title: Prevalence and correlates of fatigue in long-term survivors of childhood leukemia.
abstract: OBJECTIVE
  To estimate the prevalence of fatigue, identify the factors associated with fatigue, and to explore the relationship between fatigue and quality of life (QOL) in long-term survivors of childhood acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  One hundred sixty-one ALL survivors diagnosed at Childrens Hospital Los Angeles (Los Angeles, CA) before age 18 years and between January 1, 1975 and December 31, 1995, participated in a structured telephone interview. Participants were aged 18 to 41 years and off treatment for an average of 14 years. Four measures of fatigue, including the Revised-Piper Fatigue Scale, were used to assess fatigue; depression was assessed using the Center for Epidemiological Studies Depression Scale. Multivariate logistic regression models were developed to identify factors associated with fatigue and depression.
  
  
  RESULTS
  Prevalence of fatigue (30%) fell within the general population normal limits. Fatigue and depression were highly correlated (Pearson r = 0.75). Fatigue was associated with marriage (OR = 0.11; 95% CI, 0.02 to 0.50), having children (OR = 5.80; 95% CI, 1.30 to 25.82), sleep disturbances (OR = 6.15; 95% CI, 2.33 to 16.22), pain (OR = 5.56; 95% CI, 2.13 to 14.48), obesity (OR = 3.80; 95% CI, 1.41 to 10.26), cognitive impairment (OR = 2.56; 95% CI, 1.02 to 6.38), and exercise-induced symptoms (OR = 2.98; 95% CI, 1.11 to 8.02). Four factors associated with fatigue were also associated with depression: sleep disturbances, pain, obesity, and cognitive impairment. Fatigue was inversely related to QOL.
  
  
  CONCLUSIONS
  Some survivors of childhood ALL experience fatigue many years after treatment. Fatigued survivors represent a high-risk subgroup as they report more depression and poorer QOL than non-fatigued survivors and their peers.
authors.affiliation: Department of Preventive Medicine and USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA. kmeeske@chla.usc.edu
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Meeske
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Siegel
authors.forename: Denise R
authors.initials: DR
authors.lastname: Globe
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Mack
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D017741:Survivors