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Evaluating the Role of Mitochondrial Function in Cancer-related Fatigue
Published on: May 17, 2018
A cross-sectional study of carnitine deficiency and fatigue in pediatric cancer patients
Jin-Shei Lai1, Tracy Haertling2, Joanna Weinstein3
1Department of Medical Social Sciences and Pediatrics, Northwestern University Feinberg School of Medicine, 633 N St Clair, 19th Floor, Chicago, IL 60611, USA. js-lai@northwestern.edu.
Insights
Carnitine deficiency is common in pediatric cancer patients but not directly linked to fatigue overall. An unexpected link was observed in a subgroup of patients who completed therapy.
Area of Science:
- Pediatric Oncology
- Nutritional Biochemistry
Background:
- Carnitine deficiency is observed in cancer patients and linked to fatigue.
- Understanding carnitine levels in pediatric cancer is crucial for managing treatment side effects.
Purpose of the Study:
- To determine the prevalence of carnitine deficiency in pediatric cancer patients.
- To investigate the relationship between carnitine levels, fatigue, and other factors in this population.
Main Methods:
- 142 pediatric cancer patients (ages 8-17) were assessed.
- Carnitine levels (total, free, acylcarnitine) and fatigue were measured using validated scales and numeric ratings.
- Carnitine deficiency was defined by low total/free carnitine or high acylcarnitine levels.
Main Results:
- 19.7% had decreased total carnitine and 42.8% had decreased free carnitine.
- No patients showed elevated acylcarnitine levels.
- Carnitine deficiency was associated with age, treatment status, time since chemotherapy, and BMI, but not overall fatigue.
Conclusions:
- No direct association between carnitine deficiency and fatigue was found in the overall cohort.
- An unexpected inverse relationship between fatigue and carnitine levels was noted in patients off-therapy with high fatigue.
- Further research is needed to clarify the role of carnitine in pediatric cancer-related fatigue.
Purpose:
Carnitine deficiency has been found in cancer patients and has been associated with fatigue. This study aimed to explore the prevalence of carnitine deficiency in pediatric cancer patients and its relationship with fatigue and other potential contributing factors.
Methods:
Children with cancer or Langerhans cell histiocytosis who were receiving treatment or had completed therapy were eligible. Patients completed the Pediatric Functional Assessment of Chronic Illness-Fatigue, the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, a numeric fatigue rating, and had carnitine levels obtained. Carnitine deficiency was defined as a total and/or free carnitine level less than normal for age or an acylcarnitine value higher than normal for age.
Results:
Data from 142 children aged 8-17 were analyzed. Twenty-eight of 142 (19.7 %) had decreased total and 42.8 % (12/28) had decreased free carnitine levels. No patients had elevated acylcarnitine levels or elevated ratios. Patients with versus without carnitine deficiency differed by age (p = 0.043), treatment (p = 0.037), duration since last chemotherapy (p = 0.020), and body mass index (p = 0.010), but not fatigue, when all data were analyzed together. Yet, a negative relationship between fatigue and carnitine levels was found on a subgroup (off-therapy; fatigue worse than the norm).
Conclusion:
No significant association between fatigue and carnitine level was demonstrated when data from all patients were analyzed together; however, a significant yet unexpected relationship was found for patients who completed therapy and reported elevated fatigue. Given the small sample size, these results should be interpreted with caution. Future studies to explore impact upon excessive carnitine levels are warranted.
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