title: Chronic fatigue in long-term survivors of childhood lymphomas and leukemia: persistence and associated clinical factors.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: 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.
authors.forename: Bernward
authors.initials: B
authors.lastname: Zeller
authors.forename: Jon H
authors.initials: JH
authors.lastname: Loge
authors.forename: Adriani
authors.initials: A
authors.lastname: Kanellopoulos
authors.forename: Hanne
authors.initials: H
authors.lastname: Hamre
authors.forename: Vegard B
authors.initials: VB
authors.lastname: Wyller
authors.forename: Ellen
authors.initials: E
authors.lastname: Ruud
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D002648:Child; D059350:Chronic Pain / Q000453:epidemiology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology; D015673:Fatigue Syndrome, Chronic / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008223:Lymphoma / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology* / Q000628:therapy*; D011247:Pregnancy; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000453:epidemiology; D017741:Survivors; D013995:Time