Pain Predicts Next-Day Fatigue in Adolescents and Young Adults Receiving Maintenance Treatment for Acute Lymphoblastic Leukemia

Objective: Fatigue is a prevalent and debilitating problem in adolescents and young adults (AYAs) with cancer. AYAs with acute lymphoblastic leukemia (ALL) are at particular risk for fatigue. Other factors, such as pain, nausea, and negative mood, have also been identified as contributors to cancer-related fatigue in cross-sectional studies. Because these states rapidly fluctuate, they may also serve as important time-varying predictors of fatigue. The purpose of this study was to determine whether current pain, nausea, and negative mood predict subsequent fatigue in AYAs during maintenance therapy and whether these relationships are moderated by sociodemographic factors. Methods: Eighteen AYAs ( M age = 17.90) completed a baseline demographic questionnaire and once-daily diaries to assess current fatigue, pain, nausea, and negative mood over a 28-day period during maintenance treatment. Dynamic structural equation modeling was used to examine whether pain, nausea, or negative mood predicts next-day fatigue, and if specific demographic variables, age, biological sex, race, ethnicity, and insurance status (public vs. private) moderated these relationships. Results: Pain significantly predicted next-day fatigue in AYAs ( Est. = 0.35, p < 0.001), and age was the only significant moderator of this relationship ( Est. = −0.13, p < 0.001). Nausea and negative mood did not significantly predict next-day fatigue. Conclusions: Pain positively predicted next-day fatigue, and the effect of pain as a predictor of fatigue was found to decrease with age. Routine pain assessments that trigger timely, in-the-moment interventions may help alleviate current pain and reduce near-term fatigue in AYAs with ALL during maintenance treatment, especially among younger adolescents.