Sad, shattered or slow? Fatigue after childhood cancer

Sammanfattning: Systematic assessments of cognition, fatigue, and mental health in survivors ofchildhood cancer can serve two different purposes. One is to enable research about development over time and medical predictors of cognitive deficits. The other is to identify individual patients in need of rehabilitation or interventions. The overall aim of this doctoral thesis was to contribute to the ongoing development of systematic neuropsychological follow-up protocols for survivors of childhood cancer. The included studies investigated whether cognitive deficits were present already at diagnosis in children with brain tumours, the overlap between cognitive fatigue and symptoms of depression, and the association between fatigue and cognitive impairment.The results showed that a pre-treatment assessment was feasible for the majority of cases, and that some aspects of cognition were affected already at baseline. Assessment of fatigue at follow-up revealed that cognitive fatigue was the fatigue domain most affected in survivors, but also that survivors of brain tumours suffered more from fatigue than survivors of acute lymphoblastic leukaemia. The results also indicated that cognitive fatigue should not be assessed on its own, but that depressive symptoms and cognitive processing speed should be considered as well. A decrease in cognitive processing speed from the pre-treatment assessment to the follow-up was also associated with experiencing more cognitive fatigue.Overall, the results suggest that additional studies are warranted to further examine the relationship between baseline and long-term cognitive deficits. Regarding fatigue, more research is needed concerning the development over time, to see if it decreases or if there instead is a risk of increasing symptoms. Future studies should also focus on finding medical predictors and developing a biopsychosocial model of fatigue in survivors of childhood cancer.