Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
Support Care Cancer. 2020 Dec;28(12):5983-5993. doi: 10.1007/s00520-020-05444-7. Epub 2020 Apr 13.
To assess the impact of maintenance therapy and the additional impact of dexamethasone treatment on cancer-related fatigue and sleep-wake rhythms in pediatric acute lymphoblastic leukemia (ALL) patients and to determine the association between these outcomes.
A national cohort of pediatric ALL patients (≥ 2 years) was included (± 1 year post-diagnosis). Patients receiving dexamethasone were assessed twice (assessment with and without dexamethasone). Actigraphy assessments were used to calculate sleep-wake outcomes with nonparametric methods. Cancer-related fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Sleep-wake rhythms and cancer-related fatigue were compared between patients participating in the assessment without dexamethasone and healthy children (linear regression) and between assessments with and without dexamethasone (mixed models). Using linear regression, associations between sleep-wake outcomes and cancer-related fatigue were determined during assessments with and without dexamethasone.
Responses were collected for 125 patients (113 assessments with and 81 without dexamethasone). The sleep-wake rhythm was less stable (p = 0.03) and less robust (p = 0.01), with lower physical activity levels (p < 0.001) and higher cancer-related fatigue levels (p < 0.001) in ALL patients compared to healthy children. Physical activity was lower (p = 0.001) and cancer-related fatigue more severe (p ≤ 0.001) during assessments with dexamethasone compared to without dexamethasone. Sleep-wake outcomes were significantly associated with cancer-related fatigue during periods without dexamethasone, but not during periods with dexamethasone.
Sleep-wake rhythms are disturbed, physical activity levels lower, and cancer-related fatigue levels higher during maintenance therapy. Interventions aimed to enhance sleep-wake rhythms during maintenance therapy could improve cancer-related fatigue. Families should be supported in coping with the additional burden of dexamethasone treatment to improve well-being of ALL patients.
评估维持治疗对儿科急性淋巴细胞白血病（ALL）患者癌因性疲劳和睡眠-觉醒节律的影响，以及地塞米松治疗的额外影响，并确定这些结果之间的关联。
纳入了一个全国性的儿科 ALL 患者队列（诊断后±1 年）（≥2 岁）。接受地塞米松治疗的患者进行了两次评估（评估时使用和不使用地塞米松）。使用动态活动记录仪评估来计算非参数方法的睡眠-觉醒结果。癌因性疲劳使用 PedsQL 多维疲劳量表进行评估。在不使用地塞米松进行评估的患者和健康儿童之间（线性回归）以及在使用和不使用地塞米松进行评估之间（混合模型）比较睡眠-觉醒节律和癌因性疲劳。使用线性回归，在使用和不使用地塞米松的评估中确定睡眠-觉醒结果与癌因性疲劳之间的关联。
共收集了 125 名患者（113 次评估使用地塞米松，81 次评估不使用地塞米松）的反应。与健康儿童相比，ALL 患者的睡眠-觉醒节律更不稳定（p=0.03），更不稳定（p=0.01），体力活动水平更低（p<0.001），癌因性疲劳水平更高（p<0.001）。与不使用地塞米松相比，使用地塞米松时，体力活动水平更低（p=0.001），癌因性疲劳更严重（p≤0.001）。在不使用地塞米松的评估期间，睡眠-觉醒结果与癌因性疲劳显著相关，但在使用地塞米松的评估期间则不相关。
在维持治疗期间，睡眠-觉醒节律紊乱，体力活动水平降低，癌因性疲劳水平升高。在维持治疗期间，旨在增强睡眠-觉醒节律的干预措施可能会改善癌因性疲劳。应支持家庭应对地塞米松治疗的额外负担，以提高 ALL 患者的幸福感。
