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Abstract
BackgroundCognitive fatigue after childhood cancer is frequently overlooked despite guidelines recommending follow-up, and might be mistaken for depression due to overlapping symptoms. Our objectives were: 1) to examine ratings of fatigue in survivors of paediatric brain tumours (BT) and acute lymphoblastic leukaemia (ALL) compared to healthy controls, 2) to examine the relationship between symptoms of depression and cognitive fatigue, and 3) to evaluate parent-child concordance in ratings of cognitive fatigue.MethodsSurvivors of BT (n = 30), survivors of ALL (n = 30), and healthy controls (n = 60) aged 8–18 years completed the Pediatric Quality of Life Multidimensional Fatigue Scale and the Beck Youth Inventories. Associations between cognitive fatigue, diagnosis and depression were assessed with general linear modelling. Group differences were analysed using the Kruskal–Wallis test. Parent-child concordance was investigated with internal consistency reliability.ResultsCognitive fatigue was prevalent in 70% of survivors of BT survivors and in 30% of survivors of ALL. Diagnosis was the main predictor of cognitive fatigue (p < .001, ηp2 = 0.178), followed by depression (p = .010, ηp2 = 0.080). Survivors of BT reported significantly more fatigue than healthy controls on all fatigue subscales. While they also expressed more symptoms of depression, we found no evidence for an interaction effect. Parent-child concordance was moderate to good among survivors, but poor for controls.ConclusionsSurvivors of BT and ALL suffer from cognitive fatigue, with survivors of BT expressing more problems. Cognitive fatigue and depression should be assessed in survivors of childhood cancer using both self-rated and proxy-rated measures, and appropriate interventions offered.
Highlights
Cognitive fatigue after childhood cancer is frequently overlooked despite guidelines recommending follow-up, and might be mistaken for depression due to overlapping symptoms
The overlap between cognitive fatigue and depressive symptoms, such as mood swings and irritability, and problems associated with sleep, memory and attention [9, 13] indicates that cognitive fatigue after cancer may be mistaken for depression if not thoroughly assessed
Participant demographics and clinical characteristics Average age and standard deviations (SD) at assessment was similar across all three groups: 13.31 (SD = 2.80) years for survivors of Brain Tumour (BT), 12.47 (SD = 2.96) years for survivors of acute lymphoblastic leukaemia (ALL) and 12.18 (SD = 2.84) years for the controls (Table 1)
Summary
Cognitive fatigue after childhood cancer is frequently overlooked despite guidelines recommending follow-up, and might be mistaken for depression due to overlapping symptoms. Cognitive fatigue (sometimes referred to as mental fatigue or brain fatigue) is frequently overlooked as a long-term sequela to paediatric cancer diagnosis and treatment [1, 2]. Considering the current knowledge regarding cognitive fatigue related to adults with cancer or acquired brain injuries, as well as several other neurological conditions and disorders, this possible long-term complication should be assessed and monitored in younger patients. The overlap between cognitive fatigue and depressive symptoms, such as mood swings and irritability, and problems associated with sleep, memory and attention [9, 13] indicates that cognitive fatigue after cancer may be mistaken for depression if not thoroughly assessed. Previous studies have demonstrated that depression and cognitive fatigue are separate constructs [13, 20], and this distinction is important in ensuring that the correct therapeutic strategies are instigated
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