Article

Fatigue and Physical Performance in Children and Adolescents Receiving Chemotherapy

Mary C. Hooke

Ann W. Garwick

Cynthia R. Gross

adolescent, children, chemotherapy, fatigue
ONF 2011, 38(6), 649-657. DOI: 10.1188/11.ONF.649-657

Purpose/Objectives: To examine the relationship between physical performance and fatigue in child and adolescent cohorts during the first three cycles of chemotherapy.

Design: Prospective, observational design.

Setting: Two pediatric cancer centers in the upper Midwest region of the United States.

Sample: 16 children and 14 adolescents newly diagnosed with cancer.

Methods: Standardized instruments were administered during the first and third cycles of chemotherapy. Instruments included physical performance tests (Timed Up and Down Stairs [TUDS] and the 6-Minute Walk Test [6MWT]) and a self-report fatigue scale.

Main Research Variables: Fatigue and physical performance.

Findings: In the child cohort, physical performance appeared to improve and fatigue diminished from cycle 1 to 3 of chemotherapy. When time on TUDS decreased, fatigue tended to decrease; when 6MWT distance increased, fatigue decreased. In the adolescent cohort, fatigue seemed to decrease but physical performance measures evidenced little change. Correlations between changes in the physical performance variables and fatigue were not significant.

Conclusions: Fatigue may decrease early in treatment as disease symptoms resolve. Fatigue in the child cohort was related to physical performance, which is consistent with previous studies that defined fatigue in children as primarily a physical sensation. Findings in the adolescent cohort support research that defined adolescent fatigue as more complex with mental, emotional, and physical components.

Implications for Nursing: Knowing how fatigue relates to physical performance in children and adolescents informs the nurse in educating patients and families about symptom management.

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    References

    Al-Majid, S., & McCarthy, D.O. (2001). Cancer-induced fatigue and skeletal muscle wasting: The role of exercise. Biological Research for Nursing, 2, 186-197. doi:10.1177/109980040100200304
    American College of Sports Medicine. (2006). ACSM's guidelines for exercise testing and prescription. Baltimore, MD: Author.
    American Thoracic Society. (2002). ATS statement: Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166, 111-117. doi:10.1164/rccm.166/1/111
    Clarke-Steffen, L., Hockenberry-Eaton, M., Hinds, P.S., Mock, V., Piper, B., & White, A. (2001). Consensus statement: Analyzing a new model to evaluate fatigue in children with cancer. Journal of Pediatric Oncology Nursing, 18(2, Suppl. 1), 21-23.
    Cohen, J.W. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
    Collins, J.J., Byrnes, M.E., Dunkel, I.J., Lapin, J., Nadel, T., Thaler, H.T., … Portenoy, R.K. (2000). The measurement of symptoms in children with cancer. Journal of Pain and Symptom Management, 19, 363-373. doi:10.1016/S0885-3924(00)00127-5
    Collins, J.J., Devine, T.D., Dick, G.S., Johnson, E.Z., Kilham, H.A., Pinkerton, C.R., … Portenoy, R.K. (2002). The measurement of symptoms in young children with cancer: The validation of the Memorial Symptom Assessment Scale in children aged 7-12. Journal of Pain and Symptom Management, 23, 10-16. doi:10.1016/S0885-3924(01)00375-X
    Cramp, F., & Daniel, J. (2008). Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews, 16, CD006145. doi:10.1002/14651858.CD006145.pub2.
    Davies, B., Whitsee, S., Bruce, A., & McCarthy, P. (2002). A typology of fatigue in children with cancer. Journal of Pediatric Oncology Nursing, 19, 12-21. doi:10.1053/jpon.2002.30012
    Dimeo, F., Schwarz, S., Fietz, T., Wanjura, T., Boning, D., & Theil, E. (2003). Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. Supportive Care in Cancer, 11, 623-628. doi:10.1007/s00520-003-0512-2
    Dimeo, F.C. (2001). Effects of exercise on cancer-related fatigue. Cancer, 92(6, Suppl.), 1689-1693. doi:10.1002/1097-0142(20010915)92:6+<1689::AID-CNCR1498>3.0.CO;2-H
    Docherty, S.L. (2003). Symptom experiences of children and adolescents with cancer. Annual Review of Nursing Research, 21, 123-149.
    Gedaly-Duff, V., Lee, K.A., Nail, L.M., Nicholson, S., & Johnson, K.P. (2006). Pain, sleep disturbance, and fatigue in children with leukemia and their parents: A pilot study. Oncology Nursing Forum, 33, 641-646. doi:10.1188/06.ONF.641-646
    Genc, R.E., & Conk, Z. (2008). Impact of effective nursing interventions to the fatigue syndrome in children who receive chemotherapy. Cancer Nursing, 31, 312-317. doi:10.1097/01.NCC.0000305740.18711.c6
    Gibson, F., Garnett, M., Richardson, A., Edward, J., & Sepion, B. (2005). Heavy to carry, a survey of parents' and healthcare professionals' perceptions of cancer-related fatigue in children and young people. Cancer Nursing, 28, 27-35.
    Gocha Marchese, V., Chiarello, L.A., & Lange, B.J. (2003). Strength and functional mobility in children with acute lymphoblastic leukemia. Medical Pediatric Oncology, 40, 230-232. doi:10.1002/mpo.10266
    Gulmans, V.A.M., van Veldhoven, N.H.M.J., deMeer, K., & Helders, P.J.M. (1996). The six-minute walking test in children with cystic fibrosis: Reliability and validity. Pediatric Pulmonology, 22, 85-89. doi:10.1002/(SICI)1099-0496(199608)22:2<85::AID-PPUL1>3.0.CO;2-I
    Hinds, P.S., Hockenberry, M., Rai, S.N., Zhang, L., Razzouk, B.I., McCarthy, K., … Rodriguez-Galindo, C. (2007). Nocturnal awakenings, sleep environment interruptions, and fatigue in hospitalized children. Oncology Nursing Forum, 34, 393-402. doi:10.1188/07.ONF.393-402
    Hinds, P.S., Hockenberry, M., Tong, X., Rai, S.N., Gattuso, J.S., McCarthy, K., … Srivastava, D.K. (2007). Validity and reliability of a new instrument to measure cancer-related fatigue in adolescents. Journal of Pain and Symptom Management, 34, 607-618.
    Hinds, P.S., Hockenberry, M.J., Gattuso, J.S., Srivastava, D.K., Tong, X., Jones, H., & West, N. (2007). Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia. Cancer, 110, 2321-2230. doi:10.1002/cncr.23039
    Hinds, P.S., & Hockenberry-Eaton, M. (2001). Developing a research program on fatigue in children and adolescents with cancer. Journal of Pediatric Oncology Nursing, 18(1, Suppl.), 3-12. doi:10.1053/jpon.2001.21979
    Hinds, P.S., Hockenberry-Eaton, M., Gilger, E., Kline, N., Burleson, C., Bottomley, S., & Quargnenti, A. (1999). Comparing patient, parent, and staff descriptions of fatigue in pediatric oncology patients. Cancer Nursing, 22, 277-289.
    Hockenberry, M. (2004). Symptom management research in children with cancer. Journal of Pediatric Oncology Nursing, 21, 132-136. doi:10.1177/1043454204264387
    Hockenberry, M., Hinds, P.S., Barrera, P., Bryant, R., Adams-McNeill, J., Hooke, C., … Manteuffel, B. (2003). Three instruments to assess fatigue in children with cancer: The child, parent, and staff perspectives. Journal of Pain and Symptom Management, 25, 319-328. doi:10.1016/S0885-3924(02)00680-2
    Hockenberry, M.J., Hooke, M.C., Gregurich, M., McCarthy, K., Sambuco, G., & Krull, K. (2010). Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide [Online exclusive]. Oncology Nursing Forum, 37, E16-E27. doi:10.1188/10.ONF.E16-E27
    Hockenberry-Eaton, M., & Hinds, P.S. (2000). Fatigue in children and adolescents with cancer: Evolution of a program of study. Seminars in Oncology Nursing, 16, 261-271. doi:10.1053/sonu.2000.16577
    Hooke, M.C. (2009). Fatigue, physical performance, and carnitine levels in children and adolescents receiving chemotherapy (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3352786).
    Keats, M.R., Culors-Reed, S.N., Courneya, K.S., & McBride, M. (2006). An examination of physical activity behaviors in a sample of adolescent cancer survivors. Journal of Pediatric Oncology Nursing, 23, 135-142. doi:10.1177/1043454206287304
    Kline, N., DeSwarte-Wallace, J., Bakke, A., Barr, R., Hockenberry-Eaton, M., Hooke, C., … O'Neill, J.B. (2000). Consensus statement: Research on fatigue in children with cancer. Seminars in Oncology Nursing, 16, 277-278. doi:10.1053/sonu.2000.16581
    Knols, R., Aaronson, N.K., Uebelhar, D., Fransen, J., & Aufdemkampe, G. (2005). Physical exercise in cancer patients during and after medical treatment: A systematic review of randomized and controlled trials. Journal of Clinical Oncology, 23, 3830-3842. doi:10.1200/JCO.2005.02.148
    Li, A.M., Yin, J., Yu, C.C.W., Tsang, T., So, H.K., Wong, E., … Sung, W. (2005). The Six-Minute Walk Test in healthy children: Reliability and validity. European Respiratory Journal, 25, 1057-1060. doi:10.1183/09031936.05.00134904
    Linder, L., (2008). Developmental diversity in symptom research involving children and adolescents with cancer. Journal of Pediatric Nursing, 23, 296-309. doi:10.1016/j.pedn.2007.10.003
    Lucia, A., Earnest, C., & Perez, M. (2003). Cancer-related fatigue: Can exercise physiology assist oncologists? Lancet Oncology, 4, 616-625. doi:10.1016/S1470-2045(03)01221-X
    Marchese, V.G., & Chiarello, L.A. (2004). Relationships between specific measures of body function, activity, and participation in children with acute lymphoblastic leukemia. Rehabilitation Oncology, 22, 5-9.
    Marchese, V.G., Chiarello, L.A., & Lange, B.J. (2004). Effects of physical therapy intervention for children with acute lymphoblastic leukemia. Pediatric Blood and Cancer, 42, 127-133. doi:10.1002/pbc.10481
    Miles, M.S., & Holditch-Davis, D. (2003). Enhancing nursing research with children and families using a developmental science perspective. Annual Review of Nursing Research, 2, 1-20.
    Mitchell, S., Beck, S., Hood, L., Moore, K., & Tanner, E. (2007). Putting Evidence Into Practice: Evidence-based interventions for fatigue during and following cancer and its treatment. Clinical Journal of Oncology Nursing, 11, 99-113. doi:10.1188/07.CJON.99-113
    National Comprehensive Cancer Network. (2010). NCCN Clinical Practice Guidelines in Oncology: Cancer-related fatigue [v.1.2010]. Retrieved from http://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf
    National Institutes of Health. (2002). Symptom management in cancer: Pain, depression, and fatigue. Retrieved from http://consensus.nih.gov/2002/2002CancerPainDepressionFatiguesos022html.htm
    Nixon, P.A., Joswiak, M.L., & Fricker, F.J. (1996). A six-minute walk test for assessing exercise tolerance in severely ill children. Journal of Pediatrics, 129, 363-366. doi:10.1016/S0022-3476(96)70067-7
    Sanford, S.D., Okuma, J.O., Pan, J., Srivastava, D.K., West, N., Farr, L., & Hinds, P.S. (2008). Gender differences in sleep, fatigue, and daytime activity in a pediatric oncology sample receiving dexamethasone. Journal of Pediatric Psychology, 33, 298-306. doi:10.1093/jpepsy/jsm110
    van Brussel, M., Takken, T., Lucia, T., van der Net, J., & Helders, P.J.M. (2005). Is physical fitness decreased in survivors of childhood leukemia? A systematic review. Leukemia, 19, 13-17. doi:10.1038/sj.leu.2403547
    Winter, C., Muller, C., Brandes, M., Brinkmann, A., Hoffmann, C., Hardes, J., … Rosenbaum, D. (2009). Level of activity in children undergoing cancer treatment. Pediatric Blood and Cancer, 53, 438-443. doi:10.1002/pbc.22055
    Wright, M.J., Halton, J., Martin, R.F., & Barr, R.D. (1998). Long-term gross motor performance following treatment for acute lymphoblastic leukemia. Medical and Pediatric Oncology, 31, 86-90. doi:10.1002/(SICI)1096-911X(199808)31:2<86::AID-MPO7>3.0.CO;2-V
    Zaino, C.A., Marchese, V.G., & Westcott, S.L. (2004). Timed Up and Down Stairs test: Preliminary reliability and validity of a new measure of functional mobility. Pediatric Physical Therapy, 16, 90-98. doi:10.1097/01.PEP.0000127564.08922.6A