title: Fatigue in children with cancer at the end of life.
abstract: BACKGROUND
  Fatigue is a prevalent source of suffering in children with advanced cancer; yet, little is known about it.
  
  
  OBJECTIVE
  This study aimed to describe fatigue experienced by children with advanced cancer and to identify the factors associated with suffering from fatigue and its treatment.
  
  
  METHODS
  A retrospective cross-sectional study of 141 parents of children who died of cancer (response rate: 64%) was conducted in two tertiary-level U.S. pediatric hospitals.
  
  
  RESULTS
  By parent report, 96% of children experienced fatigue in the last month of life. Nearly 50% experienced significant suffering from fatigue; this was associated with suffering from pain, dyspnea, anorexia, nausea/vomiting, diarrhea, anxiety, sadness, or fear (P<0.05), and with side effects from pain or dyspnea treatment (P<0.05). In multivariate analysis of symptom-related factors, suffering from nausea/vomiting (odds ratio [OR]=3.93, 95% confidence interval [CI]=1.23-12.61, P=0.02); anorexia (OR=7.52, 95% CI=1.87-30.25, P=0.005); and fear (OR=5.13, 95% CI=2.03-12.96, P ≤ 0.001) remained independently associated with fatigue. Children suffering from fatigue had primary oncologists with fewer years' experience than children who did not suffer from fatigue (mean=7.7 years, standard deviation [SD]=4.9 vs. mean of 9.9 years, SD=6.0, P=0.02). Among children with fatigue, 17 of 129 (13%) received fatigue-directed treatment, which was successful in 3 of 12 (25%). Children experiencing side effects from dyspnea or pain treatment were more likely to be treated for fatigue (relative risk=1.25, 95% CI=1.06-1.47, P=0.009).
  
  
  CONCLUSIONS
  Fatigue is a common source of suffering in children with cancer at the end of life. Palliation of this symptom is rarely successful. Increased attention to factors associated with fatigue and effective interventions to ameliorate fatigue are needed.
authors.affiliation: Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. christina_ullrich@dfci.harvard.edu
authors.forename: Christina K
authors.initials: CK
authors.lastname: Ullrich
authors.forename: Veronica
authors.initials: V
authors.lastname: Dussel
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Hilden
authors.forename: Jan W
authors.initials: JW
authors.lastname: Sheaffer
authors.forename: Caron L
authors.initials: CL
authors.lastname: Moore
authors.forename: Charles B
authors.initials: CB
authors.lastname: Berde
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
mesh_terms: D001007:Anxiety / Q000150:complications; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000150:complications; D005221:Fatigue / Q000150:complications* / Q000628:therapy; D006801:Humans; D015999:Multivariate Analysis; D009325:Nausea / Q000150:complications; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D016017:Odds Ratio; D010146:Pain / Q000150:complications*; D012189:Retrospective Studies; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013727:Terminal Care; D019452:Terminally Ill