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Severely bothersome fatigue in children and adolescents with cancer and hematopoietic stem cell transplant recipients

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Abstract

Background

Objectives were to describe bothersome fatigue in children with cancer and hematopoietic stem cell (HSCT) recipients and to identify factors associated with severely bothersome fatigue.

Methods

We included children ages 8–18 years treated for cancer or HSCT recipients from three groups: [1] receiving active cancer treatment and admitted to hospital for at least 3 days, [2] attending outpatient clinic for acute lymphoblastic leukemia maintenance therapy, and [3] attending outpatient clinic following treatment completion. Fatigue was measured using the Symptom Screening in Pediatrics Tool (SSPedi); severely bothersome fatigue was defined as a lot or extremely bothersome fatigue (score of 3–4 on 0–4 scale). Factors associated with severely bothersome fatigue were examined using univariate and multiple logistic regression.

Results

Of 502 children included, 414 (82.5%) reported some degree of bothersome fatigue (scores 1–4), and 123 (24.5%) reported severely bothersome fatigue (score 3 or 4). In multiple regression analysis, factors significantly associated with severely bothersome fatigue were child age 11–14 and 15–18 years vs 8–10 years (odds ratio (OR) 2.11, 95% confidence interval (CI) 1.21–3.77 and OR 2.96, 95% CI 1.66–5.44), and inpatients receiving cancer treatment vs outpatients who had completed therapy (OR 3.85, 95% CI 2.17–7.27).

Conclusions

We found that 82.5% of children with cancer or HSCT recipients reported bothersome fatigue and 24.5% of children reported severely bothersome fatigue. Risk factors for severely bothersome fatigue were older age and inpatients receiving active cancer treatment. Future work should evaluate systematic symptom screening in clinical practice and apply interventions to reduce fatigue.

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Acknowledgements

We are grateful for the generosity of the patients and parents who participated in this study. We wish to thank all the clinical research associates and nurses who were involved in this study at each site.

Funding

This research was funded by The Pedal for Hope Impact Grant of the Canadian Cancer Society (grant #702295). The authors have declared no conflicts of interest.

Author information

Authors and Affiliations

  1. Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada

    Deborah Tomlinson, Shannon Hyslop, L. Lee Dupuis & Lillian Sung

  2. Pediatric Hematology/Oncology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Christina Baggott

  3. Division of Hematology/Oncology/BMT, Department of Pediatrics, BC Children’s Hospital, 4480 Oak Street Room B315, Vancouver, V6H 3V4, Canada

    David Dix

  4. Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada

    Paul Gibson

  5. Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

    Donna L. Johnston

  6. Division of Pediatric Hematology/Oncology, Connecticut Children’s Medical Center, 282 Washington Street, Hartford, CT, 06106, USA

    Andrea Orsey

  7. Division of Haematology/Oncology, McMaster Children’s Hospital, Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Carol Portwine

  8. Division of Pediatric hematology/Oncology, Department of Pediatrics, IWK Health Centre, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada

    Victoria Price

  9. Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Research Institute in Oncology and Hematology, Departments of Pediatrics and Child Health and Biochemistry and Medical Genetics, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada

    Magimairajan Vanan

  10. Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, ON, M2K 1S9, Canada

    Susan Kuczynski

  11. Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Brenda Spiegler

  12. Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

    George A. Tomlinson

  13. Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    L. Lee Dupuis

  14. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada

    L. Lee Dupuis

  15. Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Lillian Sung

Authors
  1. Deborah Tomlinson
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  2. Christina Baggott
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  3. David Dix
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  4. Paul Gibson
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  5. Shannon Hyslop
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  6. Donna L. Johnston
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  7. Andrea Orsey
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  8. Carol Portwine
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  9. Victoria Price
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  10. Magimairajan Vanan
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  11. Susan Kuczynski
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  12. Brenda Spiegler
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  13. George A. Tomlinson
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  14. L. Lee Dupuis
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  15. Lillian Sung
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Corresponding author

Correspondence to Lillian Sung.

Ethics declarations

Research Ethics Board approval was obtained from the coordinating site (The Hospital for Sick Children) and all other participating sites. Child participants and their parents provided informed consent or assent as appropriate.

Conflict of interest

The authors declare that they have no conflict of interest.

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Table 3 Participating sites
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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 27, 2665–2671 (2019). https://doi.org/10.1007/s00520-018-4555-9

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  • DOI: https://doi.org/10.1007/s00520-018-4555-9

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