TABLE 3.
Multivariable Analyses of Risk and Associated Factors for Chronic Fatigue in Adult Childhood Cancer Survivors
| Model I: Block 1 | Model II: Blocks 1 + 2 | Model III: Blocks 1 + 2 + 3 | Model IV: Blocks 1 + 2 + 4 | Model V: Blocks 1 + 2 + 3 + 4 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | |
| Block 1: Demographic and general disease characteristics | ||||||||||
| Gender | ||||||||||
| Male (reference) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | |||||
| Female | 2.29 (1.89‐2.77) | <.001 | 2.09 (1.71‐2.56) | <.001 | 2.12 (1.73‐2.61) | <.001 | 2.08 (1.70‐2.55) | <.001 | 2.11 (1.72‐2.60) | <.001 |
| Employment status | ||||||||||
| Employed (reference) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | |||||
| Student | 0.78 (0.56‐1.11) | .16 | 0.85 (0.60‐1.21) | .36 | 0.85 (0.60‐1.21) | .36 | 0.85 (0.60‐1.21) | .36 | 0.85 (0.60‐1.22) | .38 |
| Unemployed | 2.67 (2.07‐3.44) | <.001 | 2.20 (1.70‐2.86) | <.001 | 2.17 (1.66‐2.83) | <.001 | 2.23 (1.72‐2.91) | <.001 | 2.20 (1.69‐2.88) | <.001 |
| Educational level | ||||||||||
| Low (reference) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | |||||
| Middle | 1.11 (0.81‐1.51) | .52 | 1.23 (0.90‐1.69) | .20 | 1.24 (0.91‐1.71) | .18 | 1.22 (0.89‐1.68) | .21 | 1.24 (0.90‐1.71) | .18 |
| High | 1.14 (0.81‐1.60) | .46 | 1.41 (0.99‐2.00) | .06 | 1.42 (0.99‐2.03) | .05 | 1.38 (0.97‐1.97) | .07 | 1.40 (0.98‐2.01) | .06 |
| Marital status | ||||||||||
| Married/living as married (reference) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | |||||
| Not married | 1.00 (0.80‐1.25) | .99 | 0.95 (0.76‐1.19) | .65 | 0.93 (0.74‐1.18) | .56 | 0.96 (0.76‐1.20) | .70 | 0.94 (0.74‐1.18) | .57 |
| Divorced or widowed | 1.25 (0.68‐2.29) | .47 | 1.18 (0.63‐2.12) | .60 | 1.20 (0.64‐2.26) | .57 | 1.18 (0.63‐2.21) | .61 | 1.17 (0.62‐2.21) | .62 |
| Time since diagnosis | ||||||||||
| 10‐19 y (reference) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | |||||
| 20‐29 y | 1.14 (0.89‐1.47) | .31 | 1.09 (0.85‐1.41) | .50 | 1.10 (0.86‐1.43) | .45 | 1.10 (0.85‐1.42) | .45 | 1.12 (0.87‐1.45) | .39 |
| ≥30 y | 1.35 (1.02‐1.78) | .04 | 1.20 (0.90‐1.61) | .21 | 1.23 (0.91‐1.66) | .17 | 1.24 (0.92‐1.67) | .16 | 1.31 (0.96‐1.79) | .08 |
| Age at diagnosis | ||||||||||
| 0‐4 y (reference) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | |||||
| 5‐9 y | 0.91 (0.72‐1.15) | .42 | 0.87 (0.69‐1.11) | .26 | 0.84 (0.65‐1.08) | .17 | 0.88 (0.70‐1.12) | .31 | 0.86 (0.67‐1.10) | .23 |
| 10‐14 y | 1.18 (0.92‐1.53) | .20 | 1.11 (0.85‐1.44) | .44 | 1.07 (0.80‐1.42) | .66 | 1.13 (0.87‐1.47) | .37 | 1.10 (0.83‐1.48) | .51 |
| 15‐17 y | 0.95 (0.64‐1.41) | .81 | 0.88 (0.59‐1.32) | .55 | 0.83 (0.54‐1.29) | .41 | 0.91 (0.61‐1.36) | .65 | 0.87 (0.56‐1.36) | .55 |
| Block 2: Health‐related and lifestyle factors | ||||||||||
| Current alcohol use | ||||||||||
| No (reference) | 1.0 | 1.0 | 1.0 | 1.0 | ||||||
| Yes | 0.64 (0.52‐0.79) | <.001 | 0.64 (0.52‐0.78) | <.001 | 0.64 (0.52‐0.79) | <.001 | 0.64 (0.52‐0.79) | <.001 | ||
| Current smoker | ||||||||||
| No (reference) | 1.0 | 1.0 | 1.0 | 1.0 | ||||||
| Yes | 1.24 (0.94‐1.64) | .13 | 1.26 (0.95‐1.67) | .10 | 1.23 (0.93‐1.63) | .15 | 1.26 (0.95‐1.67) | .11 | ||
| Drug use in past year | ||||||||||
| No (reference) | 1.0 | 1.0 | 1.0 | 1.0 | ||||||
| Yes | 1.00 (0.69‐1.45) | .99 | 1.02 (0.71‐1.48) | .90 | 0.99 (0.68‐1.43) | .94 | 1.02 (0.70‐1.47) | .93 | ||
| BMI | ||||||||||
| Underweight (<18.5 kg/m2) | 1.10 (0.68‐1.76) | .70 | 1.11 (0.69‐1.78) | .68 | 1.10 (0.69‐1.77) | .69 | 1.11 (0.69‐1.78) | .67 | ||
| Normal weight (18.5‐24.9 kg/m2; reference) | 1.0 | 1.0 | 1.0 | 1.0 | ||||||
| Overweight (25‐29.9 kg/m2) | 1.08 (0.86‐1.36) | .51 | 1.08 (0.86‐1.36) | .52 | 1.09 (0.87‐1.37) | .47 | 1.09 (0.86‐1.37) | .48 | ||
| Obesity (≥30 kg/m2) | 1.00 (0.72‐1.40) | .99 | 1.01 (0.72‐1.41) | .97 | 1.00 (0.72‐1.40) | 1.00 | 1.00 (0.71‐1.41) | .99 | ||
| No. of health problems | ||||||||||
| 0 (reference) | 1.0 | 1.0 | 1.0 | 1.0 | ||||||
| 1‐2 | 1.46 (1.17‐1.82) | <.01 | 1.45 (1.15‐1.82) | <.01 | 1.49 (1.19‐1.87) | <.001 | 1.49 (1.18‐1.88) | <.01 | ||
| >2 | 2.15 (1.50‐3.08) | <.001 | 2.09 (1.44‐3.03) | <.001 | 2.24 (1.55‐3.25) | <.001 | 2.18 (1.49‐3.19) | <.001 | ||
| Block 3: Cancer diagnosis | ||||||||||
| ALL (reference) | 1.0 | 1.0 | ||||||||
| Leukemia, not ALL | 1.25 (0.76‐2.06) | .39 | 1.25 (0.76‐2.06) | .38 | ||||||
| Non‐Hodgkin lymphoma | 1.31 (0.91‐1.89) | .15 | 1.29 (0.89‐1.87) | .17 | ||||||
| Hodgkin lymphoma | 1.27 (0.84‐1.94) | .26 | 1.31 (0.86‐2.00) | .21 | ||||||
| CNS tumor | 1.47 (1.06‐2.06) | .02 | 1.73 (1.16‐2.58) | <.01 | ||||||
| Neuroblastoma | 1.05 (0.65‐1.68) | .86 | 1.10 (0.67‐1.82) | .71 | ||||||
| Retinoblastoma | 1.08 (0.31‐3.75) | .91 | 1.22 (0.34‐4.39) | .76 | ||||||
| Renal tumor | 1.25 (0.88‐1.76) | .21 | 1.27 (0.90‐1.79) | .18 | ||||||
| Hepatic tumor | 1.45 (0.52‐4.05) | .48 | 1.42 (0.50‐3.98) | .51 | ||||||
| Bone tumor | 1.14 (0.73‐1.76) | .57 | 1.13 (0.73‐1.76) | .58 | ||||||
| Soft tissue tumor | 1.33 (0.89‐1.97) | .16 | 1.37 (0.92‐2.04) | .12 | ||||||
| Germ cell tumor | 0.96 (0.55‐1.67) | .87 | 1.03 (0.58‐1.82) | .93 | ||||||
| Other and unspecified | 1.49 (0.84‐2.64) | .17 | 1.61 (0.89‐2.89) | .11 | ||||||
| Block 4: Cancer treatment | ||||||||||
| Surgery only (reference) | 1.0 | 1.0 | ||||||||
| Chemotherapy (± surgery) | 0.69 (0.43‐1.10) | .12 | 0.68 (0.42‐1.10) | .11 | ||||||
| Radiotherapy (± surgery) | 0.87 (0.62‐1.23) | .43 | 1.08 (0.71‐1.64) | .72 | ||||||
| Chemotherapy and radiotherapy (± surgery) | 0.83 (0.58‐1.20) | .33 | 0.98 (0.65‐1.49) | .93 | ||||||
| Model fit statistic: AUC | 0.681 | 0.700 | 0.705 | 0.702 | 0.707 | |||||
Abbreviations: ALL, acute lymphoblastic leukemia; AUC, area under the curve; BMI, body mass index; CI, confidence interval; CNS, central nervous system; OR, odds ratio.
Multivariable logistic regression analyses were used with possible risk and associated factors added in blocks. The dependent variable was chronic fatigue. The educational levels were low (up to and including lower technical and vocational education), middle (up to and including secondary technical and vocational education), and high (up to and including higher professional education and university).