What does this research mean for the field?

Adult survivors of childhood cancer experience significantly higher rates and severity of chronic fatigue compared to the general population, and this fatigue is associated with potentially modifiable factors such as pain interference, depressive symptoms, and sleep duration. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to compare chronic fatigue prevalence in adult childhood cancer survivors to the general population and identify associated modifiable factors.

June 1, 2026EJC Paediatric Oncology0 citationsOpen Access

Chronic fatigue among adult, long-term survivors of childhood cancer compared to the general population: The Nor-CAYACS study

CSChristina Signorelli CRCorina S. Rueegg CKCecile E. Kiserud

Key Points

The study aims to compare chronic fatigue prevalence in adult childhood cancer survivors to the general population and identify associated modifiable factors.
Inclusion of childhood cancer survivors from the NOR-CAYACS study diagnosed between 1985-2000.
Comparison of chronic fatigue using Chalder's Fatigue Questionnaire and statistical analyses including linear regression and chi-squared tests.
Identification of modifiable factors influencing fatigue severity through multivariable linear regressions.
25% of survivors reported chronic fatigue compared to 17% of the general population (p=0.022).
Greater fatigue severity and symptom duration in survivors (53% vs 39%, p<0.001).
Modifiable factors like male sex, university education, and absence of pain were linked to reduced fatigue severity.

Abstract

ABSTRACTIntroduction Fatigue is common, yet poorly understood in childhood cancer survivors, hampering effective long-term management. We aimed to compare fatigue in adult survivors of childhood cancer with the general population; and identify potentially modifiable associated factors. Methods Inclusion: childhood cancer survivors from the population-based NOR-CAYACS study (except survivors of central nervous system tumors) diagnosed 1985-2000. Normative data were available from a separate population-based study weighted according to current age and sex distribution. We assessed chronic fatigue and severity (Chalder's Fatigue Questionnaire; score ≥4) and compared chronic fatigue occurrence (total score), and fatigue duration (≥6months), in survivors and the general population using linear regression and chi-squared tests. Multivariable linear regressions with blockwise variable addition based on a directed acyclic graph identified associated modifiable factors of fatigue severity. Results 583 survivors (57% female, mean=19.1years post-diagnosis, 34% response) and 642 from the general population (35% response) were included. Significantly more survivors reported chronic fatigue than the general population (score ≥4; 25% vs 17%, p=0.022), greater fatigue severity and symptom duration (≥6months, 53% vs 39%, pβ=−1.4, 95%CI=−2.4-−0.5, p=0.002) and a university, not no university, degree (β=−1.2, 95%CI=−2.1-−0.2, p=0.015). Higher fatigue severity was associated with ≥1 self-reported late-effects (versus none), (β=2.6, 95%CI=1.6–3.6, p), more hours of daily sleep (β=0.5, 95%CI=0.2–0.9, p=0.002), greater pain interference (versus none/little) (β=3.9, 95%CI=2.7–5.1, p), and higher depressive symptoms (β=0.7, 95%CI=0.6–0.8, p) in the multivariable model, explaining 52% of variance. Conclusions Survivors reported chronic fatigue more often than the general population. Fatigue severity was associated with modifiable factors that may be targeted to mitigate the impact of fatigue on survivors' well-being.

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