EClinicalMedicine · 2025
Cancer-related fatigue in children during treatment: a 5-year cohort study of daily patient-reported outcomes with clinical implications.
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Tilg Alexander, Kuhle Stefan, Meryk Andreas, Hetzer Benjamin, Kropshofer Gabriele, Salvador Christina, Weiss Johannes G, Lehmann Jens, Riedl David, Rumpold Gerhard, Haid Alexandra, Willeit Peter, Holzner Bernhard, Crazzolara Roman
Аннотация
BACKGROUND: Cancer-related fatigue is one of the most common and distressing symptoms in pediatric oncology, yet its assessment and management remain insufficient. This study aimed to characterize trajectories of cancer-related fatigue in children and adolescents undergoing cancer treatment and to identify diagnosis- and therapy-specific fatigue predictors for personalized supportive care.
METHODS: In this prospective single-center cohort study, 104 pediatric cancer patients receiving chemotherapy (0-18 years) were enrolled at the Medical University of Innsbruck between May 1, 2020 and December 31, 2024. Daily symptom reports (patient or observer-reported) were collected via the ePROtect app and fatigue was scored 0-100, with lower values indicating greater burden. Patients were followed from diagnosis through the end of intensive therapy, and trajectories of cancer-related fatigue were analyzed across diagnostic groups and treatment phases using Locally Estimated Scatterplot Smoothing and linear mixed-effects models.
FINDINGS: In total, 11,602 daily cancer-related fatigue assessments were completed, with a median completion rate of 56·1%. Worst fatigue at diagnosis was seen in non-Hodgkin lymphoma (median: 54·2; interquartile range (IQR): 25·0, 75·0) and acute myeloid leukemia patients (median: 56·2; IQR: 33·3, 66·7); least in central nervous system tumor patients (median: 91·7; IQR: 75·0, 100). Glucocorticoid exposure was strongly associated with fatigue, especially in patients with acute lymphoblastic leukemia during steroid-intensive phases. Cancer-related fatigue was minimal during outpatient care but worsened during unplanned hospital admissions. Immunotherapy phases were associated with significant cancer-related fatigue improvement. Distinct fatigue patterns were observed across diagnoses and treatment protocols.
INTERPRETATION: Daily symptom monitoring reveals dynamic, diagnosis- and therapy-specific patterns of cancer-related fatigue in pediatric oncology patients. Glucocorticoid intensity and acute clinical events tend to be key drivers of fatigue burden. Integrating real-time symptom monitoring into clinical workflows helps identify high-risk periods for cancer-related fatigue and supports personalized supportive care to improve overall well-being in children and adolescents with cancer.
FUNDING: Kinderkrebshilfe Tirol und Vorarlberg and Kinderhilfe Südtirol-Regenbogen supported this study.
METHODS: In this prospective single-center cohort study, 104 pediatric cancer patients receiving chemotherapy (0-18 years) were enrolled at the Medical University of Innsbruck between May 1, 2020 and December 31, 2024. Daily symptom reports (patient or observer-reported) were collected via the ePROtect app and fatigue was scored 0-100, with lower values indicating greater burden. Patients were followed from diagnosis through the end of intensive therapy, and trajectories of cancer-related fatigue were analyzed across diagnostic groups and treatment phases using Locally Estimated Scatterplot Smoothing and linear mixed-effects models.
FINDINGS: In total, 11,602 daily cancer-related fatigue assessments were completed, with a median completion rate of 56·1%. Worst fatigue at diagnosis was seen in non-Hodgkin lymphoma (median: 54·2; interquartile range (IQR): 25·0, 75·0) and acute myeloid leukemia patients (median: 56·2; IQR: 33·3, 66·7); least in central nervous system tumor patients (median: 91·7; IQR: 75·0, 100). Glucocorticoid exposure was strongly associated with fatigue, especially in patients with acute lymphoblastic leukemia during steroid-intensive phases. Cancer-related fatigue was minimal during outpatient care but worsened during unplanned hospital admissions. Immunotherapy phases were associated with significant cancer-related fatigue improvement. Distinct fatigue patterns were observed across diagnoses and treatment protocols.
INTERPRETATION: Daily symptom monitoring reveals dynamic, diagnosis- and therapy-specific patterns of cancer-related fatigue in pediatric oncology patients. Glucocorticoid intensity and acute clinical events tend to be key drivers of fatigue burden. Integrating real-time symptom monitoring into clinical workflows helps identify high-risk periods for cancer-related fatigue and supports personalized supportive care to improve overall well-being in children and adolescents with cancer.
FUNDING: Kinderkrebshilfe Tirol und Vorarlberg and Kinderhilfe Südtirol-Regenbogen supported this study.