Chronic fatigue in adult survivors of childhood cancer: Associated symptoms, neuroendocrine markers and autonomic cardiovascular responses

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By Bernward Zeller et al.

Purpose: Chronic fatigue (CF) is a common late effect after childhood cancer. Based upon findings among patients with the chronic fatigue syndrome (CFS), this study explored symptoms, neuroendocrine markers and autonomic cardiovascular responses associated with CFS in childhood cancer survivors.

Methods: Long-term survivors of childhood lymphoma and acute lymphoblastic leukemia reporting CF were compared to survivors without CF. Data included patient-reported outcomes, clinical examination, head-up tilt test (HUT) and neuroendocrine markers in blood and urine.

Results: Of 102 included survivors, 15 were excluded from comparative analyses due to significant comorbidity or pregnancy. Of the remaining 87 participants (median age 33.0 years, follow-up time 25.2 years), 35 had CF and 52 did not have CF. Compared to non-CF controls, CF cases reported significantly (p<.01) higher frequency of symptoms typical of the chronic fatigue syndrome (muscle and/or joint pain, feeling confused/disoriented) and symptoms of autonomic dysfunction (palpitations, feeling intermittently heat and cold, watery diarrhea). CF cases and controls did not differ regarding autonomic cardiovascular responses to orthostatic stress, but the CF group had lower levels of plasma ACTH (p=.002), and higher levels of urine norepinephrine (p=.017).

Conclusions: Survivors with CF reported a high symptom-burden compared to controls. There were few differences between the two groups regarding biomarkers, but slight alterations of the hypothalamus-pituitary-adrenal axis and sympathetic nervous activity were detected. CF in cancer survivors has features in common with the chronic fatigue syndrome, but further efforts are required to clarify the pathophysiology.

Source:Zeller,Bernward, MD, Ellen Ruud, MD, PhD, Jon Havard Loge, MD, PhD, Adriani Kanellopoulos, MD, Hanne Hamre, MD, Kristin Godang, BScd, Vegard Bruun Wyller, MD, PhD. Chronic fatigue in adult survivors of childhood cancer: Associated symptoms, neuroendocrine markers and autonomic cardiovascular responses. Psychosomatics, December 8, 2013.