Predictors of fatigue and poor sleep in adult survivors of childhood Hodgkin’s lymphoma: a report from the Childhood Cancer Survivor Study

Amanda M. Rach, Valerie Mc Laughlin Crabtree, Tara M. Brinkman, Lonnie Zeltzer, Jordan Gilleland Marchak, Deokumar Srivastava, Brooklee Tynes, Jin Shei Lai, Leslie L. Robison, Gregory T. Armstrong, Kevin R. Krull*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Purpose: Survivors of pediatric Hodgkin’s lymphoma (HL) are at risk for a number of debilitating late effects. Excessive fatigue and poor sleep quality are primary complaints of HL survivors. Understanding the emotional and physical factors that influence fatigue and sleep quality may provide opportunities for intervention to improve health-related quality of life for HL survivors. Methods: Data from 751 adult survivors of childhood HL who participated in the Childhood Cancer Survivor Study (CCSS) from 2000–2002 were analyzed. Multivariable logistic regression analyses investigated the demographic, psychological, and physical variables that predicted clinically significant levels of poor sleep quality, fatigue, and excessive daytime sleepiness. Results: Survivors’ self-reported level of emotional distress, pain, and physical functioning limitations did not differ from population norms. Clinically elevated levels of emotional distress (OR 8.38, 95% CI 4.28–16.42) and pain (OR 3.73, 95% CI 2.09–6.67) increased the risk for endorsing elevated levels of fatigue. Survivors with elevated levels of emotional distress (OR 6.83, 95% CI 2.71–15.90) and pain (OR 5.27, 95% CI 1.78–15.61) were more likely to report poor sleep quality. Pain (OR 2.11, 95% CI 1.39–3.34) was related to excessive daytime sleepiness. Conclusions: Emotional and physical factors are associated with elevated levels of fatigue, excessive daytime sleepiness, and poor sleep quality in survivors of pediatric HL. This is consistent with findings from research conducted with non-cancer survivors. Implications for cancer survivors: These results suggest that interventions designed to target sleep and fatigue difficulties in the general population may be well suited for pediatric HL survivors as well.

Original languageEnglish (US)
Pages (from-to)256-263
Number of pages8
JournalJournal of Cancer Survivorship
Issue number2
StatePublished - Apr 1 2017


  • Fatigue
  • Hodgkin’s lymphoma
  • Pediatric cancer
  • Psychological distress
  • Sleep

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)


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