Increased Incidence of Fatigue in Pediatric Hematopoetic STEM CELL Transplant Recipients

Background: Fatigue is a common side effect of chemotherapy, but is poorly studied in pediatric HSCT recipients. Hope, or goal-directedness, may be impacted by fatigue. The incidence and severity of fatigue and its impact on hope warrants investigation.
Patients and Methods: Patients were eligible for enrollment in this prospective study if they were between the ages of 5-18 years. Patients unable to read English or otherwise unable to complete the survey were ineligible. Subjects completed the PedsQL Multidimensional Fatigue Scales(Fatigue QOL) and Children's Hope Scale. Subjects were enrolled during a regular follow-up clinic visit and completed the survey. The results of the fatigue surveys were then compared to healthy subjects and oncology patients in a validated sample as reported by Varni et al (Cancer, 2002; 94:2090-2106).
Results: A total of 25 subjects who had HSCT were enrolled, at a mean of 12 yrs. (range of 6-19 yrs). 2 had received autologous HSCT, 23 had received allogeneic HSCT, and 1 patient received an auto followed by an allo HSCT. 6 had GVHD at the time of survey completion. HSCT recipients had an average Total Fatigue QOL score of 69.9 (range 38.9-95.8) and 18/25 (72%) had a lower score than the average for healthy subjects. HSCT recipients had a statistically significant lower average Total Fatigue QOL score (69.9 vs. 80.5, p=0.002) and average General Fatigue QOL score (71.3 vs. 85.3, p=0.002 ), and a trend to a lower average Sleep Fatigue QOL score (62.65 vs. 75, p=0.002), when compared with healthy subjects. There was no statistically significant difference in average Cognitive Fatigue QOL scores (73.98 vs. 81.14, p=0.63).There was no statistically significant differences in average Fatigue QOL scores in SCT recipients when compared to patients undergoing chemotherapy. Proxy reports of fatigue were higher than comparative populations. An analysis of factors failed to show any significant impact on fatigue including age, days post transplant, sex, TBI received, GVHD, mental illness, ICU admission, and malnutrition impacted fatigue or hope. The average hope score was 0.76 (range of 0.46-1), which corresponds to feeling hopeful “a lot of the time.” There was a direct correlation between Total Fatigue QOL and hope scores (r-0.472, p=0.02).
Conclusions: Fatigue is more prominent in pediatric HSCT recipients than a control population. Fatigue is related to hope. Fatigue experienced by HSCT recipients was similar to that seen in children receiving chemotherapy. Proxy reports of fatigue were much greater than those reported by both the subject and compared to healthy and oncology proxy reports. Larger prospective studies are needed to determine risk factors for fatigue and to develop interventions to alleviate fatigue in pediatric HSCT recipients.