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A Prospective Evaluation of Fatigue in Pediatric Brain Tumor Patients Treated With Radiation Therapy
Kellen Gandy1, Tiffany Chambers1, Kimberly P Raghubar1
1Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Insights
Pediatric brain tumor patients experience significant fatigue before and during radiotherapy. This acute fatigue is widespread and may not be linked to specific radiation types or clinical factors.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Clinical Psychology
Background:
- Fatigue is a known long-term side effect of cranial radiotherapy in pediatric brain tumor survivors.
- Limited data exists on the prevalence and trajectory of acute fatigue during active radiotherapy treatment.
Purpose of the Study:
- To longitudinally assess acute fatigue in pediatric patients newly diagnosed with brain tumors during radiotherapy.
- To identify clinical factors associated with fatigue during treatment.
Main Methods:
- Proxy-reported Parent Fatigue Scale administered weekly during radiotherapy.
- Multiple linear regressions used to analyze associations between clinical factors and fatigue.
- Comparison of fatigue levels across different radiation modalities.
Main Results:
- Moderate-to-severe fatigue was reported by 94% of patients during treatment.
- Craniospinal irradiation dose was a significant predictor of fatigue only in the first week.
- Fatigue levels were not significantly associated with radiation modality or other clinical factors by therapy completion.
Conclusions:
- Acute, moderate-to-severe fatigue is prevalent in pediatric brain tumor patients before and throughout radiotherapy.
- Further research is needed to understand the link between acute and long-term fatigue and to develop interventions.
Abstract:
Background: Fatigue is a well-established consequence of cranial radiotherapy in survivors of pediatric brain tumor, but less is known about acute fatigue during radiotherapy treatment. This study aimed to longitudinally evaluate fatigue in newly diagnosed pediatric patients with brain tumors during treatment. Methods: Primary caregivers of pediatric patients with brain tumors completed the proxy-reported Parent Fatigue Scale assessments prior to radiotherapy and weekly during radiotherapy treatment. The association between clinical factors and fatigue at each assessment was evaluated with multiple linear regressions. A comparison of fatigue between radiation modalities was also analyzed. Results: A total of 33 caregivers completed pre-radiation fatigue assessments, with 29 reporting fatigue during radiotherapy. Patients were aged 3 to 16 years (M = 8.32) at diagnosis and diagnosed with medulloblastoma (n = 23), primitive neuroectodermal tumor (n = 2), ependymoma (n = 1), germ cell tumor (n = 1), pineoblastoma (n = 1), atypical teratoid rhabdoid (n = 1), and other unspecific tumors (n = 3). Moderate-to-severe fatigue was reported for the majority of patients (31/33; 94%) during treatment. Craniospinal irradiation dose was the only significant predictor of fatigue (p < .05), but this association was restricted to the first week of therapy and was attenuated by therapy completion. Discussion: Although fatigue is often considered a long-term consequence of cranial radiotherapy, this pilot study demonstrates that moderate-to-severe fatigue is pervasive prior to radiotherapy and persists throughout treatment in pediatric patients with brain tumors, regardless of radiation modality or clinical factors. Additional research is warranted to establish a link between acute and long-term fatigue and develop interventions to mitigate this adverse outcome.
