In the last decades, treatment of childhood and adolescent cancer has improved markedly. Most patients can be cured, but many suffer from late effects even decades after treatment ended. Cancer-related fatigue is a late effect experienced by many survivors. Regular follow-up appointments, in which survivors are systematically screened for late effects, are recommended for all survivors. Surveillance guidelines help to provide adequate follow-up care for all survivors.
The International Late Effects of Childhood Cancer Guideline Harmonization Group aims to harmonize existing surveillance guidelines. Led by Prof. Dr. Gisela Michel, Prof. Dr. Jordan Gilleland Marchak (Emory University School of Medicine, USA) and Prof. Dr. Katrin Scheinemann (Cantonal Hospital Aarau), existing guidelines were evaluated and complemented with up-to-date scientific evidence. Scientific and clinical experts formulated the recommendations, in collaboration with survivor representatives. In addition to Prof. Michel Salome Christen, Dr. Katharina Roser and Anica Ilic were involved from the University of Lucerne.
Recommendation. Screening at each appointment
Four existing guidelines and 70 studies from a systematic literature search were included. The study found that 10 to 85 percent of survivors suffer from cancer-related fatigue. Additionally, survivors were more likely to suffer from fatigue compared to other, general population samples. Survivors who experienced psychological distress, late effects, pain, relapse, and who were older were at especially high risk to experience fatigue. Based on this evidence, the newly developed guideline recommends surveillance of cancer-related fatigue in all survivors, at each follow-up appointment or general medical check-up. Recommendations on how to screen, and treatment options are presented as well.
The figure presents the process of screening.
The project was funded by the Cancer League Central Switzerland with 72'000 CHF. For the open access publication funding was provided by the Department of Health Sciences and Medicine at the University Lucerne, and the research committee of the University of Lucerne. The results have been published in the "Journal of Cancer Survivorship" entitled "Recommendations for the Surveillance of Cancer-related Fatigue in Childhood, Adolescent, and Young adult Cancer Survivors: a Report from the International Late Effects of Childhood Cancer Guideline Harmonization Group". The authors are: Salome Christen, Katharina Roser, Renée L. Mulder, Anica Ilic, Hanne C. Lie, Jacqueline J. Loonen, Anneli V. Mellblom, Leontien C. M. Kremer, Melissa M. Hudson, Louis S. Constine, Roderick Skinner, Katrin Scheinemann, Jordan Gilleland Marchak and Gisela Michel.