Puhr 2019.
| Methods | Study design: cross‐sectional study Instrument used to assess fatigue: Fatigue Questionnaire Validated questionnaire: yes Cut‐off score or criterion for severe fatigue: sum score of ≥ 4 on the fatigue questionnaire and symptom duration of ≥ 6 months Time points at which outcome data were collected: NA, cross‐sectional study Inclusion criteria: treatment for paediatric brain tumour during the first 16 years of life, diagnosis during the period 1990 ‐ 2012, aged 18 ‐ 30 at the time of recruitment, completed treatment no later than 2 years prior to recruitment in the study Exclusion criteria: self‐reported severe difficulties with activities of daily life, self‐reported severe sensory and motor disabilities, pre‐tumour cognitive/neurological problems due to non‐tumour diagnosis evidenced in patient records |
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| Participants | Sample characteristics: N of participants original cohort: 353; N of participants described study group: 114; N of participants study group of interest: 114; N of participants fatigue assessed: 110 Participant characteristics: Tumour type: brain tumour n = 114 Tumour stage: nm Age at diagnosis: mean 9.4 years (range 0.5 ‐ 17; SD 4.43) Time since end of therapy: mean 13.9 years (range 2.6 ‐ 25.1; SD 5.61) Age at assessment: mean 23.4 years (SD 3.5) F/M: 66/48 BMI: nm Race/ethnicity: nm Marital status: nm Highest completed education level: 1st to 10th grade: 0.1%, vocational studies: 16.7%, general studies: 27.2%, higher education: 55.3% Employment: nm Physical activity level: nm Sleeping problems: nm Psychosocial problems: SCL‐90‐R depression subscale mean 51.3 (SD 11.58), SCL‐90‐R anxiety subscale mean 52.4 (SD 10.05) Comorbidities: nm Genetic factors/mutations: nm |
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| Interventions | N of participants surgery only: 74 N of participants chemotherapy only: 1 N of participants surgery + chemotherapy: 2 N of participants surgery + cranial irradiation: 5 N of participants surgery + chemotherapy + cranial irradiation: 22 N of participants no treatment: 3 N of participants treatment unknown: 7 |
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| Outcomes | Severe fatigue: N of participants with severe fatigue: 16/110 (14.5%) Risk and associated factors: Dependent factor: severe fatigue (yes/no)a Univariable: Significant: type of treatment (surgery, CRT and chemotherapy: fatigued 26.9% vs non‐fatigued 8.3%, P = 0.017), time since treatment (fatigued mean 10.95 years vs non‐fatigued mean 14.32, P = 0.045) Not significant: gender, age at time of survey, age at diagnosis, type of brain tumour, psychiatric comorbidity |
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| Notes | Funding sources: Supported by the Norwegian Cancer Society (6865381); the Norwegian ExtraFoundation for Health and Rehabilitation (2013/2/0234); Oslo University Hospital’s Childrens’ Foundation (36219) Declaration of interest: nm The following data were obtained from the study author: N of participants with severe fatigue aUnivariable analysis for continuous data and Chi2 test for categorical data were applied (characteristics fatigued vs non‐fatigued were compared). Effect estimates were not reported for non‐significant factors. Psychiatric comorbidity was classified according to ICD‐10 codes F01‐F99. |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Representative study group (selection bias) | High risk | The described study group consisted of < 90% of the original cohort |
| 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 | No multivariable analyses |
| 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 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 | Unclear risk | Effect estimated were not reported for all factors |