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Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer

A report from the childhood cancer survivor study

  1. Nancy R. Clanton PhD1,
  2. James L. Klosky PhD1,
  3. Chenghong Li PhD2,
  4. Neelam Jain PhD3,
  5. Deo Kumar Srivastava PhD2,
  6. Daniel Mulrooney MD4,
  7. Lonnie Zeltzer MD5,6,7,
  8. Marilyn Stovall PhD8,
  9. Leslie L. Robison PhD3,
  10. Kevin R. Krull PhD3,†,*

Article first published online: 11 APR 2011

DOI: 10.1002/cncr.25797

Issue

Cancer

Cancer

Volume 117, Issue 11, pages 2559–2568, 1 June 2011

Additional Information

How to Cite

Clanton, N. R., Klosky, J. L., Li, C., Jain, N., Srivastava, D. K., Mulrooney, D., Zeltzer, L., Stovall, M., Robison, L. L. and Krull, K. R. (2011), Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer. Cancer, 117: 2559–2568. doi: 10.1002/cncr.25797

Author Information

  1. 1

    Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee

  2. 2

    Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee

  3. 3

    Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee

  4. 4

    Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota

  5. 5

    Department of Pediatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California

  6. 6

    Department of Anesthesiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California

  7. 7

    Department of Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California

  8. 8

    Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

  1. †

    Fax: (901) 595-5845

*Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 735, Memphis, TN 38105-3678

Publication History

  1. Issue published online: 19 MAY 2011
  2. Article first published online: 11 APR 2011
  3. Manuscript Accepted: 25 OCT 2010
  4. Manuscript Revised: 4 OCT 2010
  5. Manuscript Received: 5 AUG 2010

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Keywords:

  • Childhood Cancer Survivor Study;
  • neurocognitive;
  • sleep;
  • fatigue;
  • vitality

Abstract

BACKGROUND:

Long-term survivors of childhood cancer are at risk for fatigue, sleep problems, and neurocognitive impairment, although the association between these outcomes has not been previously examined.

METHODS:

Outcomes were evaluated in 1426 survivors from the Childhood Cancer Survivor Study using a validated Neurocognitive Questionnaire. Relative risks for neurocognitive impairment were calculated using demographic and treatment factors, and survivors' report on the Functional Assessment of Chronic Illness Therapy-Fatigue, the Short Form-36 Vitality Scale, the Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale.

RESULTS:

Neurocognitive impairment was identified in >20% of survivors, using sibling-based norms for comparison. Multivariate logistic regression models revealed that fatigue (risk ratio [RR], 1.34; 95% confidence interval [CI], 1.13-1.59), daytime sleepiness (RR, 1.68; 95% CI, 1.55-1.83), poor sleep quality (RR, 1.23; 95% CI, 1.01-1.49), and decreased vitality (RR, 1.75; 95% CI 1.33-2.30) were all associated with impaired task efficiency. Likewise, fatigue (RR, 1.77; 95% CI, 1.23-2.55), sleepiness (RR, 1.38; 95% CI, 1.14-1.67), and decreased vitality (RR, 3.08; 95% CI, 1.98-4.79) were predictive of emotional regulation problems. Diminished organization was associated with increased sleepiness (RR, 1.80; 95% CI, 1.31-2.48) and decreased vitality (RR, 1.90; 95% CI, 1.37-2.63). Impaired memory was associated with poor sleep quality (RR, 1.45; 95% CI, 1.19-1.76), increased sleepiness (RR, 2.05; 95% CI, 1.63-2.58), and decreased vitality (RR, 2.01; 95% CI, 1.42-2.86). The impact of fatigue, sleepiness, sleep quality, and vitality on neurocognitive outcomes was independent of the effects of cranial radiation therapy, steroids and antimetabolite chemotherapy, sex, and current age.

CONCLUSIONS:

Neurocognitive function in long-term survivors of childhood cancer appears particularly vulnerable to the effects of fatigue and sleep disruption. These findings suggest sleep hygiene should be emphasized among survivors, as it may provide an additional mechanism for intervention to improve neurocognitive outcomes. Cancer 2011;. © 2011 American Cancer Society.

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