How does fatigue contribute to cognitive dysfunction in childhood acute lymphoblastic leukemia survivors
Objectives: The present study aims to (1) describe neurocognitive difficulties and fatigue in a well-characterized cohort of long-term acute lymphoblastic leukemia (ALL) survivors and (2) explore the contribution of self-reported fatigue to objective neurocognitive difficulties typically studied in this population. Method: Pediatric ALL survivors (N = 285) from the PETALE PSY-ALL cohort completed the DIVERGT battery of cognitive tests, the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS) and the Distress Thermometer (DT). We conducted frequency and comparison analyses for factors of interest. We performed multiple regression models to assess the contribution of fatigue in explaining cognitive deficits beyond known risk factors (age, age at diagnosis, sex, ALL risk status, emotional distress). Results: At least one cognitive difficulty (one DIVERGT scale <1.5 SD) occurred in 66% of participants. Domains primarily affected were verbal fluency, working memory and fine motor skills. Participants had normal levels of fatigue except for the subscale Sleep/rest fatigue showing 7% higher fatigue in those <18 years than in comparison samples across ages. Sleep/rest fatigue was associated with working memory (Digit Span Total score, r = 0.117; p = 0.049). Fatigue did not explain neurocognitive dysfunction beyond known risk factors from the clinical history. Conclusions: Pediatric ALL survivors have many cognitive difficulties and experience fatigue due to sleep/rest issues. The contribution of fatigue to cognitive dysfunction is lower than expected, which may be due to specificities of cognitive dysfunctions, the impact of normalization processes on the measure of fatigue or the lack of sensibility of our fatigue measure.
Fatigue Neurocognitive Oncology Pediatric acte lymphoblastic leukemia Survivors