title: Predictors of fatigue and poor sleep in adult survivors of childhood Hodgkin's lymphoma: a report from the Childhood Cancer Survivor Study.
abstract: Survivors of pediatric Hodgkin's lymphoma (HL) are at risk for a number of debilitating late effects. Excessive fatigue and poor sleep quality are primary complaints of HL survivors. Understanding the emotional and physical factors that influence fatigue and sleep quality may provide opportunities for intervention to improve health-related quality of life for HL survivors.
  
  
  
  Data from 751 adult survivors of childhood HL who participated in the Childhood Cancer Survivor Study (CCSS) from 2000-2002 were analyzed. Multivariable logistic regression analyses investigated the demographic, psychological, and physical variables that predicted clinically significant levels of poor sleep quality, fatigue, and excessive daytime sleepiness.
  
  
  
  Survivors' self-reported level of emotional distress, pain, and physical functioning limitations did not differ from population norms. Clinically elevated levels of emotional distress (OR 8.38, 95% CI 4.28-16.42) and pain (OR 3.73, 95% CI 2.09-6.67) increased the risk for endorsing elevated levels of fatigue. Survivors with elevated levels of emotional distress (OR 6.83, 95% CI 2.71-15.90) and pain (OR 5.27, 95% CI 1.78-15.61) were more likely to report poor sleep quality. Pain (OR 2.11, 95% CI 1.39-3.34) was related to excessive daytime sleepiness.
  
  
  
  Emotional and physical factors are associated with elevated levels of fatigue, excessive daytime sleepiness, and poor sleep quality in survivors of pediatric HL. This is consistent with findings from research conducted with non-cancer survivors.
  
  
  
  These results suggest that interventions designed to target sleep and fatigue difficulties in the general population may be well suited for pediatric HL survivors as well.
authors.affiliation: UVA Neurocognitive Assessment Lab, The University of Virginia Health System, Charlottesville, VA, 22908, USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Rach
authors.affiliation: Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, 38105, USA.
authors.forename: Valerie McLaughlin
authors.initials: VM
authors.lastname: Crabtree
authors.affiliation: Epidemiology and Cancer Control, St. Jude Children's Research Hospital, MS 735, Room S6047, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Brinkman
authors.affiliation: Division of Pediatric Hematology-Oncology, David Geffen School of Medicine at UCLA, 22-464 MDCC, 10833 LeConte Ave, Los Angeles, CA, 90095, USA.
authors.forename: Lonnie
authors.initials: L
authors.lastname: Zeltzer
authors.affiliation: Emory Children's Center, 2015 Uppergate Dr. 416D, Atlanta, GA, 30322, USA.
authors.forename: Jordan Gilleland
authors.initials: JG
authors.lastname: Marchak
authors.affiliation: Biostatistics, St. Jude Children's Research Hospital, MS 768, Room 6010, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
authors.forename: Deokumar
authors.initials: D
authors.lastname: Srivastava
authors.affiliation: Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, 38105, USA.
authors.forename: Brooklee
authors.initials: B
authors.lastname: Tynes
authors.affiliation: Department of Medical Social Sciences, Northwestern University, 633 N St. Clair 19th Floor, Chicago, IL, 60611, USA.
authors.forename: Jin-Shei
authors.initials: JS
authors.lastname: Lai
authors.affiliation: Epidemiology and Cancer Control, St. Jude Children's Research Hospital, MS 735, Room S6010, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: Epidemiology and Cancer Control, St. Jude Children's Research Hospital, MS 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Ms 735, Room S6037, 262 Danny Thomas Place, Memphis, TN, 38105, USA. kevin.krull@stjude.org.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006689:Hodgkin Disease / Q000150:complications* / Q000523:psychology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D011788:Quality of Life / Q000523:psychology; D012893:Sleep Wake Disorders / Q000209:etiology*; D017741:Survivors / Q000523:psychology*; D055815:Young Adult
keywords: Fatigue; Hodgkin’s lymphoma; Pediatric cancer; Psychological distress; Sleep