Structural equation modeling to explore putative causal factors for chronic fatigue in childhood cancer survivors: a...

To explore putative causal relations for chronic fatigue (CF) in childhood cancer survivors (CCS) using structural equation modeling (SEM).

Interrelationships between factors that were previously associated with CF and their causal relation with CF were investigated using SEM and causal discovery methodology. A bootstrap method was used to ascertain how robust each finding was, presenting the percentage of times that each discovered edge was found in 1000 bootstrap samples as a measure of confidence (with > 50% needed to be confident in a found edge).

1927 CCS (51.7% male) with a mean age of 35 years (SD 9) participated in the study (23.6% reported CF). Results indicated that sex had a putative causal effect on CF (bootstrap confidence 81%), while CF was causally linked to helplessness, physical activity, pain, BMI, and sleep problems (bootstrap confidence 82%, 78%, 78%, 51%, and 51%, respectively). The relation between CF and depression was found to be two-way (bootstrap confidence 68%), indicating a reciprocal relation or the presence of a latent confounder. The same applied to the relations between CF and anxiety, self-esteem, and social functioning, but this could not be confirmed with high confidence (bootstrap confidence < 50%).

This study provides insight into the complex etiology of CF and could give guidance in the development of appropriate prevention and/or intervention strategies for CF in CCS.

Results show the consequences of having CF and could help to understand the impact it has on daily life.