A cross-sectional study of carnitine deficiency and fatigue in pediatric cancer patients

Abstract

Purpose 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). Conclusion 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.

Symptoms in Children Receiving Treatment for Cancer—Part I: Fatigue, Sleep Disturbance, and Nausea/Vomiting

“…Carnitine, a micronutrient needed for energy production, has been studied in relation to fatigue levels with conflicting results. One study found no relationship between carnitine levels and fatigue (Lai et al, 2016), while another study found that when carnitine levels decreased, fatigue increased in children who had received previous chemotherapy (Hockenberry et al, 2009). Measures of oxidative stress have been correlated with increased fatigue in children with ALL as well (Hockenberry et al, 2014; Rodgers et al, 2016).…”

“…A cross-sectional study of carnitine deficiency and fatigue in pediatric cancer patients (Lai, Haertling, Weinstein, Rademaker, & Goldman, 2016) 142 children ages 8 to 17 years, 56% were receiving chemotherapy Peds FACIT-F and PedsQL-Fatigue No significant association between fatigue and carnitine level was found.…”

“…Clinical factors associated with fatigue over time in paediatric oncology patients receiving chemotherapy (Yeh et al, 2008) 48 Taiwanese children ages 7 to 17 years measured over the 11 days after starting a cycle of chemotherapy A cross-sectional study of carnitine deficiency and fatigue in pediatric cancer patients (Lai, Haertling, Weinstein, Rademaker, & Goldman, 2016) 142 children ages 8 to 17 years, 56% were receiving chemotherapy Peds FACIT-F and PedsQL-Fatigue No significant association between fatigue and carnitine level was found.…”

Iranian Version of Cancer-Related Fatigue Questionnaire: Construction and Validation

“…Fatigue is a common and serious symptom for cancer patients. The effect of fatigue on the quality of life of cancer patients may be negative (3) and may influence the patient's ability to complete treatment (4). Studies show that 90% of patients with cancer experience fatigue during the treatment process; and more than 50% of patients report fatigue even after the end of treatment (5).…”

“…A better understanding of possible factors affecting fatigue in cancer patients may lead to the development of a structured intervention for patients. Carnitine deficiency in patients with cancer may promote the risk of chronic fatigue, which may be caused due to reduction in the use of long-chain fatty acids in energy metabolism (10), enhanced metabolic requirements, and treatment with medications that disrupt the metabolism of carnitine (3).…”