title: A cross-sectional study of carnitine deficiency and fatigue in pediatric cancer patients.
abstract: OBJECTIVE
  Carnitine deficiency has been found in cancer patients and has been associated with fatigue. This study aimed to explore the prevalence of carnitine deficiency in pediatric cancer patients and its relationship with fatigue and other potential contributing factors.
  
  
  METHODS
  Children with cancer or Langerhans cell histiocytosis who were receiving treatment or had completed therapy were eligible. Patients completed the Pediatric Functional Assessment of Chronic Illness-Fatigue, the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, a numeric fatigue rating, and had carnitine levels obtained. Carnitine deficiency was defined as a total and/or free carnitine level less than normal for age or an acylcarnitine value higher than normal for age.
  
  
  RESULTS
  Data from 142 children aged 8-17 were analyzed. Twenty-eight of 142 (19.7 %) had decreased total and 42.8 % (12/28) had decreased free carnitine levels. No patients had elevated acylcarnitine levels or elevated ratios. Patients with versus without carnitine deficiency differed by age (p = 0.043), treatment (p = 0.037), duration since last chemotherapy (p = 0.020), and body mass index (p = 0.010), but not fatigue, when all data were analyzed together. Yet, a negative relationship between fatigue and carnitine levels was found on a subgroup (off-therapy; fatigue worse than the norm).
  
  
  CONCLUSIONS
  No significant association between fatigue and carnitine level was demonstrated when data from all patients were analyzed together; however, a significant yet unexpected relationship was found for patients who completed therapy and reported elevated fatigue. Given the small sample size, these results should be interpreted with caution. Future studies to explore impact upon excessive carnitine levels are warranted.
authors.affiliation: Department of Medical Social Sciences and Pediatrics, Northwestern University Feinberg School of Medicine, 633 N St Clair, 19th Floor, Chicago, IL 60611, USA. js-lai@northwestern.edu.
authors.forename: Jin-Shei
authors.initials: JS
authors.lastname: Lai
authors.affiliation: Memorial Hospital of South Bend, 615 N Michigan St, South Bend, IN, 46601, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Haertling
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Chicago, IL, 60611, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Weinstein
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Rademaker
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.
authors.forename: Stewart
authors.initials: S
authors.lastname: Goldman
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects; D002331:Carnitine / Q000097:blood*; D002648:Child; D002853:Chromatography, Liquid; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D011795:Surveys and Questionnaires; D053719:Tandem Mass Spectrometry
chemical_list: D000970:Antineoplastic Agents; D002331:Carnitine
keywords: Cancer; Carnitine; Children; Fatigue
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