Predictors of fatigue and poor sleep in adult survivors of childhood Hodgkin’s lymphoma: a report from the Childhood Cancer Survivor Study

Abstract

Purpose 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. Methods 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. Results 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. Conclusions 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. Implications for 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.

A systematic review of self‐reported pain in childhood cancer survivors

“…Twenty cross‐sectional studies were identified (Table ). Seventeen studies were multicentre studies and fifteen of those studies were based on data from the Childhood Cancer Survivor Study (CCSS). The CCSS is a large multi‐institutional cohort study of childhood cancer survivors in the United States and Canada .…”

“…Regarding diagnostic groups, 17 studies included patients with heterogeneous diagnoses . Furthermore, nine studies focused on specific homogenous subgroups of patients with diagnoses such as acute lymphoblastic leukaemia (ALL), leukaemia, lymphoma, Hodgkin's lymphoma, rhabdomyosarcoma, osteosarcoma, soft tissue sarcoma, Ewing's sarcoma, other bone tumours and CNS tumours …”

“…The bodily scale from the 36‐item Short Form Health Survey (SF‐36) was used in eight studies, the RAND‐36, which is similar to the SF‐36, was used in one study, and the other studies used the Brief Pain Inventory (BPI) method . The Health Utilities Index questionnaire (HUI2 and HUI3) was used by Alessi et al and two Swedish studies .…”

“…All studies were based on survivor self‐reporting. Three studies used both the generic SF‐36 measure and a pain measure from the CCSS survey …”

“…Comorbid distress was found to be associated with headaches, and bodily pain . In a study conducted by Rach et al, fatigue was associated with elevated bodily pain. In an investigation of long‐term survivors of childhood ALL and lymphoma with persistent chronic fatigue (PCF), Zeller et al found that a subgroup had more severe levels of pain.…”