Recommendations for the Surveillance of Cancer-Related Fatigue in Childhood, Adolescent, and Young Adult Cancer Survivors

Cancer-related fatigue (CRF) negatively affects the lives of childhood, adolescent, and young adult (CAYA) cancer survivors. We aimed to provide an evidence-based clinical practice guideline (CPG) with internationally harmonized CRF surveillance recommendations for CAYA cancer survivors diagnosed < 30 years.

This CPG was developed by a multidisciplinary panel under the umbrella of the International Late Effects of Childhood Cancer Guideline Harmonization Group. After evaluating the concordances and discordances of four existing CPGs, we performed systematic literature searches. We screened articles for eligibility, assessed quality, and extracted, and summarized the data from included articles. We formulated recommendations based on the evidence and clinical judgment. Of 3647 articles identified, 70 articles from 14 countries were included. The prevalence of cancer-related fatigue in CAYA cancer survivors ranged from 10–85%. The use of so many different assessments for fatigue and heterogeneity in study populations likely contributed to the large differences in the prevalence of fatigue in CAYA cancer survivors. We recommend that healthcare providers are aware of the risk of CRF, implement regular screening with validated measures, and recommend effective interventions for fatigued survivors.

Future studies should focus on high-quality research to investigate the risk of and risk factors for fatigue in CAYA cancer survivors using scientifically validated fatigue measures (preferably PROMIS Pediatric Fatigue Measure or PedsQL MFS) in CAYA cancer survivors and especially in older adult survivors of CAYA cancers. In addition, a longitudinal assessment of fatigue in CAYA cancer patients and survivors is needed to identify the change in fatigue patterns over time.