marrow transplant patients, and the incidence may be different for survivors of other cancers. Experiencing fatigue before treatment, being depressed or anxious, getting too little exercise, and having other medical conditions are all associated with higher levels of fatigue in post-treatment cancer survivors. Receiving multiple types of treatments, such as chemotherapy and radiation, is associated with more fatigue. Older adults have a higher risk of long-term fatigue. Cancer-related fatigue after treatment for childhood cancer. Cancer-related fatigue has consistently been found to be one of the most prevalent and distressing symptoms in childhood cancer survivors. The International Late Effects of Childhood Cancer Guidelines Harmonization Group (IGHG) has published recommendations regarding the surveillance of fatigue in survivors of childhood cancer. These recommendations include regular screenings of fatigue in survivors of childhood cancer. Survivors of pediatric brain tumors report more fatigue after end of treatment than survivors of acute lymphoblastic leukemia, but both groups experience more fatigue than healthy children and adolescents. While considered a long-term effect of the treatment, children and adolescents experience fatigue already during the treatment for acute lymphoblastic leukemia and this side-effect of treatment remains in some patients after the treatment has ended. References Paraneoplastic syndromes