Structural equation modeling to explore putative causal factors for chronic fatigue in childhood cancer survivors: a DCCSS LATER study
Journal of Cancer Survivorship, vol. 20, pp. 1367–1376
Abstract
PURPOSE: To explore putative causal relations for chronic fatigue (CF) in childhood cancer survivors (CCS) using structural equation modeling (SEM). METHODS: Interrelationships between factors that were previously associated with CF and their causal relation with CF were investigated using SEM and causal discovery methodology. A bootstrap method was used to ascertain how robust each finding was, presenting the percentage of times that each discovered edge was found in 1000 bootstrap samples as a measure of confidence (with > 50% needed to be confident in a found edge). RESULTS: 1927 CCS (51.7% male) with a mean age of 35 years (SD 9) participated in the study (23.6% reported CF). Results indicated that sex had a putative causal effect on CF (bootstrap confidence 81%), while CF was causally linked to helplessness, physical activity, pain, BMI, and sleep problems (bootstrap confidence 82%, 78%, 78%, 51%, and 51%, respectively). The relation between CF and depression was found to be two-way (bootstrap confidence 68%), indicating a reciprocal relation or the presence of a latent confounder. The same applied to the relations between CF and anxiety, self-esteem, and social functioning, but this could not be confirmed with high confidence (bootstrap confidence < 50%). CONCLUSION: This study provides insight into the complex etiology of CF and could give guidance in the development of appropriate prevention and/or intervention strategies for CF in CCS. IMPLICATIONS FOR CANCER SURVIVORS: Results show the consequences of having CF and could help to understand the impact it has on daily life.
Authors 20
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Adriaan Penson corresponding
Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands. adriaan.penson@radboudumc.nl
Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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Affiliation as printed
Department of Data Science, Institute for Computing and Information Sciences, Radboud University Nijmegen, Nijmegen, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Erasmus MC · Princess Máxima Center
Affiliation as printed
Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Erasmus MC · University Medical Center Utrecht · Princess Máxima Center · Wilhelmina Children's Hospital
Affiliation as printed
Department of Pediatric Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
Wilhelmina Children's Hospital, UMCU, Utrecht, The Netherlands
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Erasmus MC · Princess Máxima Center
Affiliation as printed
Department of Medicine, Erasmus Medical Center, Section Endocrinology, Rotterdam, The Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Pediatric Oncology/Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Emma Kinderziekenhuis · Princess Máxima Center · University of Amsterdam
Affiliation as printed
Department Pediatric Oncology, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Affiliation as printed
Department of Data Science, Institute for Computing and Information Sciences, Radboud University Nijmegen, Nijmegen, The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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Amsterdam Public Health · Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Cancer Center Amsterdam, Amsterdam, The Netherlands
Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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