Sciences and Pediatrics, Northwestern University Feinberg School of Medicine, 633 N St Clair, 19th Floor, Chicago, IL 60611, USA

    Jin-Shei Lai

  2. Memorial Hospital of South Bend, 615 N Michigan St, South Bend, IN, 46601, USA

    Tracy Haertling

  3. Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Chicago, IL, 60611, USA

    Joanna Weinstein

  4. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA

    Alfred W. Rademaker

  5. Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA

    Stewart Goldman

Authors
  1. Jin-Shei Lai
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  2. Tracy Haertling
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  3. Joanna Weinstein
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  4. Alfred W. Rademaker
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  5. Stewart Goldman
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Corresponding author

Correspondence to Jin-Shei Lai.

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Conflict of interest statement

The authors declare that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding source

Dr. Haertling’s efforts were supported by a grant from the SurvivorVision when she was on fellowship at Ann & Robert H. Lurie Children’s Hospital of Chicago.

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Lai, JS., Haertling, T., Weinstein, J. et al. A cross-sectional study of carnitine deficiency and fatigue in pediatric cancer patients. Childs Nerv Syst 32, 475–483 (2016). https://doi.org/10.1007/s00381-015-2983-0

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  • DOI: https://doi.org/10.1007/s00381-015-2983-0

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