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Chronic Fatigue in Long-term Survivors of Childhood Lymphomas and Leukemia: Persistence and Associated Clinical Factors

Zeller, Bernward MD*; Loge, Jon H. MD, PhD†,‡; Kanellopoulos, Adriani MD*; Hamre, Hanne MD; Wyller, Vegard B. MD, PhD*; Ruud, Ellen MD, PhD*

Journal of Pediatric Hematology/Oncology: August 2014 - Volume 36 - Issue 6 - p 438–444
doi: 10.1097/MPH.0000000000000051
Original Articles

Background: Chronic fatigue (CF) is an important late effect after childhood malignancies. Our aim was to assess CF persistence over time, concurrent comorbidities, and associations with clinical symptoms.

Procedure: A total of 102 long-term survivors of childhood lymphomas and acute lymphoblastic leukemia, 53 and 49 reporting CF and no CF, respectively, at time point (TP)1, were evaluated for CF at a second TP after a median interval of 2.7 years. At TP2 a survey, including self-reported and objectively measured variables, assessed depressive symptoms, pain, and physical activity.

Results: A total of 32 of the 53 reported CF cases at both TPs and 40/49 survivors had no CF at both TPs, whereas 30 had changed their fatigue status between first and second assessment (converters). Major somatic comorbidities were equally distributed among the groups. After exclusion of converters and survivors with major comorbidity/pregnancy, 27 persistent CF (PCF) cases and 35 controls were compared. PCF cases reported significantly more depression, sleeping problems, anxiety, pain, and reduced physical function. Further, they were less physically active than controls (steps/d; P=0.009). In a multiple regression analysis, depressive symptoms remained the only significant predictor of PCF.

Conclusions: Long-term survivors of childhood cancer with PCF are characterized by more depressive symptoms, anxiety, pain, insomnia, and less physical activity.

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Departments of *Pediatric Medicine

Oncology, National Resource Center for Late Effects after Cancer Treatment

Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway

Supported by the Norwegian ExtraFoundation for Health and Rehabilitation.

The authors declare no conflict of interest.

Reprints: Bernward Zeller, MD, Department of Pediatric Medicine, Oslo University Hospital, Mailbox 4950 Nydalen, N-0424 Oslo, Norway (e-mail: Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Received June 24, 2013

Accepted September 11, 2013

© 2014 by Lippincott Williams & Wilkins.