Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.
Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.
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DOI：
10.1002/cncr.25797
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发表时间：
2011-06-01
期刊：
影响因子：
6.2
通讯作者：
Krull, Kevin R.
中科院分区：
文献类型：
--
作者：
Clanton, Nancy R.;Klosky, James L.;Li, Chenghong;Jain, Neelam;Srivastava, Deo Kumar;Mulrooney, Daniel;Zeltzer, Lonnie;Stovall, Marilyn;Robison, Leslie L.;Krull, Kevin R.
儿童癌症的长期幸存者有疲劳、睡眠问题和神经认知障碍的风险，尽管这些结果之间的关联以前没有被研究过。使用经验证的神经认知问卷对1426名儿童癌症幸存者研究的幸存者进行了结局评估。使用人口统计学和治疗因素，以及FACIT-疲劳、简明36活力量表（SF-36-V）、匹兹堡睡眠质量指数（PSQI）和埃普沃思嗜睡量表（ESS）的幸存者报告计算神经认知损害的相对风险。神经认知功能障碍被确定在超过20%的幸存者，使用同胞为基础的规范进行比较。多变量Logistic回归模型显示疲劳（RR=1.34，1.13-1.59）、白天嗜睡（RR=1.68，1.55-1.83）、睡眠质量差（RR=1.23，1.01-1.49）和活力下降（RR=1.75，95%CI 1.33-2.30）均与任务效率受损相关。同样，疲劳（RR=1.77，1.23-2.55），嗜睡（RR=1.38，1.14-1.67）和活力下降（RR=3.08，1.98-4.79）预测情绪调节问题。组织性下降与嗜睡增加（RR=1.80，1.31-2.48）和活力下降（RR=1.90，1.37-2.63）相关。记忆力受损与睡眠质量差（RR=1.45，1.19-1.76）、嗜睡增加（RR=2.05，1.63-2.58）和活力下降（RR=2.01，1.42-2.86）相关。疲劳、嗜睡、睡眠质量和活力对神经认知结果的影响与颅放射治疗、类固醇和抗代谢药物化疗、性别和当前年龄的影响无关。儿童癌症长期幸存者的神经认知功能似乎特别容易受到疲劳和睡眠中断的影响。这些发现表明，幸存者应强调睡眠卫生，因为它可能为改善神经认知结果的干预提供额外的机制。
Long-term survivors of childhood cancer are at risk for fatigue, sleep problems, and neurocognitive impairment, though the association between these outcomes has not been previously examined. Outcomes were evaluated in 1426 survivors from the Childhood Cancer Survivor Study using a validated Neurocognitive Questionnaire. Relative risks for neurocognitive impairment were calculated using demographic and treatment factors, and survivors’ report on the FACIT-Fatigue, the Short Form-36 Vitality Scale (SF-36-V), the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS). Neurocognitive impairment was identified in over 20% of survivors, using sibling-based norms for comparison. Multivariable logistic regression models revealed that fatigue (RR=1.34, 1.13–1.59), daytime sleepiness (RR=1.68, 1.55–1.83), poor sleep quality (RR=1.23, 1.01–1.49) and decreased vitality (RR=1.75, 95% CI 1.33–2.30) were all associated with impaired task efficiency. Likewise, fatigue (RR=1.77, 1.23–2.55), sleepiness (RR=1.38, 1.14–1.67) and decreased vitality (RR=3.08, 1.98–4.79) were predictive of emotional regulation problems. Diminished organization was associated with increased sleepiness (RR=1.80, 1.31–2.48) and decreased vitality (RR=1.90, 1.37–2.63). Impaired memory was associated with poor sleep quality (RR=1.45, 1.19–1.76), increased sleepiness (RR=2.05, 1.63–2.58), and decreased vitality (RR=2.01, 1.42–2.86). The impact of fatigue, sleepiness, sleep quality and vitality on neurocognitive outcomes was independent of the effects of cranial radiation therapy, steroids and antimetabolite chemotherapy, sex, and current age. Neurocognitive function in long-term survivors of childhood cancer appears particularly vulnerable to the effects of fatigue and sleep disruption. These findings suggest sleep hygiene should be emphasized among survivors, as it may provide an additional mechanism for intervention to improve neurocognitive outcomes.
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