Fatigue among adult survivors of childhood cancer: findings from the French Childhood Cancer Survivor Study

Introduction: Fatigue is a prevalent and late effect among childhood cancer survivors (CCSs). Few large studies have comprehensively evaluated its prevalence and determinants. Identifying risk factors for fatigue and severe fatigue (SF) is crucial to improving survivorship care. This study assessed the prevalence of fatigue and SF, as well as demographic, clinical, and treatment-related predictors in the French Childhood Cancer Survivor Study (FCCSS).

Methods: This cross-sectional analysis included adult 5-year CCSs diagnosed before age 21 (1946–2000) in the FCCSS cohort. Fatigue was measured using the French Multidimensional Fatigue Inventory (MFI-20); SF was defined as a total score > 60. Associations with sex, age, cancer type, treatment, and social deprivation were estimated using multivariable regressions. Analyses were stratified by central nervous system (CNS) vs. non-CNS tumors and compared to general population norms.

Results: Among 3170 CCSs, fatigue scores exceeded population norms from age 30, with women affected earlier and more severely. General (10.0 ± 4.2) and physical fatigue (9.6 ± 4.2) were the most pronounced dimensions, increasing with age and peaking at ≥ 50 years. Higher fatigue scores were independently associated with female sex, obesity, older age, and CNS tumor history. SF affected 16% of CCSs, more frequently in women (OR = 1.30), obese survivors (OR = 2.40), CNS tumor survivors (OR = 3.27), hematologic tumor survivors (OR = 1.46), and radiotherapy exposure (OR = 1.46).

Conclusion: Fatigue remains a common, persistent late effect in CCSs. Female sex, older age, CNS tumors, and radiotherapy were strong predictors, underscoring the needs for targeted screening and long-term management.

Journal of Cancer Survivorship , résumé, 2026

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