title: Fatigue and carnitine levels over multiple cycles of chemotherapy in children and adolescents.
abstract: OBJECTIVE
  Fatigue in childhood cancer is a pervasive and distressing symptom described as a "lack of energy". Carnitine is a micronutrient used to transport long chain fatty acids into muscle mitochondria. Some chemotherapy drugs interfere with the carnitine network. Both carnitine and fatigue relate to physical energy and may be influenced by chemotherapy. Using a repeated measures design, change in carnitine levels and change in fatigue in childhood cancer patients receiving ifosfamide, cisplatin, or doxorubicin were examined over multiple chemotherapy cycles. The influence of carnitine levels on fatigue was evaluated.
  
  
  METHODS
  Fifty-eight patients, between ages 3 and 18 years, within two months from diagnosis and receiving cisplatin, doxorubicin, and/or ifosfamide chemotherapy drugs, participated. Measurements included carnitine plasma levels and self-reported fatigue using established child or adolescent fatigue scales and were collected during the 2nd cycle of chemotherapy, and repeated on alternating cycles up to cycle 8. The Parent Fatigue Scale was used for children under age 7.
  
  
  RESULTS
  Total and free carnitine levels did not change significantly for the group. Fatigue decreased significantly in children age 7-12 (p = 0.04). Relationships between fatigue and carnitine were not significant.
  
  
  CONCLUSIONS
  Changes in carnitine plasma levels were not significant in this sample of patients. The carnitine levels remained within the reference values for children and were not associated with fatigue levels. School-age children may be more resilient to fatigue over the trajectory of treatment. Further research is needed into the biologic mechanisms of fatigue.
authors.affiliation: School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455, USA; Children's Hospitals and Clinics of Minnesota Cancer and Blood Disorders Program, 2525 Chicago Ave. S., Minneapolis, MN, USA. Electronic address: hook0035@umn.edu.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Hooke
authors.affiliation: Texas Children's Cancer and Hematology Centers, Texas Children's Hospital/Baylor College of Medicine, 1102 Bates St, Suite 1580, Houston, TX 77030, USA. Electronic address: ksmccart@txch.org.
authors.forename: Kathleen
authors.initials: K
authors.lastname: McCarthy
authors.affiliation: Texas Children's Cancer and Hematology Centers, Texas Children's Hospital/Baylor College of Medicine, 1102 Bates St, Suite 1580, Houston, TX 77030, USA. Electronic address: oataylor@txch.org.
authors.forename: Olga
authors.initials: O
authors.lastname: Taylor
authors.affiliation: School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27278, USA. Electronic address: marilyn.hockenberry@duke.edu.
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Hockenberry
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002331:Carnitine / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005221:Fatigue / Q000097:blood* / Q000209:etiology; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008297:Male; D009369:Neoplasms / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D057566:Self Report
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin; D002945:Cisplatin; D002331:Carnitine; D007069:Ifosfamide
keywords: Carnitine; Chemotherapy; Childhood cancer; Fatigue