Changes in children's fatigue during the course of treatment for paediatric cancer. Chemotherapy-Related Fatigue in Childhood Cancer: Correlates, Consequences, and Coping Strategies Self‐reported fatigue in children with advanced cancer: Results of the PediQUEST study Fatigue and physical performance in children and adolescents receiving chemotherapy. Impact of Effective Nursing Interventions to the Fatigue Syndrome in Children Who Receive Chemotherapy Psychometric testing of fatigue instruments for use with cancer patients. Pain, sleep disturbance, and fatigue in children with leukemia and their parents: a pilot study. Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early-stage breast cancer. Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study. Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide. The measurement of symptoms in young children with cancer: the validation of the Memorial Symptom Assessment Scale in children aged 7-12. Prospective study of fatigue in localized prostate cancer patients undergoing radiotherapy. Management of cancer-related fatigue during chemotherapy through telephone motivational interviewing: modeling and randomized exploratory trial. Fatigue in patients with cancers of the breast or prostate undergoing radical radiotherapy. Feasibility of a patient-controlled cognitive-behavioral intervention for pain, fatigue, and sleep disturbance in cancer. Will Improvement in Quality of Life (QOL) Impact Fatigue in Patients Receiving Radiation Therapy for Advanced Cancer? Clinical factors associated with fatigue over time in paediatric oncology patients receiving chemotherapy
BACKGROUND Fatigue is described as one of the most distressing symptoms of cancer therapy ; yet it has received limited clinical attention . Children are suffering from a symptom that is under-diagnosed during their treatment . AIM The aim of this study is : ( a ) to assess the change in fatigue scores during cancer treatment according to children 's perspectives , and ( b ) to describe the possible causes of fatigue from children 's points of view . SAMPLE AND METHODS The present study is part of an ongoing prospect i ve study . The research group consisted of 40 ( n = 40 ) children aged 7 - 12 years with cancer who are being followed up in the oncology clinic of a Greek children 's hospital . After parental consent was obtained , data were collected using the Child Fatigue Scale and a sociodemographic data form . RESULTS The children with cancer reported a statistically significant increase in fatigue scores during their treatment ( F = 6.846 , P = 0.003 ) . Gender was the only demographic factor associated with a significant increase in the fatigue scores ( F = 4.857 , P = 0.034 ) . CONCLUSIONS Cancer treatment was found significantly to increase children 's fatigue levels . Medical procedures and the hospital environment seemed to be major causative factors of the fatigue experienced by children with cancer during their treatment The aim of this research is to examine the experience and impact of  chemotherapy-related fatigue in recently diagnosed pediatric oncology patients . A repeated- measures , within-subjects , mixed ( quantitative plus qualitative ) design was used to prospect ively assess fatigue during early chemotherapy cycles and to compare fatigue to depressive symptoms . Parental interviews collected concurrently were analyzed for descriptions of the child 's fatigue and mood states and for strategies to cope with fatigue . Results indicated a significant correlation between fatigue and depression , but qualitative analyses suggested that the 2 phenomena may be unique and distinguishable . Qualitative analyses of parent interviews also identified specific strategies that were frequently used in response to high levels of fatigue . The findings illustrate the significant impact of chemotherapy-related fatigue in children being treated for cancer . The study also provides guidance for the assessment of fatigue and related symptoms and identifies specific strategies for coping with fatigue Pediatric cancer‐related fatigue is prevalent and significantly impairs health‐related quality of life , yet its patterns and correlates are poorly understood . The objectives of this study were to describe fatigue as prospect ively reported by children with advanced cancer and to identify the factors associated with fatigue and associated distress PURPOSE / OBJECTIVES To examine the relationship between physical performance and fatigue in child and adolescent cohorts during the first three cycles of chemotherapy . DESIGN Prospect i ve , observational design . SETTING Two pediatric cancer centers in the upper Midwest region of the United States . SAMPLE 16 children and 14 adolescents newly diagnosed with cancer . METHODS St and ardized instruments were administered during the first and third cycles of chemotherapy . Instruments included  physical performance tests ( Timed Up and Down Stairs [ TUDS ] and the 6-Minute Walk Test [ 6MWT ] ) and a self-report fatigue scale .  MAIN RESEARCH VARIABLES Fatigue and physical performance . FINDINGS In the child cohort , physical performance appeared to improve and fatigue diminished from cycle 1 to 3 of chemotherapy . When time on TUDS decreased , fatigue tended to decrease ; when 6MWT distance increased , fatigue decreased . In the adolescent cohort , fatigue seemed to decrease but physical performance measures evidence d little change . Correlations between changes in the physical performance variables and fatigue were not significant . CONCLUSIONS Fatigue may decrease early in treatment as disease symptoms resolve . Fatigue in the child cohort was related to physical performance , which is consistent with previous studies that defined fatigue in children as primarily a physical sensation . Findings in the adolescent cohort support research that defined adolescent fatigue as more complex with mental , emotional , and physical components . IMPLICATION S FOR NURSING Knowing how fatigue relates to physical performance in children and adolescents informs the nurse in educating patients and families about symptom management This experimental , r and omized controlled study was conducted for children with cancer who are 7 to 12 years of age and receiving chemotherapy treatment to detect the impact of appropriate nursing interventions on decreasing the fatigue syndrome . The research sample is composed of a total of 60 children with cancer , with 30 children being included in the experimental group and 30 children included in the control group with their mothers . In the experimental group , after the 7th to 10th day of the chemotherapy treatment , throughout a week , the research er conducted the effective nursing interventions every day for 45 to 60 minutes . In the control group , routine nursing interventions were carried out . The experimental and control group children 's mean scores for the Fatigue Scale-Child and those of mothers for Fatigue Scale-Parent were compared . A statistically significant difference was found between the Fatigue Scale-Child and Fatigue Scale-Parent mean scores of the experimental and the control group children ( P < .00 ) . These results suggest that fatigue of children with cancer can be reduced by implementing appropriate nursing interventions BACKGROUND Cancer treatment-related fatigue ( CRF ) is a common side effect of cancer treatment . A problem identified in most review s of CRF is lack of sound approaches to measurement that are congruent with the conceptualization of CRF as a self-perceived state . The diversity of instruments available to measure fatigue and the lack of comprehensive testing of several promising instruments with cancer patients undergoing treatment provided the rationale for this study . The purpose of this article is to report the results of psychometric testing of several fatigue instruments in patients undergoing cancer treatment . OBJECTIVES The aims of this study were to determine the reliability , validity , and responsiveness of each instrument and to determine the ability of each instrument to capture CRF . METHODS Existing fatigue instruments with published psychometric information that indicated suitability for further testing were selected and included the Profile of Mood States Short Form fatigue subscale ( F_POMS-sf ) ,  Multidimensional Assessment of Fatigue ( MAF ) ,  Lee Fatigue Scale ( LFS ) , and the  Multidimensional Fatigue Inventory ( MFI ) . Data were collected at a university-based clinical cancer center and a freest and ing comprehensive cancer center . Subjects completed all study instruments , which were presented in r and om order , at a time when CRF was expected to be high and again when it was expected to be low . A subset of subjects completed the instruments within 48 hours of one of the data collection points when CRF was expected to be relatively unchanged to provide stability data . RESULTS Reliability estimates using Cronbach 's alpha indicated that all instruments examined had good internal consistency . Test-retest correlations showed good stability for total scores on all the instruments , but some subscales of the LFS and MFI had marginal stability . Factor analysis of all instruments indicated that only the LFS and the F_POMS-sf fully supported their construct validity . All of the instruments showed responsiveness to changes in CRF related to treatment . CONCLUSIONS The results of the study provide research ers and clinicians with detailed comparisons of the performance of established fatigue measures in cancer patients undergoing treatment to use when selecting measures of CRF PURPOSE / OBJECTIVES To determine the feasibility of collecting symptom data at home from school-age children with acute lymphoblastic leukemia ( ALL ) and from their fathers and mothers and to obtain initial descriptions of pain , sleep disturbance , and fatigue experienced by the family members at home . DESIGN Prospect i ve and descriptive . SETTING Children 's homes in Oregon and southwestern Washington . SAMPLE 9 children with ALL ( aged 8 - 16 years ) , 6 fathers , and 7 mothers . The children received vincristine during the maintenance phase of their outpatient chemotherapy treatments . METHODS With age-appropriate , paper- and -pencil diaries and wrist actigraphy , data were collected for three days in the families ' homes . Families were reminded by telephone to complete their sleep and activity diaries . MAIN RESEARCH VARIABLES Pain , sleep disturbance , and fatigue in school-age children and their fathers and mothers . FINDINGS Most of the families who were approached indicated willingness to participate in the study . After receiving outpatient chemotherapy , the children reported pain , sleep disturbance , and fatigue data over three days . Fathers and mothers also reported symptoms . Actigraphy showed children waking more often during the night than mothers or fathers . CONCLUSIONS Children 's pain , sleep disturbance , and fatigue suggest that the symptoms are influencing families ' quality of life . Larger studies are needed to examine the symptom patterns and health outcomes of children , fathers , and mothers over the course of chemotherapy . IMPLICATION S FOR NURSING Improving sleep and managing pain and fatigue after chemotherapy treatment for children with ALL may improve health outcomes for children and parents PURPOSE To evaluate the efficacy of a psychoeducational intervention in improving cancer-related fatigue .  PATIENTS AND METHODS This r and omized controlled trial involved 109 women commencing adjuvant chemotherapy for stage I or II breast cancer in five chemotherapy treatment centers . Intervention group patients received an individualized fatigue education and support program delivered in the clinic and by phone over three 10- to 20-minute sessions 1 week apart . Instruments included a numeric rating scale assessing confidence with managing fatigue ; 11-point numeric rating scales measuring fatigue at worst , average , and best ; the Functional Assessment of Cancer Therapy-Fatigue and Piper Fatigue Scales ; the Cancer Self-Efficacy Scale ; the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ; and the Hospital Anxiety and Depression Scale . For each outcome , separate analyses of covariance of change scores between baseline ( T1 ) and the three follow-up time points ( T2 , T3 , and T4 ) were conducted , controlling for the variable 's corresponding baseline value . RESULTS Compared with the intervention group , mean difference scores between the baseline ( T1 ) and immediate after the test ( T2 ) assessment s increased significantly more for the control group for worst and average fatigue , Functional Assessment of Cancer Therapy-Fatigue , and Piper fatigue severity and interference measures . These differences were not observed between baseline and T3 and T4 assessment s. No significant differences were identified for any pre- or post-test change scores for confidence with managing fatigue , cancer self-efficacy , anxiety , depression , or quality of life . CONCLUSION Preparatory education and support has the potential to assist women to cope with cancer-related fatigue in the short term . However , further research is needed to identify ways to improve the potency and sustainability of psychoeducational interventions for managing cancer-related fatigue PURPOSE / OBJECTIVES To examine patterns of and relationships between activity , sleep , symptom distress , health status , and fatigue during and following adjuvant breast cancer chemotherapy with doxorubicin and cyclophosphamide . DESIGN Prospect i ve , descriptive , repeated measures . SETTING Midwestern , urban , oncology clinics . SAMPLE 14 women , ages 32 - 69 ( X = 52.4 ) , with stage I or II breast cancer receiving four cycles of chemotherapy .  METHODS Wrist actigraph , modified Morin Sleep Diary , Symptom Experience Scale , Medical Outcomes Study -Short Form 36 , and Piper Fatigue Scale  were used to collect data two days prior to and during the 21-day cycle 3 , and for three days at three weeks and two months following treatment 4 . MAIN RESEARCH VARIABLES Activity , sleep , symptom distress , health status , and fatigue . FINDINGS Fluctuating patterns of lowered activity , disturbed sleep , mild-to-moderate symptom distress , and moderate fatigue were identified . Mean activity levels ranged from 65%-80 % of norms during and following treatments . Patterns of sleep ( total rest , sleep latency , wake after sleep onset , and sleep efficiency ) differed from established norms . Patients experienced the highest levels of fatigue and symptom distress during the first four days after treatment 3 . Correlates of fatigue were greater symptom distress , lower activity , and poorer physical and social health status ; variables representing disturbed sleep trended toward associations with fatigue . CONCLUSION Activity , sleep , symptom distress , and health status cluster in patterns associated with either lower or higher fatigue . IMPLICATION S FOR NURSING PRACTICE Efforts to manage symptoms , remain active , and obtain quality sleep , especially in women with poorer health status , may assist in modifying fatigue PURPOSE / OBJECTIVES To examine the influence of the proposed symptom cluster of fatigue , nausea and vomiting , and sleep disturbances on clinical outcomes defined as behavior changes , depression , and performance status in children and adolescents before and after receiving cisplatin , doxorubicin , or ifosfamide chemotherapy .  DESIGN A prospect i ve , descriptive , within-group , before- and -after-chemotherapy design was used . SETTING Two major childhood cancer treatment hospitals in the United States . SAMPLE 67 patients aged 7 - 18 years who were receiving chemotherapy courses of cisplatin , doxorubicin , or ifosfamide .  METHODS Fatigue , depression , behavior , and performance assessment s were completed on the first day of cisplatin , doxorubicin , or ifosfamide therapy and one week later . Patients wore a  wrist actigraph on the nondominant h and during the course of therapy and for 48 hours after discharge from the hospital . Nausea and vomiting were measured every 24 hours during the course of therapy and for 48 hours after discharge . A linear mixed model was used to evaluate the influence of the symptom cluster . Regression analysis was used to examine the associations between performance status and the symptom cluster . Principal component analysis with varimax rotation was used to produce the correlation of sleep symptoms . MAIN RESEARCH VARIABLES Fatigue , nausea and vomiting , sleep disturbances , behavior , depression , and performance . FINDINGS Adolescents with the cluster of increased fatigue and sleep disturbances  experienced more depressive symptoms and behavior changes . Children with higher levels of fatigue had increased depressive symptoms . The more fatigue parents perceived in their children or adolescents , the more behavior and emotional difficulties were reported . CONCLUSIONS Fatigue , sleep disturbance , and nausea and vomiting , when clustered , impacted depressive symptoms and behavior changes in adolescents after chemotherapy . In children , fatigue alone impacted depressive symptoms and behavior changes . IMPLICATION S FOR NURSING Symptom clusters can have a significant impact on children 's and adolescents ' quality of life during cancer treatment . Early recognition and intervention for these symptoms are an important nursing role Few studies have attempted to describe the experience of symptoms in young children with cancer . This is due , in part , to the lack of vali date d symptom assessment scales for this patient population . The objective of this study was to evaluate the reliability and validity of a revised Memorial Symptom Assessment Scale ( MSAS ) in patients aged 7 - 12 as an instrument for the assessment of symptoms in young children with cancer . The MSAS ( 7 - 12 ) was administered to 149 children ( in patients and out patients ) who were undergoing treatment at either the Royal Marsden NHS Trust , London , United Kingdom or The Children 's Hospital at Westmead , Sydney , Australia . Validity was evaluated by comparison with the medical record , parental report , and concurrent assessment on visual analogue scales for selected symptoms . The data provide evidence of the reliability and validity of MSAS ( 7 - 12 ) and demonstrate that children with cancer as young as 7 years can report clinical ly relevant and consistent information about their symptom experience . Young children with cancer experience multiple symptoms . Approximately one-third had experienced lethargy and /or pain and /or insomnia during the 48 hours prior to the completion of MSAS ( 7 - 12 ) . The completion rate for MSAS ( 7 - 12 ) was high and the majority of children completed the instrument in a short period of time and with little difficulty . The instrument appears to be age appropriate and may be helpful to older children unable to independently complete MSAS ( 10 - 18 ) . Systematic symptom assessment may be useful in future epidemiological studies of symptoms and in cancer chemotherapy drug trials The objectives were to ( 1 ) prospect ively evaluate fatigue utilizing vali date d instruments in patients with localized prostate cancer , and ( 2 ) examine the relationships between fatigue , depression , quality of life , and sleep disturbance . The instruments used included : Piper Fatigue Scale , Beck Depression Inventory , Epworth Sleepiness Scale , and Functional Assessment of Cancer Therapy for Prostate Scale . Data on cancer stage , prostate specific antigen levels , hematocrit , patient 's body weight and radiation dosage were recorded . Patients were evaluated preradiotherapy , middle of radiotherapy , completion of radiotherapy , and at 4 - 5 weeks follow-up . Thirty-six veterans with localized prostate cancer were studied . Mean age was 66.9 years ( range 55 - 79 ) . Duration of treatment was 7 - 8 weeks . Univariate procedure and Wilcoxon Signed Rank-test were used to examine changes in pretreatment scores for each of the three subsequent study periods . To adjust for multiple comparisons Bonferroni test was used . Spearman Correlations were calculated among parameters . No significant changes were noted in mean scores of hematocrit and body weight during the study period . On the Piper Fatigue Scale , adjusted for multiple comparisons , the median scores were significantly higher at completion of radiotherapy as compared with preradiotherapy values . Three patients ( 8 % ) were experienced fatigue according to Piper Fatigue Scale before treatment as compared to nine patients ( 25 % ) at completion of radiotherapy . On Prostate Cancer Specific and Physical Well Being subscales of the Functional Assessment for Prostate Cancer Therapy , the scores were significantly lower at middle and completion of radiotherapy than at pretreatment . At preradiotherapy , middle of radiotherapy , completion of radiotherapy and follow-up evaluation , patients scoring higher on the Piper Fatigue Scale were more likely to report a poorer quality of Physical Well Being on Functional Assessment of Cancer Therapy for Prostates . No significant changes were noted in the Beck Depression Inventory and Epworth Sleepiness Scale scores during treatment . Eight patients scored 10 or more on the Beck Depression Inventory before starting radiotherapy , suggesting depressive symptomatology . Of these , only seven patients scored 10 or more at completion of treatment . The incidence of fatigue is lower in our study than in previously published data . A relationship exists between fatigue scores and physical well being subscale scores . Higher scores on the Piper Fatigue Scale at the completion of radiotherapy , as well as no changes on depression and sleepiness scales , suggest that fatigue may not be the result of depression or sleep disturbance . Based upon our previous work , we propose that the physical expression of fatigue may be secondary to a decline in neuromuscular efficiency and enhanced muscle fatigue OBJECTIVE Fatigue is a common cancer-related symptom and exacerbated by chemotherapy . Psychological interventions for fatigue show promise . One , Beating Fatigue , was adapted for delivery by telephone and evaluated in an exploratory trial . METHODS Eight patients and 12 professionals contributed to focus groups that guided adaptation of the intervention . The intervention , modified for delivery by telephone using motivational interviewing , was tested in an exploratory trial . Forty-four patients were recruited to the trial and r and omized between the intervention ( n=23 ) and control ( n=21 ) . Outcome data were collected on fatigue intensity , fatigue distress , fatigue self-efficacy , anxiety and depression at baseline and following completion of chemotherapy . These data were augmented by interviews conducted to inform underst and ing of the intervention 's mechanism , feasibility and acceptability . RESULTS The intervention was both feasible and acceptable to patients and most reduced fatigue distress ( Effect Size ES=0.62 ) . It also reduced fatigue intensity ( ES=0.18 ) , fatigue self-efficacy ( ES=-0.34 ) , and anxiety ( ES=0.31 ) . It did not reduce depression . CONCLUSION These preliminary data are encouraging and support the delivery of interventions for cancer-related fatigue by telephone . Motivational interviewing appeared key to the intervention 's success . A larger definitive RCT is indicated . PRACTICE IMPLICATION S Opportunities should be sought to deliver psychologically-based interventions for fatigue by telephone To determine the prevalence , severity , and correlates of fatigue among patients with cancers of the prostate or breast receiving high dose radiotherapy with curative intent , a prospect i ve , question naire-based study evaluated a convenience sample of 62 patients who were about to start a course of radiotherapy .  Patients were assessed immediately prior to treatment , and again within a week of finishing . Fatigue was assessed using the Fatigue Severity Scale ( FSS ) and the Bidimensional Fatigue Scale ( BFS ) . Quality of life was assessed using the European Organisation for Research and Treatment of Cancer 30-item Quality of Life Question naire ( EORTC QLQc30 ) . Psychological distress was assessed using the Hospital Anxiety and Depression Scale ( HADS ) . Personality Traits were assessed using the Eysenck Personality Inventory ( EPI ) . Fatigue severity increased significantly on 3 out of the 5 assessment instruments used . Radiotherapy was associated with a decline in global quality of life , role , cognitive and social functioning , and an increase in nausea/vomiting , pain , insomnia , diarrhea , and financial difficulty . At baseline , 39 % of the variation in fatigue scores among the patients could be explained by a combination of measures of their global quality of life and physical functioning . A combination of fatigue and anxiety scores at baseline was able to predict 54 % of the variation in fatigue scores at the completion of radiotherapy . These data indicate that fatigue is a significant problem for patients receiving radical radiotherapy , although its severity is relatively modest PURPOSE / OBJECTIVES To evaluate the feasibility of a patient-controlled cognitive-behavioral intervention for  pain , fatigue , and sleep disturbance during treatment for advanced cancer and to assess initial efficacy of the intervention . DESIGN One group pre- and post-test design . SETTING Outpatient oncology clinics at a comprehensive cancer center in the midwestern United States . SAMPLE 30 adults with advanced ( recurrent or metastatic ) colorectal , lung , prostate , or gynecologic cancer receiving chemotherapy or radiotherapy . METHODS Participants completed baseline measures ( e.g. , demographics , symptom inventory ) and received education and training to use an MP3 player loaded with 12 cognitive-behavioral strategies ( e.g. , relaxation exercises , guided imagery , nature sound recordings ) . Participants used the strategies as needed for symptom management for two weeks , keeping a log of symptom ratings with each use . Following the two-week intervention , participants completed a second symptom inventory and an evaluation of the intervention . MAIN RESEARCH VARIABLES Feasibility , patient-controlled cognitive-behavioral intervention , pain , fatigue , and sleep disturbance . FINDINGS Thirty of 43 eligible patients ( 73 % ) agreed to participate ; of them , 27 ( 90 % ) completed the study . Most reported that they enjoyed the intervention , had learned useful skills , and perceived improvement in their symptoms . Symptom scores at two weeks did not differ significantly from baseline ; however , significant reductions in pain , fatigue , and sleep disturbance severity were found in ratings made immediately before and after use of a cognitive-behavioral strategy . CONCLUSIONS The patient-controlled cognitive-behavioral intervention appears to be feasible for additional study and could reduce day-to-day severity of co-occurring pain , fatigue , and sleep disturbance . IMPLICATION S FOR NURSING A r and omized , controlled trial is needed to test efficacy of the intervention for co-occurring pain , fatigue , and sleep disturbance . Meanwhile , based on previous efficacy studies , cognitive-behavioral strategies can be recommended for certain individual symptoms Background : Fatigue has a significant impact on the quality of life ( QOL ) of cancer patients . Recent research has suggested that physical activity can reduce fatigue in patients receiving active cancer treatment . In this project , we examined the impact that participation in a r and omized controlled trial of a multidisciplinary intervention design ed to impact overall QOL had on fatigue for advanced cancer patients actively receiving treatment . Methods : Patients with newly diagnosed cancer were r and omly assigned to an 8-session structured multidisciplinary intervention or a st and ard-care arm at the beginning of their course of radiotherapy ( RT ) design ed to impact QOL . Ninety-minute sessions were led by either a psychiatrist or psychologist , collaborating with a nurse , physical therapist , chaplain , or social worker , depending on the session 's theme . The fatigue assessment s used in this trial included the Linear Analogue Self Assessment ( LASA ) , the Profile of Mood States ( POMS ) , Spielberger 's State-Trait Anxiety Inventory ( STAI ) , and the Symptom Distress Scale ( SDS ) . Results : There were 115 participants enrolled and the 2 r and omization arms were well balanced in terms of baseline characteristics and treatment received except for increased commuting distance for the patients in the intervention arm ( P = 0.042 ) . Most of scores indicated less fatigue ( higher score ) in the st and ard treatment group , but there were no statistically significant differences found at baseline and weeks 4 , 8 , and 27 except for SDS at week 8 ( P = 0.018 ) with less patients reporting significant fatigue in the st and ard treatment arm . For the entire participant population , fatigue levels initially worsened with radiotherapy , stabilized at week 8 , and returned to baseline by week 27 . Disease site , chemotherapy use , and radiotherapy dose did not have a significant impact on fatigue levels . Conclusions : Radiotherapy initially caused a worsening of fatigue but with time fatigue levels returned to baseline . Clinical ly , this structured multidisciplinary intervention had no impact on fatigue , and there was the suggestion the multiple sessions may have contributed to worse fatigue during active cancer treatment The purpose of this study was to investigate the relationships between clinical factors ( including haemoglobin value , chemotherapeutic agents , and corticosteroid use ) and changing patterns of fatigue before and for the next 10 days following the start of a new round of chemotherapy in children with cancer . A prospect i ve longitudinal design was used to collect data from 48 paediatric oncology patients who were about to begin a new round of chemotherapy and their parents .  Fatigue levels were assessed using multidomain question naires with three categories of patient self-report ( including ‘ General Fatigue ’ , ‘ Sleep/Rest Fatigue ’ , and ‘ Cognitive Fatigue ’ ) and four categories of parent proxy-report ( including ‘ Lack of Energy ’ , ‘ Unable to Function ’ , ‘ Altered Sleep ’ , and ‘ Altered Mood ’ ) . The findings suggest that fatigue from both patient self-report and parent proxy-report changed significantly over time . The major findings from this study are that patients have more problems with fatigue in the first few days after the start of a cycle of chemotherapy . Corticosteroid use and haemoglobin value were associated with significant increases in fatigue that were sustained for several days and reached the highest level of fatigue at day 5 for those receiving concurrent steroids . The association of chemotherapeutic agents with fatigue varied between patient self-report and parent report , but the type of chemotherapeutic agents used was not associated with most changes in fatigue
These two scales show similar attributes with reasonably good internal consistency and responsiveness .
Either the Fatigue Scale or PedsQL Multidimensional Fatigue Scale can be incorporated into clinical research .
CONTEXT Despite the recognized distressing symptom of fatigue in children with cancer , little information is available to assist in the selection of an instrument to be used to measure fatigue .
OBJECTIVES The objectives of this study were to 1 ) describe the instruments that have been used to measure cancer-related fatigue in children and adolescents and 2 ) summarize the psychometric properties of the most commonly used instruments used to measure fatigue in children and adolescents with cancer .