Sleep and fatigue in pediatric oncology: A review of the literature

Walter, Lisa M.; Nixon, Gillian M.; Davey, Margot J; Downie, Peter; Horne, Rosemary Sylvia Claire

doi:10.1016/j.smrv.2015.01.001

Cited by 87 publications

(127 citation statements)

References 107 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…As with fatigue, sleep difficulties in long-term pediatric survivors has not been much studied (45). However, reduced sleep quality and quantity contribute to poor HRQOL in pediatric oncology patients through their adulthood (47, 48). …”

Section: Resultsmentioning

confidence: 99%

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

Bevans

El‐Jawahri

Tierney

et al. 2017

Biology of Blood and Marrow Transplantation

120

145

View full text Add to dashboard Cite

In 2015 the National Institutes of Health (NIH) convened six working groups to address the research needs and best practices for patient-centered late effects of hematopoietic stem cell transplantation (HCT) survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to 1) summarize the current literature describing patient-centered outcomes (PCO) in survivors including the various dimensions of healthrelated quality of life affected by HCT and describe interventions tested to improve these outcomes; 2) highlight areas with sufficient evidence allowing for integration into standard practice; 3) address methodological issues that restrict progress in this field; 4) identify major gaps to guide future research; and 5) specify priority research recommendations. PCOs were summarized within physical, psychological, social and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of PCO measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included: integration of annual screening of PCOs; use of evidence based practice guidelines; and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included: 1) Design and test risk-targeted interventions with dose intensity modulation matching the needs of HCT survivors with priority domains including sexual dysfunction, fatigue, sleep disruption, non-adherence to medications & recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplant centers, 2) Design a consensus based methodologic framework for outcomes evaluation, and 3) Evaluate and compare existing practices for integrating PCOs screening and interventions across HCT survivorship programs.

show abstract

Section: Resultsmentioning

confidence: 99%

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

Bevans

El‐Jawahri

Tierney

et al. 2017

Biology of Blood and Marrow Transplantation

120

145

View full text Add to dashboard Cite

show abstract

“…[26] High-dose corticosteroids greatly impact the functioning of the HPA axis and the rhythmicity of cortisol, and the finding that adrenalectomy decreases hypothalamic orexin expression suggests that the orexin system may be the mediator between HPA axis dysfunction and sleep disturbances. [27, 28]…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone Chemotherapy Does Not Disrupt Orexin Signaling

et al. 2016

View full text Add to dashboard Cite

BackgroundSteroid-induced sleep disturbance is a common and highly distressing morbidity for children receiving steroid chemotherapy for the treatment of pediatric acute lymphoblastic leukemia (ALL). Sleep disturbance can negatively impact overall quality of life, neurodevelopment, memory consolidation, and wound healing. Hypothalamic orexin neurons are influential wake-promoting neurons, and disturbances in orexin signaling leads to abnormal sleep behavior. A new class of drug, the orexin receptor antagonists, could be an intriguing option for sleep disorders caused by increased orexinergic output. Our aim was to examine the impact of ALL treatment doses of corticosteroids on the orexin system in rodents and in children undergoing treatment for childhood ALL.MethodsWe administered repeated injections of dexamethasone to rodents and measured responsive orexin neural activity compared to controls. In children with newly diagnosed standard risk B-cell ALL receiving dexamethasone therapy per Children’s Oncology Group (COG) induction therapy from 2014–2016, we collected pre- and during-steroids matched CSF samples and measured the impact of steroids on CSF orexin concentration.ResultsIn both rodents, all markers orexin signaling, including orexin neural output and orexin receptor expression, were preserved in the setting of dexamethasone. Additionally, we did not detect a difference in pre- and during-dexamethasone CSF orexin concentrations in children receiving dexamethasone.ConclusionsOur results demonstrate that rodent and human orexin physiology is largely preserved in the setting of high dose dexamethasone. The data obtained in our experimental model fail to demonstrate a causative role for disruption of the orexin pathway in steroid-induced sleep disturbance.

show abstract

“…Despite research identifying the negative impact of fatigue and sleep disturbance on quality of life [24, 25], as well as elevated levels of emotional distress, pain, and physical limitations in pediatric HL survivors, the relation between these factors is largely unknown. The purpose of this study was to investigate the associations between clinically elevated levels of pain, emotional distress, and physical functioning limitations and clinically elevated sleep outcomes.…”

mentioning

confidence: 99%

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

et al. 2016

View full text Add to dashboard Cite

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.

show abstract

Sleep and fatigue in pediatric oncology: A review of the literature

Cited by 87 publications

References 107 publications

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

Dexamethasone Chemotherapy Does Not Disrupt Orexin Signaling

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

Contact Info

Product

Resources

About