Hamre 2013a.

Methods	Study design: cross‐sectional study Instrument used to assess severe fatigue: Fatigue Questionnaire Validated questionnaire: yes Cut‐off score or criterion for severe fatigue: sum score ≥ 4 for all 11 dichotomised items and duration of symptoms for ≥ 6 months Time points at which outcome data were collected: NA, cross‐sectional study Inclusion criteria: treatment for HL as first cancer at university hospitals in Norway or treatment at Oslo University Hospital for ALL or NHL, diagnosed between 1970 and 2000 (1970 and 2002 for ALL), age at diagnosis ≤ 18 years (≤ 16 years for ALL), survival for ≥ 5 years, age at survey > 18 years, alive at June 2007 (April 2009 for ALL)a Exclusion criteria: second cancer or pregnancy (except for comparison to control group), incomplete questionnaires
Participants	Sample characteristics: N of participants original cohort: unknown; N of participants described study group: 290; N of participants study group of interest: 290; N of participants fatigue assessed: 290 Participants characteristics: Tumour type: ALL n = 151, HL n = 92, NHL n = 47 Tumour stage: nm Age at diagnosis: median 9.5 years (range 0.3 ‐ 18.4) Time since diagnosis: median 21.1 years (range 6.9 ‐ 39.4) Age at assessment: median 29.6 years (range 18.3 ‐ 54.5) F/M: 139/140 BMI: > 30 kg/m2 n = 31 Race/ethnicity: nm Marital status: in a partnership: n = 145 Highest completed education: education ≥ 12 years: n = 175 Employment: nm Physical activity level: nm Sleeping problems: nm Psychosocial problems: mental distress: HADS total score mean 8.4 (SD 6.2) Comorbidities: impaired heart function n = 73, reduced lung function n = 70, present hypothyroidism n = 49 Genetic factors/mutations: nm
Interventions	N of participants chemotherapy: 179 N of participants radiotherapy: 13 N of participants chemotherapy + radiotherapy: 87 N of participants surgery: 0 N of participants cranial irradiation: 19; dose median range: 20 Gy (12 ‐ 54 Gy) N of participants radiotherapy mediastinum: 69; dose median range: 36 Gy (18 ‐ 44 Gy) N of participants other radiotherapy:12; dose median range: 40 Gy (13 ‐ 41 Gy) N of participants anthracyclines: 199; dose median range: 150 mg/m2 (40 ‐ 510 mg/m2)
Outcomes	Severe fatigue: N of participants with severe fatigue: 79/290 (27.2%); ALL 34/151 (22.5%), NHL 14/47 (29.8%), HL 32/92 (34.8%) Risk and associated factors: Dependent factor: severe fatigue (yes/no)b Univariable: Significant: age at survey (OR 1.04 (95% CI 1.00 to 1.07), P = 0.01), tumour type (ALL = ref, NHL OR 1.4 (95% CI 0.6 to 2.9), P = 0.4, HL OR 1.8 (95% CI 1.0 to 3.3), P = 0.05), mental distress (OR 1.1 (95% CI 1.1 to 1.2), P < 0.001)) Non‐significant: BMI ≥ 30 kg/m2 (OR 1.8 (95% CI 0.8 to 4.0), P = 0.1), education (≤ 11 years, OR 1.6 (95% CI 0.8 to 2.7), P = 0.1), marital status (not in a partnership, OR 0.7 (95% CI 0.4 to 1.3), P = 0.3), present hypothyroidism (OR 1.8 (95% CI 0.9 to 3.4), P = 0.09), gender (female, OR 0.9 (95% CI 0.5 to 1.5), P= 0.7) Multivariable: Significant: mental distress (OR 1.15 (95% CI 1.1 to 1.2), P < 0.001) Non‐significant: age at survey (OR 1.05 (95% CI 1.00 to 1.1), P = 0.1), present hypothyroidism (OR 1.4 (95% CI 0.7 to 3.0), P= 0.4), gender (female, OR 0.8 (95% CI 0.46 to 1.5), P = 0.6), tumour type (ALL = ref, NHL OR 1.5 (95% CI 0.6 to 3.4), P = 0.4, HL OR 1.7 (95% CI 0.8 to 3.5), P = 0.2)
Notes	Funding sources: Supported by “Helse Sorost HF” Declaration of interest: No competing financial interest exist Numbers of gender, BMI and interventions is based on n = 279 aStudy author confirmed that the study population had no evidence of disease at time of the study. bAnalysis for associated factors is based on n = 279, participants who were pregnant (n = 6) or had a second cancer (n = 5) were excluded from risk factor analysis.
Risk of bias
Bias	Authors' judgement	Support for judgement
Representative study group (selection bias)	High risk	Size of original cohort unclear, > 430 eligible participants, 290 described study group, < 90%
Adequate follow‐up assessment (attrition bias)	Low risk	Outcome was assessed for > 95% of the study group of interest
Blinded outcome assessor (detection bias) All outcomes	High risk	Outcome assessors were not blinded to the investigated determinant
Adjustment important confounders	High risk	Follow‐up was not taken into account
Well‐defined study group (reporting bias)	Unclear risk	Type of cancer and cancer treatment are mentioned, specific chemotherapeutic agents and doses is not reported (only for anthracyclines). Inclusion and exclusion criteria are described.
Well‐defined follow‐up (reporting bias)	Low risk	Length of follow‐up is mentioned
Well‐defined outcome severe fatigue (reporting bias) All outcomes	Low risk	The authors reported which instrument they used to assess fatigue and what they considered to be severe fatigue
Well‐defined outcome fatigue (reporting bias)	Low risk	Authors reported which instrument they used to assess fatigue, and how they described fatigue (severe fatigue)
Well‐defined risk estimation	Low risk	Prevalence rates for subgroup diagnosis are provided and odds ratio are calculated for all factors