Langeveld 2003.
| Methods | Study design: cross‐sectional study Instrument used to assess fatigue: Multidimensional Fatigue Inventory Validated questionnaire: yes Cut‐off score or criterion for severe fatigue: NAa Time points at which outcome data were collected: NA, cross‐sectional study Inclusion criteria: aged 16 or older, pathological confirmation of malignancy, cancer had to have been diagnosed before the participants were 19 years of age Exclusion criteria: schizophrenic, developmentally delayed, ineligible because of a current health problem causing emotional upset |
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| Participants | Sample characteristics: N of participants original cohort: unknown; N of participants described study group: 416; N of participants study group of interest: 416; N of participants fatigue assessed: 416 Participant characteristics: Tumour type: Leukaemia/non‐Hodgkins lymphoma without CRT n = 116; Leukaemia/non‐Hodgkins lymphoma with CRT n = 87, solid tumour n =183, brain/CNS tumour n = 30 Tumour stage: nm Age at diagnosis: mean 8 years (SD 4.7; range 0 ‐ 18) Time since end of therapy: mean 15 years (SD 5.9; range 5 ‐ 33) Age at assessment: mean 24 years (SD 5.2; range 16 ‐ 49) F/M: 200/216 BMI: nm Race/ethnicity: nm Marital status: single n = 300, living together/married n = 116 Highest completed education level: lower level (less than high school) n = 278, higher level (high school or advanced degree) n = 138 Employment: employed n = unknown, student/homemaker n = unknown, unemployed n = 42 Physical activity level: nm Sleeping problems: nm Psychosocial problems: nm Comorbidities: medical limitations (graded with an adapted version of the Scale for Medical Limitations): none/mild n = 68, moderate n = 189, severe n = 159 Genetic factors/mutations: nm |
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| Interventions | N of participants chemotherapy (with or without surgery): 197 N of participants radiotherapy (with or without surgery): 29 N of participants radiotherapy + chemotherapy (with or without surgery): 190 |
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| Outcomes | Severe fatigue: N of participants with severe fatigue: NDa Risk and associated factors: Dependent factor: fatigue (continuous)b Multivariable: Significant: gender (female, b = 0.19, P < 0.001), employment status (ref = unemployed; student/homemaker, b = −0.12; employed, b = −0.20, P < 0.05), late effects/health problems (b = 0.14, P < 0.05), depression (b = 0.54, P < 0.001), CRT (b = −0.16, P < 0.05) Non‐significant: age at follow‐up (b = 0.01), marital status (married, b = 0.04), educational level (higher level, b = 0.03), age at diagnosis (b = 0.06), treatment (ref = CT, RT b = 0.02, RT+CT b = 0.04), years since completion of therapy (b = 0.02), diagnosis (ref = leukaemia/NHL without CRT, solid tumour b = 0.02, CNS tumour b = −0.08) |
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| Notes | Funding sources: Supported by a grant from the Dutch Cancer Society Declaration of interest: nm aAuthors report fatigue on continuous scale. Additional information on severe fatigue was requested and not available. bAnalyses were performed with fatigue score on a continuous scale as outcome (regression analyses). P values were not reported for non‐significant risk and associated factors |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Representative study group (selection bias) | High risk | Size of original cohort is unclear, 459 eligible participants, 416 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 | Low risk | Important prognostic factors and follow‐up were taken into account |
| Well‐defined study group (reporting bias) | Unclear risk | Type of cancer and cancer treatment are mentioned but information about specific chemotherapeutic agents, radiotherapy fields and doses are not reported. Inclusion and exclusion criteria are described |
| Well‐defined follow‐up (reporting bias) | Low risk | Length of follow‐up is mentioned |
| Well‐defined outcome fatigue (reporting bias) | Low risk | Authors reported which instrument they used to assess fatigue, and how they described fatigue (continuous scale) |
| Well‐defined risk estimation | Low risk | Regression coefficients of linear regression are provided |