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Penson A, Walraven I, Bronkhorst E, Grootenhuis MA, Maurice-Stam H, Loo MVDHVD, Tissing WJE, van der Pal HJH, de Vries ACH, Bresters D, Ronckers CM, van den Heuvel-Eibrink MM, Neggers S, Versluys BAB, Louwerens M, Pluijm SMF, Blijlevens N, van Dulmen-den Broeder E, Kremer LCM, Knoop H, Loonen J. Different subtypes of chronic fatigue in childhood cancer survivors: A DCCSS LATER study. Pediatr Blood Cancer 2024; 71:e30951. [PMID: 38556733 DOI: 10.1002/pbc.30951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The aim of the current study was to investigate whether subtypes of chronic fatigue (CF) can be identified in childhood cancer survivors (CCS), and if so, to determine the characteristics of participants with a specific subtype. METHODS Participants were included from the nationwide DCCSS LATER cohort. The Checklist Individual Strength (CIS) was completed to assess fatigue. Participants with CF (scored ≥35 on the fatigue severity subscale and indicated to suffer from fatigue for ≥6 months) were divided into subgroups using two-step cluster analysis based on the CIS concentration, motivation, and physical activity subscales. Differences between groups on demographics, psychosocial, lifestyle, and treatment-related variables were determined using ANOVA and chi-square analyses (univariable) and multinomial regression analysis (multivariable). RESULTS A total of 1910 participants participated in the current study (n = 450 with CF; n = 1460 without CF). Three CF subgroups were identified: Subgroup 1 (n = 133, 29% of participants) had CF with problems in physical activity; Subgroup 2 (n = 111, 25% of participants) had CF with difficulty concentrating; and Subgroup 3 (n = 206, 46% of participants) had multi-dimensional CF. Compared to Subgroup 1, Subgroup 2 more often reported sleep problems, limitations in social functioning, and less often have more than two comorbidities. Subgroup 3 more often reported depression, sleep problems, a lower self-esteem, and limitations in social functioning and a lower educational level compared to Subgroup 1. CONCLUSION Different subgroups of CCS with CF can be identified based on fatigue dimensions physical activity, motivation and concentration. Results suggest that different intervention strategies, tailored for each subgroup, might be beneficial.
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Affiliation(s)
- Adriaan Penson
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | | | - Andrica C H de Vries
- Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sebastian Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Medicine, section Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Nicole Blijlevens
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jacqueline Loonen
- Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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Röttgering JG, Taylor JW, Brie M, Luks T, Hervey-Jumper SL, Phan S, Bracci PM, Smith E, De Witt Hamer PC, Douw L, Weyer-Jamora C, Klein M. Understanding the association between fatigue and neurocognitive functioning in patients with glioma: A cross-sectional multinational study. Neurooncol Pract 2024; 11:284-295. [PMID: 38737609 PMCID: PMC11085845 DOI: 10.1093/nop/npae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Fatigue and neurocognitive impairment are highly prevalent in patients with glioma, significantly impacting health-related quality of life. Despite the presumed association between these two factors, evidence remains sparse. Therefore, we aimed to investigate this relationship using multinational data. Methods We analyzed data on self-reported fatigue and neurocognitive outcomes from postoperative patients with glioma from the University of California San Francisco (n = 100, UCSF) and Amsterdam University Medical Center (n = 127, Amsterdam UMC). We used multiple linear regression models to assess associations between fatigue and seven (sub)domains of neurocognitive functioning and latent profile analysis to identify distinct patterns of fatigue and neurocognitive functioning. Results UCSF patients were older (median age 49 vs. 43 years, P = .002), had a higher proportion of grade 4 tumors (32% vs. 18%, P = .03), and had more neurocognitive deficits (P = .01). While the number of clinically fatigued patients was similar between sites (64% vs. 58%, P = .12), fatigue and the number of impaired neurocognitive domains were not correlated (P = .16-.72). At UCSF, neurocognitive domains were not related to fatigue, and at Amsterdam UMC attention and semantic fluency explained only 4-7% of variance in fatigue. Across institutions, we identified four distinct patterns of neurocognitive functioning, which were not consistently associated with fatigue. Conclusions Although individual patients might experience both fatigue and neurocognitive impairment, the relationship between the two is weak. Consequently, both fatigue and neurocognitive functioning should be independently assessed and treated with targeted therapies.
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Affiliation(s)
- Jantine G Röttgering
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, The Netherlands
| | - Jennie W Taylor
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Melissa Brie
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, California, USA
| | - Tracy Luks
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Stephanie Phan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Ellen Smith
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Philip C De Witt Hamer
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam, The Netherlands
| | - Linda Douw
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam, The Netherlands
| | - Christina Weyer-Jamora
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, California, USA
| | - Martin Klein
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Brain Tumor Center Amsterdam, The Netherlands
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Deng WH, Zürcher SJ, Schindera C, Jung R, Hebestreit H, Bänteli I, Bologna K, von der Weid NX, Kriemler S, Rueegg CS. Effect of a 1-year physical activity intervention on quality of life, fatigue, and distress in adult childhood cancer survivors-A randomized controlled trial (SURfit). Cancer 2024; 130:1869-1883. [PMID: 38315522 DOI: 10.1002/cncr.35207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/24/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Childhood cancer survivors (CCS) are at risk of experiencing lower quality-of-life, fatigue, and depression. Few randomized controlled trials have studied the effect of physical activity (PA) on these in adult long-term CCS. This study investigated the effect of a 1-year individualized PA intervention on health-related quality-of-life (HRQOL), fatigue, and distress symptoms in adult CCS. METHODS The SURfit trial randomized 151 CCS ≥16 years old, <16 at diagnosis and ≥5 years since diagnosis, identified through the Swiss Childhood Cancer Registry. Intervention participants received personalized PA counselling to increase intense PA by ≥2.5 h/week for 1 year. Controls maintained usual PA levels. The authors assessed physical- and mental-HRQOL, fatigue, and distress symptoms at baseline, 3, 6, and 12 months. T-scores were calculated using representative normative populations (mean = 50, standard deviation = 10). Generalized linear mixed-effects models with intention-to-treat (ITT, primary), and three per-protocol allocations were used. RESULTS At 12 months, ITT (-3.56 larger decrease, 95% confidence interval -5.69 to -1.43, p = .001) and two per-protocol analyses found significantly lower fatigue. Physical-HRQOL improved significantly in two per-protocol analyses at 12 months. No other effects were found. CONCLUSION SURfit showed that increased intense PA over 1 year improved fatigue in adult CCS. Survivors should be recommended PA to reduce the burden of late-effects.
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Affiliation(s)
- Wei H Deng
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Simeon J Zürcher
- Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christina Schindera
- Department of Pediatric Hematology and Oncology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ruedi Jung
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Helge Hebestreit
- Pediatric Department, University Hospital, Julius-Maximilians University, Würzburg, Germany
| | - Iris Bänteli
- Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Katja Bologna
- Pediatric Department, Children's Hospital of Eastern Switzerland, St.Gallen, Switzerland
| | - Nicolas X von der Weid
- Department of Pediatric Hematology and Oncology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Corina S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Sláma T, Belle FN, Strebel S, Christen S, Hägler-Laube E, Rössler J, Kuehni CE, von der Weid NX, Schindera C. Prevalence and factors associated with cancer-related fatigue in Swiss adult survivors of childhood cancer. J Cancer Surviv 2024; 18:135-143. [PMID: 37312001 PMCID: PMC10866786 DOI: 10.1007/s11764-023-01413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/26/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Reported prevalence of cancer-related fatigue (CRF) among childhood cancer survivors (CCS) varies widely, and evidence on factors associated with CRF among CCS is limited. We aimed to investigate the prevalence of CRF and its associated factors among adult CCS in Switzerland. METHODS In a prospective cohort study, we invited adult CCS who survived at least 5 years since last cancer diagnosis, and were diagnosed when age 0-20 years and treated at Inselspital Bern between 1976 and 2015 to complete two fatigue-measuring instruments: the Checklist Individual Strength subjective fatigue subscale (CIS8R; increased fatigue 27-34, severe fatigue ≥ 35) and the numerical rating scale (NRS; moderate fatigue 4-6, severe fatigue 7-10). We collected information about previous cancer treatment and medical history, and calculated β coefficients for the association between CIS8R/NRS fatigue scores and potential determinants using multivariable linear regression. RESULTS We included 158 CCS (participation rate: 30%) with a median age at study of 33 years (interquartile range 26-38). Based on CIS8R, 19% (N = 30) of CCS reported increased fatigue, yet none reported severe fatigue. CRF was associated with female sex, central nervous system (CNS) tumors, sleep disturbance, and endocrine disorders. Lower CRF levels were observed among CCS age 30-39 years compared to those younger. CONCLUSIONS A considerable proportion of adult CCS reported increased levels of CRF. IMPLICATIONS FOR CANCER SURVIVORS CCS who are female and < 30 years old, have a history of CNS tumor, report sleep disturbance, or have an endocrine disorder should be screened for CRF.
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Affiliation(s)
- Tomáš Sláma
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Fabiën N Belle
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sven Strebel
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- CANSEARCH Research Platform in Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Salome Christen
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Eva Hägler-Laube
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Jochen Rössler
- Pediatric Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas X von der Weid
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Christina Schindera
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
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Altay B, Çoban E. Dental Implant Corrosion Products May Accumulate in the Human Body. J Oral Maxillofac Surg 2024; 82:56-64. [PMID: 37898154 DOI: 10.1016/j.joms.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Corrosion products resulting from the degradation of the dental implant surface due to biological fluids and infection may accumulate in the body and lead to clinical consequences. PURPOSE The primary aim of this study is to measure the accumulation of dental implant corrosion products in the human body and the secondary aim is to estimate the association between corrosion products and fatigue. STUDY DESIGN, SETTING, SAMPLE This study was designed as a prospective cross-sectional and was conducted with patients presenting at to the Department of Oral and Maxillofacial Surgery. The study included patients with Grade IV dental implants made of pure titanium (Ti) at the bone level and Grade V abutments composed of Ti, aluminum (Al), and vanadium (V). Individuals possessing different metallic implants and those prone to metal exposure were not included in the study. Blood and hair samples were procured from each participant and subsequently analyzed. PREDICTOR VARIABLES The predictor variable is implant exposure, and it was divided into 3 groups; Group I, patients with healthy dental implants; Group II, patients with peri-implantitis; Control Group, individuals without dental implants. MAIN OUTCOME VARIABLES The primary outcome variables are Al, Ti, V levels in blood and hair samples and the secondary outcome variable is the fatigue questionnaire score. COVARIATES Age and gender, along with the dental implant number and duration of exposure within the study groups, are utilized as covariates. ANALYSES Groups were compared using the Kruskal-Wallis and Mann-Whitney U-tests. Spearman's correlation coefficient determined relationships between groups, signifying significance with P values <.05. RESULTS The sample consisted of 30 patients aged 18 to 68, with 53% being female and 47% male. The differences among the 3 groups in the median values of blood Ti, V; hair Al, Ti, V; and fatigue questionnaire scores were not statistically significant (P > .05). However, the median blood Al value was statistically higher in Group II (P < .05). CONCLUSIONS AND RELEVANCE While the presence of healthy dental implants may not affect the accumulation of Al, Ti, and V within the body, patients with peri-implantitis exhibited elevated blood Al levels, possibly due to infection influencing the corrosion process.
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Affiliation(s)
- Berkan Altay
- Assistant Professor, Department Head, Department of Oral and Maxillofacial Surgery, Kırıkkale University, Kırıkkale, Turkey.
| | - Elif Çoban
- Resarch Assistant, Department of Oral and Maxillofacial Surgery, Kütahya Health Sciences University, Kütahya, Turkey
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Penson A, Walraven I, Bronkhorst E, Grootenhuis MA, Maurice-Stam H, de Beijer I, van der Heiden-van der Loo M, Tissing WJE, van der Pal HJH, de Vries ACH, Bresters D, Ronckers CM, van den Heuvel-Eibrink MM, Neggers S, Versluys BAB, Louwerens M, Pluijm SMF, Blijlevens N, van Dulmen-den Broeder E, Kremer LCM, Knoop H, Loonen J. Chronic fatigue in childhood cancer survivors is associated with lifestyle and psychosocial factors; a DCCSS LATER study. ESMO Open 2023; 8:102044. [PMID: 37922688 PMCID: PMC10774970 DOI: 10.1016/j.esmoop.2023.102044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
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.
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Affiliation(s)
- A Penson
- Radboud University Medical Center, Center of Expertise for Cancer Survivorship, Department of Hematology, Nijmegen.
| | - I Walraven
- Department for Health Evidence, Radboud University Medical Center, Nijmegen
| | - E Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen
| | | | | | - I de Beijer
- Princess Máxima Center for Pediatric Oncology, Utrecht
| | | | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen
| | | | - A C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht
| | - C M Ronckers
- 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
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands; Wilhelmina Children's Hospital, UMCU, Utrecht
| | - S Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Medicine, Section Endocrinology, Erasmus Medical Center, Rotterdam
| | | | - M Louwerens
- Leiden University Medical Center, Department of Internal Medicine, Leiden
| | - S M F Pluijm
- Princess Máxima Center for Pediatric Oncology, Utrecht
| | - N Blijlevens
- Radboud University Medical Center, Center of Expertise for Cancer Survivorship, Department of Hematology, Nijmegen
| | | | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pediatric Oncology, Emma Children's Hospital, University of Amsterdam, Amsterdam
| | - H Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - J Loonen
- Radboud University Medical Center, Center of Expertise for Cancer Survivorship, Department of Hematology, Nijmegen
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Rangel SM, Kim T, Sheth A, Blumstein A, Lai JS, Cella D, Paller AS, Silverberg JI. Prevalence and associations of fatigue in childhood atopic dermatitis: A cross-sectional study. J Eur Acad Dermatol Venereol 2023; 37:763-771. [PMID: 36541250 PMCID: PMC10062493 DOI: 10.1111/jdv.18819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fatigue is a symptom that can negatively impact patients' quality of life. However, the relationship of AD with fatigue has not been fully studied, especially in children. OBJECTIVE To determine the prevalence of fatigue in AD patients, and whether AD severity, demographics and comorbidities are associated with increased fatigue in children. METHODS A cross-sectional observational study was performed among 248 children with AD. Paediatric patients (ages 8-17 years) and parents (of children ages 0-17 years) completed a questionnaire, including demographics, history of atopic comorbidities and validated severity measures of AD, itch, pain, sleep disturbance, sleep-related impairment and fatigue. AD severity was also assessed by clinician-reported Eczema Area and Severity Index (EASI), Scoring AD (SCORAD) and Investigator's Global Assessment (IGA). Fatigue was assessed using Patient Reported Outcome Measurement Information System (PROMIS) Pediatric Fatigue T-score. RESULTS Most children with AD had no (38.6%) or mild (32.1%) fatigue, with fewer having moderate (27.2%) or severe (2%) fatigue. Moderate/severe PROMIS Pediatric fatigue T-scores were increased with moderate (25.7%/1.4%) and severe (39.3%/5.4%) IGA vs. mild IGA (18.0%/0.0%) and those with 5-6 (44.4%/0.0%) and 7 (44.2%/5.2%) nights of SD from eczema. Moderate-severe PROMIS Pediatric Fatigue T-scores were associated with history of hay fever (adjusted OR [95% Cl]: 2.803 [1.395-5.632]) and family income (<$100,000: 3.049 [1.294-7.181]), but inversely with Black (0.40 [0.168-0.969]) and AAPI (0.285 [0.094-0.859]) race. In multivariable regression models controlling for demographic factors, PROMIS Pediatric Fatigue T-score was significant with more severe scores for IGA, POEM, EASI, SCORAD, NRS-itch, SCORAD-itch, average itch in the past 7 days, PROMIS Pediatric Pain severity, PROMIS Pediatric SD, PROMIS Pediatric SRI, SCORAD-sleep and more frequent SD from AD. CONCLUSIONS Fatigue is a common yet underappreciated symptom in children with AD, particularly those with moderate-severe AD, and warrants more attention in clinical practice and trials.
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Affiliation(s)
- Stephanie M. Rangel
- School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Theodore Kim
- Departments of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Anjani Sheth
- School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Alli Blumstein
- School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Jin-Shei Lai
- School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - David Cella
- School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Amy S. Paller
- School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC USA
- Departments of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Jonathan I. Silverberg
- School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC USA
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC USA
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8
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Paediatric short fatigue questionnaire, a 4-item fatigue questionnaire for children. J Psychosom Res 2023; 165:111130. [PMID: 36608507 DOI: 10.1016/j.jpsychores.2022.111130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate whether a paediatric Short Fatigue Questionnaire (pSFQ) assesses a valid construct for subjective fatigue, to assess its psychometric properties and provide a cut-off score for severe fatigue in children. METHODS The pSFQ consists of 4 items from the Checklist Individual Strength-8 (CIS-8). Data of previous studies using the CIS-8 were used to assess the pSFQ in healthy children (n = 316), children with chronic fatigue syndrome (n = 173), and children with a chronic disease (n = 442). All children were 12-18 years old. Confirmatory factor analysis (CFA) was performed, followed by Cronbach alpha's to investigate internal consistency, and Spearman's correlations to assess construct validity. With ROC analysis, we determined a cut-off score for severe fatigue and provide normative data on the pSFQ for children with and without a chronic disease. RESULTS CFA confirmed a one-factor model in the pSFQ representing subjective fatigue. Cronbach's alpha ranged from good to excellent (0.84-0.94), as did construct validity (-0.76 and - 0.87 for correlation with two other fatigue measurements). ROC analysis delivered a cut-off score of ≥21, with a sensitivity of 93.9% and specificity of 96.2% for severe fatigue. Normative data for children with and without a chronic disease showed similar patterns compared to other fatigue questionnaires. CONCLUSION The pSFQ is a practical and reliable screening instrument for severe fatigue in children with and without a chronic disease, and effectively reduces the questionnaire length with 50% compared to the conventional CIS-8.
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Levesque A, Caru M, Duval M, Laverdière C, Marjerrison S, Sultan S. Cancer-related fatigue in childhood cancer survivors: A systematic scoping review on contributors of fatigue and how they are targeted by non-pharmacological interventions. Crit Rev Oncol Hematol 2022; 179:103804. [PMID: 36087854 DOI: 10.1016/j.critrevonc.2022.103804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We aimed to identify contributors to cancer-related fatigue (CRF), explore non-pharmacological interventions addressing CRF, and highlight which contributors were targeted by these interventions in childhood cancer survivors. METHODS We performed a search in various databases and used the PRISMA-ScR checklist. Findings were synthesized in various different tables and figures in accordance with our objectives. RESULTS We included 49 articles in this systematic scoping review. We identified 59 significant contributors. Depression and physical activity level were some of the most studied significant contributors. Ten interventional studies were identified (e.g., yoga, physical activity intervention) that addressed 6 contributors (e.g., physical activity level). DISCUSSION This review is the first to describe and relate contributors and non-pharmacological interventions targeting CRF in childhood cancer survivors. Important clinical implications could be derived from the variety of factors explaining CRF and how it is currently addressed.
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Affiliation(s)
- Ariane Levesque
- Department of Psychology, Université de Montreal, Montreal, Canada; Research Center, Sainte-Justine University Health Center, Montreal, Canada.
| | - Maxime Caru
- Department of Pediatric Hematology and Oncology, and Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Michel Duval
- Research Center, Sainte-Justine University Health Center, Montreal, Canada; Charles-Bruneau Cancer Care Center, Sainte-Justine University Health Center, Montreal, Canada; Department of Pediatrics, Université de Montreal, Montreal, Canada
| | - Caroline Laverdière
- Research Center, Sainte-Justine University Health Center, Montreal, Canada; Charles-Bruneau Cancer Care Center, Sainte-Justine University Health Center, Montreal, Canada; Department of Pediatrics, Université de Montreal, Montreal, Canada
| | - Stacey Marjerrison
- Department of Pediatrics, McMaster University Children's Hospital, Hamilton, Ontario, Canada
| | - Serge Sultan
- Department of Psychology, Université de Montreal, Montreal, Canada; Research Center, Sainte-Justine University Health Center, Montreal, Canada; Charles-Bruneau Cancer Care Center, Sainte-Justine University Health Center, Montreal, Canada; Department of Pediatrics, Université de Montreal, Montreal, Canada
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10
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Penson A, Walraven I, Bronkhorst E, Maurice-Stam H, Grootenhuis MA, Van der Heiden-van der Loo M, Tissing WJE, Van der Pal HJH, De Vries ACH, Bresters D, Ronckers C, Van den Heuvel MM, Neggers SJCMM, Versluys BAB, Louwerens M, Pluijm SMF, Kremer LCM, Blijlevens N, Van Dulmen-den Broeder E, Knoop H, Loonen J. The Impact of Cancer-Related Fatigue on HRQOL in Survivors of Childhood Cancer: A DCCSS LATER Study. Cancers (Basel) 2022; 14:cancers14122851. [PMID: 35740518 PMCID: PMC9221067 DOI: 10.3390/cancers14122851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Survivors of childhood cancer have an increased risk to experience symptoms of severe and persistent fatigue. We studied how fatigue might affect the health-related quality of life of these survivors. Questionnaire items asking about a broad range of daily life aspects were compared between fatigued survivors, survivors without fatigue and the general Dutch population. A total of eleven aspects were studied which were all negatively affected by fatigue, with the largest impact seen for Vitality (how much energy does a person have), General Health (perception of current and future health) and Role Limitations (work-related activities). Results show the negative impact fatigue can have on the daily lives of survivors and why it is important to treat fatigue adequately. Abstract Background: Early detection and management of late effects of treatment and their impact on health-related quality of life (HRQOL) has become a key goal of childhood cancer survivorship care. One of the most prevalent late effects is chronic fatigue (CF). The current study aimed to investigate the association between CF and HRQOL in a nationwide cohort of CCS. Methods: Participants were included from the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort, a nationwide cohort of CCS. Participants completed the Checklist Individual Strength (CIS) to indicate CF (CIS fatigue severity subscale ≥ 35 and duration of symptoms ≥6 months) and the Short Form-36 (SF-36) and TNO (Netherlands Organization for Applied Scientific Research) and AZL (Leiden University Medical Centre) Adult’s Health-Related Quality of Life questionnaire (TAAQOL) as measures for HRQOL. Differences in mean HRQOL domain scores between CF and non-CF participants were investigated using independent samples t-tests and ANCOVA to adjust for age and sex. The association between CF and impaired HRQOL (scoring ≥ 2 SD below the population norm) was investigated using logistic regression analyses, adjusting for confounders. Results: A total of 1695 participants were included in the study. Mean HRQOL domain scores were significantly lower in participants with CF. In addition, CF was associated with impaired HRQOL on all of the domains (except physical functioning) with adjusted odds ratios ranging from 2.1 (95% CI 1.3–3.4; sexuality domain) to 30.4 (95% CI 16.4–56.2; vitality domain). Conclusions: CF is associated with impaired HRQOL, urging for the screening and regular monitoring of fatigue, and developing possible preventative programs and interventions.
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Affiliation(s)
- Adriaan Penson
- Department of Hematology, Radboud University Medical Center, Geert-Grooteplein Zuid 8, 6500 HB Nijmegen, The Netherlands;
- Correspondence:
| | - Iris Walraven
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Geert-Grooteplein 21, 6500 HB Nijmegen, The Netherlands; (I.W.); (E.B.); (N.B.)
| | - Ewald Bronkhorst
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Geert-Grooteplein 21, 6500 HB Nijmegen, The Netherlands; (I.W.); (E.B.); (N.B.)
| | - Heleen Maurice-Stam
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Martha A. Grootenhuis
- Department of Psychology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands;
| | - Margriet Van der Heiden-van der Loo
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Department of Pediatric Oncology/Hematology, University of Groningen/University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Helena J. H. Van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Andrica C. H. De Vries
- Department of Pediatric Oncology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Willem-Alexander Children’s Hospital, Department of Pediatrics, Leiden University Medical Center, Einthovenweg 20, 2333 ZC Leiden, The Netherlands
| | - Cécile Ronckers
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraβe 114, 26129 Oldenburg, Germany
| | - Marry M. Van den Heuvel
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Department of Pediatric Oncology, Erasmus Medical Center—Sophia Children’s Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Sebastian J. C. M. M. Neggers
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- Department of Medicine, Section Endocrinology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Birgitta A. B. Versluys
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Marloes Louwerens
- Leiden University Medical Center, Department of Internal Medicine, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Saskia M. F. Pluijm
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (H.M.-S.); (M.V.d.H.-v.d.L.); (W.J.E.T.); (H.J.H.V.d.P.); (D.B.); (C.R.); (M.M.V.d.H.); (S.J.C.M.M.N.); (B.A.B.V.); (S.M.F.P.); (L.C.M.K.)
- University Medical Center Utrecht, Wilhelmina’s Children’s Hospital, Lundlaan 6, 3584 EA Utrecht, The Netherlands
- Department Pediatric Oncology, Emma Children’s Hospital, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Nicole Blijlevens
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Geert-Grooteplein 21, 6500 HB Nijmegen, The Netherlands; (I.W.); (E.B.); (N.B.)
| | - Eline Van Dulmen-den Broeder
- Department of Pediatric Oncology/Hematology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Geert-Grooteplein Zuid 8, 6500 HB Nijmegen, The Netherlands;
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