Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update

Priya Patel, Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada.
Paula D. Robinson, Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada.
Patrick van der Torre, Sport and Exercise Center, Princess Máxima Center for Pediatric Oncology, Utrecht 3584CS, the Netherlands.
Deborah Tomlinson, Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
Jennifer Seelisch, Division of Hematology/Oncology, Children's Hospital London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada.
Sapna Oberoi, Department of Pediatrics and Child Health, Max Rady College of Medicine, CancerCare Manitoba, University of Manitoba, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada.
Jessica E. Morgan, Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
Pamela S. Hinds, Department of Nursing Science, Professional Practice, and Quality, Children's National Health System, Washington, DC, USA.
Miriam Götte, University Hospital Essen, West German Cancer Center, Hufelandstraße 55, Essen 45147, Germany.
Faith Gibson, Centre for Outcomes and Experiences Research in Children's Health, Illness, and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Nathan Duong, Not Applicable (Patient Representative).
Hailey Davis, Not Applicable (Patient Representative).
S Nicole Culos-Reed, Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
Danielle Cataudella, Department of Pediatric Psychology, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada.
Vanessa Miranda, Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada.
L Lee Dupuis, Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
Lillian Sung, Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.

Document Type

Journal Article

Publication Date

9-1-2023

Journal

EClinicalMedicine

Volume

63

DOI

10.1016/j.eclinm.2023.102147

Keywords

Fatigue; Pediatric oncology; Practice guideline

Abstract

Objective was to update a clinical practice guideline (CPG) for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients. We reconvened a multi-disciplinary and multi-national panel. While the previous 2018 CPG evaluated adult and pediatric randomized controlled trials (RCTs) to manage fatigue, this 2023 update revised previous recommendations based only on pediatric RCTs. Twenty RCTs were included in the updated systematic review. Physical activity significantly reduced fatigue (standardized mean difference -0.44, 95% confidence interval -0.64 to -0.24; n = 8 RCTs). Using the 2018 recommendations as a basis, the panel continued to make strong recommendations to use physical activity, and to offer relaxation, mindfulness or both, to manage fatigue in pediatric patients. Cognitive or cognitive behavioral therapies may be offered. Pharmacological approaches should not be routinely used. The panel made a new good practice statement to routinely assess for fatigue, ideally using a validated scale.

Department

Pediatrics

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