PHOENIX—Over the trajectory of chemotherapy treatment, school-age children appear to develop resilience to fatigue, according to research presented at the Oncology Nursing Society (ONS) Connections: Advancing Care Through Science conference.

In childhood cancer, fatigue, or “lack of energy,” is pervasive and distressing. Physical energy relates to both fatigue and carnitine, which is a micronutrient that delivers long-chain fatty acids to muscle mitochondria. The carnitine network is disrupted by the chemotherapy drugs ifosfamide, cisplatin, and doxorubicin. Chemotherapy may influence both carnitine and fatigue.

This study examined changes in carnitine and fatigue levels during the first eight cycles of chemotherapy with ifosfamide, cisplatin, or doxorubicin in 58 childhood cancer patients, age 3 to 18 years. The patients were within 2 months of diagnosis and 38 were males. The age distribution of the patients was 13 patients under 7 years old, 31 age 7-12 years, and 14 age 13-18 years. Among the patients, 34 had solid tumors and 24 had leukemia or lymphoma. One or two of the three chemotherapy drugs were received by 50 of the patients, while eight received all three drugs. Measurements of carnitine plasma levels and self-reported fatigue occurred between day 15 and 29 of the second, fourth, sixth, and eighth cycles of chemotherapy. The fatigue of children younger than age 7 years was measured through the Parent Fatigue Scale.

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Among children age 7 to 12 years, fatigue significantly decreased. Total carnitine levels did not change significantly for the group. However, carnitine levels were higher at the last measurement in the group who received all three chemotherapy drugs, compared with those who received only one or two of the drugs. During cancer treatment, carnitine did not decrease, and it was not found to influence the fatigue levels of children undergoing cancer treatment.

The decrease in fatigue in the school-age group over 8 cycles of chemotherapy is consistent with an earlier study (Hooke et al, 2011) that found a decrease over the first 3 cycles, said Mary C. Hooke, RN, PhD, CPON, during a presentation of the research at the ONS Connections meeting. This means the school-age group may be more resilient to fatigue—which will be important to consider when developing intervention studies, Hooke concluded.

Larger multi-site studies are needed to learn about fatigue and related symptoms in both specific disease groups and specific developmental groups, the researchers added.