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Quitmann J, Rohenkohl A, Sommer R, Bullinger M, Silva N. Explaining parent-child (dis)agreement in generic and short stature-specific health-related quality of life reports: do family and social relationships matter? Health Qual Life Outcomes 2016; 14:150. [PMID: 27769269 PMCID: PMC5075198 DOI: 10.1186/s12955-016-0553-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the context of health-related quality of life (HrQoL) assessment in pediatric short stature, the present study aimed to examine the levels of agreement/disagreement between parents' and children's reports of generic and condition-specific HrQoL, and to identify socio-demographic, clinical and psychosocial variables associated with the extent and direction of parent-child discrepancies. METHODS This study was part of the retest phase of the QoLISSY project, which was a multicenter study conducted simultaneously in France, Germany, Spain, Sweden and UK. The sample comprised 137 dyads of children/adolescents between 8 and 18 years of age, diagnosed with growth hormone deficiency (GHD) or idiopathic short stature (ISS), and one of their parents. The participants completed child- and parent-reported questionnaires on generic (KIDSCREEN-10 Index) and condition-specific HrQoL (QoLISSY Core Module). Children/adolescents also reported on social support (Oslo 3-items Social Support Scale) and parents assessed the parent-child relationships (Parental Role subscale of the Social Adjustment Scale) and burden of short stature on parents (QoLISSY- additional module). RESULTS The parent-child agreement on reported HrQoL was strong (intraclass correlation coefficients between .59 and .80). The rates of parent-child discrepancies were 61.5 % for generic and 35.2 % for condition-specific HrQoL, with the parents being more prone to report lower generic (42.3 %) and condition-specific HrQoL (23.7 %) than their children. The extent of discrepancies was better explained by family and social relationships than by clinical and socio-demographic variables: poorer parent-child relationships and better children's social support were associated with larger discrepancies in generic HrQoL, while more parental burden was associated with larger discrepancies in condition-specific HrQoL reports. Regarding the direction of discrepancies, higher parental burden was significantly associated with parents' underrating, and better children's social support was significantly associated with parents' overrating of condition-specific HrQoL. CONCLUSIONS Routine assessment of pediatric HrQoL in healthcare and research contexts should include child- and parent-reported data as complementary sources of information, and also consider the family and social context.
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Affiliation(s)
- Julia Quitmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 D, 20246, Hamburg, Germany.
| | - Anja Rohenkohl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 D, 20246, Hamburg, Germany
| | - Rachel Sommer
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 D, 20246, Hamburg, Germany
| | - Monika Bullinger
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 D, 20246, Hamburg, Germany
| | - Neuza Silva
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 D, 20246, Hamburg, Germany.,Cognitive and Behavioural Center for Research and Intervention, Faculty of Psychology and Educational Sciences of the University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
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Vlachioti E, Perdikaris P, Megapanou E, Sava F, Matziou V. Assessment of quality of life in adolescent patients with cancer and adolescent survivors of childhood cancer. J SPEC PEDIATR NURS 2016; 21:178-188. [PMID: 27554139 DOI: 10.1111/jspn.12154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/10/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the study was to assess the quality of life (QoL) of adolescents with cancer and survivors of childhood cancer as well as the effect of various demographic factors upon it. DESIGN AND METHODS The sample of the study included 82 adolescents aged 13-20 years who had been diagnosed with any type of cancer. Twenty-six of them received treatment and 56 survivors of childhood cancer had successfully completed their treatment. Data collection lasted from July 2010 to December 2012 in Children's Hematology-Oncology Unit in Athens. For data collection, Minneapolis-Manchester Quality Questionnaire of Life Instrument was used. The assessment of the QoL of adolescents undergoing treatment was performed with three measurements and that of the survivors with one. RESULTS The QoL of adolescent patients did not significantly change during treatment and they showed a satisfactory QoL. Boys scored higher than girls (z = -1.78, p = .04 in psychological function and t = 2.27, p = .02 in body image) as far as QoL in social relations is concerned (z = -2.79, p = .002 in first measurement and z = -2.31, p = .01 in second measurement). Scores on the scale for the QoL of survivors of childhood cancer who completed treatment was 3.91. Survivors showed a higher QoL than the adolescent patients. CONCLUSIONS This research has shown that the studied population scored a sufficient QoL, especially survivors of childhood cancer ones. Moreover, their QoL seemed to be influenced by the stage of treatment, the type of cancer, sex, age, family support, and their level of education.
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Affiliation(s)
- Efrosini Vlachioti
- Service Nursing Education Department, "Agia Sophia" Children's Hospital, Athens, Greece
| | - Pantelis Perdikaris
- Head Nurse, Pediatric Oncology Department, General Children's Hospital "P & A Kyriakou," Lecturer (407/80), Department of Nursing, University of Peloponnese, Athens, Greece.
| | | | - Floria Sava
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Matziou
- Professor of Paediatric Nursing, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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Children with minimal chance for cure: parent proxy of the child's health-related quality of life and the effect on parental physical and mental health during treatment. J Neurooncol 2016; 129:373-81. [PMID: 27344555 DOI: 10.1007/s11060-016-2187-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
To assess health-related quality of life (HRQOL) from the time of diagnosis until disease progression in a cohort of children with diffuse intrinsic pontine glioma (DIPG). The assessment was collected from the perspectives of the child and their parents and evaluated the effect of the child's HRQOL on their parents' physical and mental well-being, thus providing insight into the optimal timing of palliative consultation, including anticipatory grief and bereavement services. This longitudinal study assessed 25 parents and their children, ages 2-17 years of age with DIPG across five time-points, baseline and weeks 2, 4, 6, 16, 24. Assessments included the PedsQL 4.0 Core Scales, PedsQL 3.0 Brain Tumor Scale, and Short-Form 36. HRQOL instruments were completed by the child (age ≥5 years) and parent-proxy (ages 2-17 years), with the parent completing the SF-36. Children's reports and parents' proxy of their child's HRQOL indicated poor physical functioning and increased anxiety at the initiation of therapy. A trending improvement in the children's HRQOL was reported by children and parents from baseline to week 6, with a decline at week 16. The childs' parent proxy reported cognitive problems, procedural anxiety and lower overall brain tumor HRQOL were assoicated with poorer self-reported parental mental status. Palliative care consultation should be initiated at the time of diagnosis and is supported in the high physical and emotional symptom burden reported by our patients, with heightened involvement initiated at 16 weeks. Prompt palliative care involvement, mitigating anxiety associated with clinic visits and procedures, management of brain tumor specific symptoms, advanced care planning, anticipatory grief and bereavement services, and care coordination may maximize HRQOL for patients and ensure positive long-term outcomes for parents of children with DIPG.
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Matziou V, Vlachioti E, Megapanou E, Ntoumou A, Dionisakopoulou C, Dimitriou V, Tsoumakas K, Matziou T, Perdikaris P. Perceptions of children and their parents about the pain experienced during their hospitalization and its impact on parents’ quality of life. Jpn J Clin Oncol 2016; 46:862-70. [DOI: 10.1093/jjco/hyw074] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/19/2016] [Indexed: 11/13/2022] Open
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Children's perspective on health-related quality of life during active treatment for acute lymphoblastic leukemia: an advanced content analysis approach. Cancer Nurs 2016; 38:49-58. [PMID: 25075644 DOI: 10.1097/ncc.0000000000000174] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Qualitative research provides insight into the cancer experience through the perspective of the pediatric patient. However, somewhat small sample sizes can hinder full discovery of new knowledge and limit interpretation of data. OBJECTIVE The objective of this study was to describe health-related quality of life (HRQOL) reported by children and adolescents in responses to 2 interview questions during treatment for acute lymphoblastic leukemia (ALL) and compare their responses by age, gender, risk group, and time in treatment through a quantitative content analysis approach. METHODS Children and adolescents (N = 150) were asked 2 validated questions in pediatric patients receiving treatment for ALL: "What makes a good day for you?" and "How has being sick been for you?" over 6 treatment time points. Interview data were coded analyzed quantitatively. RESULTS Code frequencies differed significantly by age, gender, risk group, and time in treatment. Adolescents had a greater focus on being with friends, and females generally reported more codes representing negative experiences. Children and adolescents reported being affected by symptoms resulting from cancer treatment. Some adolescents described that being sick positively changed their lives and viewed their illness as a new life experience. CONCLUSION The 2 proposed questions are feasible to use clinically to assess HRQOL in children and adolescents with ALL, and the qualitative codes from their descriptions can be used to identify factors affecting HRQOL of children and adolescents with leukemia. IMPLICATIONS FOR PRACTICE Nurses can use these 2 questions to assess the HRQOL of children and adolescents during and following treatment for ALL.
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Cornelio SJ, Nayak BS, George A. Experiences of Mothers on Parenting Children with Leukemia. Indian J Palliat Care 2016; 22:168-72. [PMID: 27162428 PMCID: PMC4843556 DOI: 10.4103/0973-1075.179608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Childhood cancer is the leading cause of death among children. Leukemia is one of the most common childhood cancers. OBJECTIVE The objective of this study was to explore the experiences of mothers on parenting children with leukemia. MATERIALS AND METHODS A qualitative approach with phenomenological design was used. To collect depth information from the mothers of children with leukemia, purposive sampling technique was adopted. Data were collected from ten mothers. Semi-structured interview schedule was used to collect the data. Data were analyzed using Husserl's method. RESULT The themes derived are the pivotal moment in life, the experience of being with a seriously ill child, having to keep distance with the relatives, overcoming the financial and social commitments, responding to challenges, experience of faith as being key to survival, health concerns of the present and future, and optimism. CONCLUSION The study concluded that chronic illness such as leukemia in children results in negative impact on the child and on the mother.
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Affiliation(s)
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal University, Manipal, Karnataka, India
| | - Anice George
- Department of Child Health Nursing, Manipal College of Nursing, Manipal University, Manipal, Karnataka, India
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Vlachioti E, Matziou V, Perdikaris P, Mitsiou M, Stylianou C, Tsoumakas K, Moschovi M. Assessment of quality of life of children and adolescents with cancer during their treatment. Jpn J Clin Oncol 2016; 46:453-461. [PMID: 26889049 DOI: 10.1093/jjco/hyw009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/12/2016] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the quality of life of children and adolescents with any type of cancer in all phases of their treatment. METHODS Fifty-six newly diagnosed patients diagnosed with malignancy and hospitalized in a Pediatric Hematology-Oncology Unit in Athens were included in the study. Minneapolis-Manchester Quality of Life Instrument was used for data collection from July 2010 to December 2012. The assessment of children and adolescents' quality of life who were under treatment was performed in three different stages of treatment. RESULTS The results of the study showed that the quality of life of children and adolescents with cancer did not change notably during their treatment (F = 0.16, P = 0.86 and F = 0.03, P = 0.97). For the first measurement, at the beginning of the therapy, the score on the scale for quality of life for children and adolescents was 3.44 and 3.88, respectively, in the middle of the treatment 3.36 and 3.89, respectively, and 3.43 and 3.89, respectively, when therapy was completed. Children and adolescents diagnosed with hematologic cancer stated higher quality of life scores (z = -1.61, P = 0.05 and t = 2.64, P = 0.007). Moreover, teenage patients (F = 13.22, P = 0.001) and male patients (t = 2.31, P = 0.02 and t = 2.27, P = 0.02) expressed better quality-of-life scores. CONCLUSION According to the results, children and adolescents with any kind of cancer have better quality-of-life scores at the end of their treatment, and when they are supported by their family.
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Affiliation(s)
- Efrosini Vlachioti
- In Service Nursing Education Department, "Agia Sophia" Children's Hospital, Athens
| | - Vasiliki Matziou
- Department of Nursing, National and Kapodistrian University of Athens, Athens
| | | | - Maria Mitsiou
- HR Management Department, Hellenic MoD of Athens, Athens
| | - Christos Stylianou
- Department of Nursing, Technological Educational Institute of Athens, Athens
| | | | - Maria Moschovi
- Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Baytan B, Aşut Ç, Çırpan Kantarcıoğlu A, Sezgin Evim M, Güneş AM. Health-Related Quality of Life, Depression, Anxiety, and Self-Image in Acute Lymphocytic Leukemia Survivors. Turk J Haematol 2016; 33:326-330. [PMID: 27094799 PMCID: PMC5204188 DOI: 10.4274/tjh.2015.0356] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: With increasing survival rates in childhood acute lymphocytic leukemia (ALL), the long-term side effects of treatment have become important. Our aim was to investigate health-related quality of life, depression, anxiety, and self-image among ALL survivors. Materials and Methods: Fifty patients diagnosed with ALL and their siblings were enrolled. The Kovacs Children’s Depression Inventory, State-Trait Anxiety Inventory, Offer Self-Image Questionnaire, and Pediatric Quality of Life InventoryTM were used for collecting data. ANOVA tests were used to determine if there were any significant differences between groups. Results: ALL survivors had higher depression, more anxiety symptoms, lower quality of life, and more negative self-image when compared to their siblings. Conclusion: Continuous diagnostic and interventional mental health services might be necessary for possible emotional side effects of treatment during and after the treatment. Rehabilitation and follow-up programs should be implemented for children during and after treatment for ALL.
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Affiliation(s)
- Birol Baytan
- Uludağ University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Bursa, Turkey, Phone: +90 224 295 06 03, E-mail:
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Schulte F, Wurz A, Reynolds K, Strother D, Dewey D. Quality of Life in Survivors of Pediatric Cancer and Their Siblings: The Consensus Between Parent-Proxy and Self-Reports. Pediatr Blood Cancer 2016; 63:677-83. [PMID: 26739262 DOI: 10.1002/pbc.25868] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the discrepancy between survivor-parent and sibling-parent reports of health-related quality of life (HRQL) and the level of agreement (i.e., correlation) between child reports (i.e., survivor and sibling) and parent-proxy reports of HRQL. METHODS Fifty-one families participated. Pediatric cancer survivors (49% male; 6-18 years of age) and one sibling (47% male; 9-18 years of age) completed a measure of their HRQL. As well, one parent (14% male; 27-65 years of age) from each family completed a proxy report of their children's (i.e., survivor and sibling) HRQL. Consensus was determined through discrepancy and agreement scores, between parent-proxy and children's (i.e., survivors and siblings) self-reports of total HRQL, and physical, emotional, social, and school functioning subscales. RESULTS Repeated-measures analysis of variance (ANOVA) revealed significant group differences for total HRQL (F = 6.79, P ≤ 0.01). Repeated-measure ANOVAs of subscale discrepancy scores revealed significant group differences for physical functioning scores (F = 6.39, P < 0.01). A significant interaction was also found for social functioning when age at diagnosis was considered as a covariate (F = 10.30, P < 0.01). Zero-order and intraclass correlation coefficients revealed different levels of agreement between parent and child reports. Specifically, there was poorer agreement between parent-proxy and sibling's self-reports, particularly on social and emotional subscales. CONCLUSIONS Discrepancy and agreement are both important indices to consider when examining consensus between parent-proxy and child self-reports. The findings from this study have important implications for future research and suggest that the impact of cancer on siblings should be further investigated.
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Affiliation(s)
- Fiona Schulte
- Division of Hematology Oncology Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Oncology and Paediatrics, University of Calgary, Alberta, Canada
| | - Amanda Wurz
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Reynolds
- Long Term Survivor Clinic, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Douglas Strother
- Division of Hematology Oncology Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Oncology and Paediatrics, University of Calgary, Alberta, Canada
| | - Deborah Dewey
- Departments of Pediatrics & Community Health Sciences, University of Calgary, Alberta, Canada.,Behavioural Research Unit, Calgary, Alberta, Canada
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Steur LMH, Kolk RHE, Mooij F, de Vries R, Grootenhuis MA, Kaspers GJL, Van Litsenburg RRL. The prevalence and risk factors of sleep problems in pediatric oncology: its effect on quality of life during and after cancer treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23809000.2016.1168265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Lindsay M. H. Steur
- Department of pediatric oncology-hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Roos H. E. Kolk
- Department of pediatric oncology-hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Floor Mooij
- Department of pediatric oncology-hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Martha A. Grootenhuis
- Psychosocial department, Emma Childrens’ Hospital, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
- Psycho-oncology Research Group, Princess Máxima Center for pediatric oncology Utrecht, Utrecht, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of pediatric oncology-hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Director of Academy, Princess Máxima Center for pediatric oncology Utrecht, Utrecht, The Netherlands
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Tsimicalis A, Denis-Larocque G, Michalovic A, Lepage C, Williams K, Yao TR, Palomo T, Dahan-Oliel N, Le May S, Rauch F. The psychosocial experience of individuals living with osteogenesis imperfecta: a mixed-methods systematic review. Qual Life Res 2016; 25:1877-96. [PMID: 26894269 DOI: 10.1007/s11136-016-1247-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Osteogenesis imperfecta (OI) is a genetic disorder (prevalence: 1:10,000), leading to bone fragility, frequent fractures, and varying degrees of physical limitations. Despite a substantial amount of research on the genetics, pathophysiology, and treatments related to OI, there remains a paucity of knowledge concerning the lived psychosocial experience of the OI population. This mixed-methods systematic review aimed to review, appraise, and synthesize the literature on the psychosocial experience of children and adults with OI with the goal of identifying implications for research, practice, and policy-making. METHODS Using a systematic methodology, quantitative, qualitative, and mixed-methods studies were accessed through database searching, screened, assessed for eligibility, and appraised. Data from the selected studies fulfilling the eligibility and quality criteria were extracted and synthesized using thematic analysis with an inductive approach. RESULTS A total of four qualitative and 20 quantitative studies, with various study designs and methodologies ranging in quality, were included in the review (n = 800; comprising 610 children and 175 adults with OI types I, III, IV, and V, ten parents and five healthcare professionals). Six themes were identified: intellectual feats, isolation and feeling different, fear of fractures, coping with challenges, adapting by learning new skills, and social relationships. CONCLUSION These findings highlighted key aspects of the experiences of children and adults with OI and will be essential for improving the quality and direction of research, tailoring clinical interventions addressing the psychosocial needs and quality of life of individuals with OI, and raising awareness among caregivers, healthcare professionals, administrators, and policy-makers associated with the OI population.
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Affiliation(s)
- Argerie Tsimicalis
- Ingram School of Nursing, Faculty of Medicine, McGill University, Wilson Hall, 3506 University St., Montreal, QC, H3A 2A7, Canada.
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada.
| | - Gabrielle Denis-Larocque
- Ingram School of Nursing, Faculty of Medicine, McGill University, Wilson Hall, 3506 University St., Montreal, QC, H3A 2A7, Canada
| | - Alisha Michalovic
- Ingram School of Nursing, Faculty of Medicine, McGill University, Wilson Hall, 3506 University St., Montreal, QC, H3A 2A7, Canada
| | - Carolann Lepage
- Ingram School of Nursing, Faculty of Medicine, McGill University, Wilson Hall, 3506 University St., Montreal, QC, H3A 2A7, Canada
| | - Karl Williams
- Ingram School of Nursing, Faculty of Medicine, McGill University, Wilson Hall, 3506 University St., Montreal, QC, H3A 2A7, Canada
| | - Tian-Ran Yao
- Ingram School of Nursing, Faculty of Medicine, McGill University, Wilson Hall, 3506 University St., Montreal, QC, H3A 2A7, Canada
| | - Telma Palomo
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada
- Bone and Mineral Unit, Division of Endocrinology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Noemi Dahan-Oliel
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sylvie Le May
- CHU Ste-Justine, Montreal, QC, Canada
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Frank Rauch
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada
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Momani TG, Hathaway DK, Mandrell BN. Factors Affecting Health-Related Quality of Life in Children Undergoing Curative Treatment for Cancer: A Review of the Literature. J Pediatr Oncol Nurs 2015; 33:228-40. [PMID: 26611756 DOI: 10.1177/1043454215609585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is an important measure to evaluate a child's reported treatment experience. Although there are numerous studies of HRQoL in children undergoing curative cancer treatment, there is limited literature on factors that influence this. OBJECTIVE To review published studies that describe the HRQoL and associated factors in children undergoing curative cancer treatment. METHOD Full-text publications in English from January 2005 to March 2013 were searched in PubMed, PsychINFO, and CINAHL for children ≤18 years of age undergoing curative cancer treatment. HRQoL-associated factors were categorized as cancer diagnosis, treatment, child, family, and community. RESULTS Twenty-six studies met the inclusion criteria. The most frequently used generic and cancer-specific instruments were PedsQL (Pediatric Quality of Life Inventory) Generic and PedsQL Cancer, respectively. Cancer diagnosis and treatment were the most frequently identified variables; fewer studies measured family and community domains. Gender, treatment intensity, type of cancer treatments, time in treatment, and cancer diagnosis were correlated with HRQoL. CONCLUSION Our study highlights the need to develop interventions based on diagnosis and treatment regimen to improve the HRQoL in children undergoing curative cancer treatment.
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Affiliation(s)
- Tha'er G Momani
- St. Jude Children's Research Hospital, Memphis, TN, USA University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Belinda N Mandrell
- St. Jude Children's Research Hospital, Memphis, TN, USA University of Tennessee Health Science Center, Memphis, TN, USA
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Hamner T, Latzman RD, Latzman NE, Elkin TD, Majumdar S. Quality of life among pediatric patients with cancer: Contributions of time since diagnosis and parental chronic stress. Pediatr Blood Cancer 2015; 62:1232-6. [PMID: 25755193 PMCID: PMC5839300 DOI: 10.1002/pbc.25468] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric cancer is associated with a host of negative psychosocial consequences; however, outcomes vary extensively suggesting a need to better understand this variation. Empirical research suggests a positive association between time since diagnosis (TSD) and Quality of Life (QoL). In addition to TSD, family stressors have been found to be particularly important in predicting QoL among children. The current study examined parental chronic stress beyond TSD in explanation of QoL functioning among a sample of pediatric patients with cancer. PROCEDURE Participants included 43 pediatric patients aged 5-18 years (M(age) = 10.2 ± 3.6) who were undergoing oncological treatment. Parents reported on TSD, child's QoL, and their own chronic stress. RESULTS TSD was associated with greater physical functioning (r = 0.30, P < 0.05). Parental chronic stress was associated with poorer emotional (r = -0.54, P < 0.01), physical (r = -0.41, P < 0.01), and social functioning (r = -0.44, P < 0.01). Further, hierarchal linear regression analyzes indicated parental chronic stress contributed incrementally beyond TSD in the explanation of physical (β = -0.37, t = -2.58, P < 0.01), emotional (β = -0.47, t = -3.51, P < 0.00), and social functioning (β = -0.38, t = -2.67, P < 0.01). CONCLUSIONS Parental chronic stress is associated with reduced levels of emotional, physical, and social functioning among pediatric patients. Future research is needed to further investigate the process by which chronic stress within the family interferes with adaptive coping among pediatric patients. In addition, clinical services may benefit from increased consideration of family factors, such as parental chronic stress, during oncological treatment.
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Affiliation(s)
| | - Robert D. Latzman
- Georgia State University, Atlanta, Georgia,Correspondence to: Robert D. Latzman, Department of Psychology, Georgia State University, PO Box 5010, Atlanta, GA 30302-5010.
| | | | - T. David Elkin
- University of Mississippi Medical Center, Jackson, Mississippi
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Dobrozsi S, Panepinto J. Patient-reported outcomes in clinical practice. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:501-506. [PMID: 26637765 DOI: 10.1182/asheducation-2015.1.501] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Patient-reported outcome (PRO) measurement plays an increasingly important role in health care and understanding health outcomes. PROs are any report of a patient's health status that comes directly from the patient, and can measure patient symptoms, patient function, and quality-of-life. PROs have been used successfully to assess impairment in a clinical setting. Use of PROs to systematically quantify the patient experience provides valuable data to assist with clinical care; however, initiating use of PROs in clinical practice can be daunting. Here we provide suggestions for implementation of PROs and examples of opportunities to use PROs to tailor individual patient therapy to improve patient outcomes, patient-physician communication, and the quality of care for hematology/oncology patients.
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Affiliation(s)
- Sarah Dobrozsi
- Pediatric Hematology/Oncology, Medical College of Wisconsin/Children's Research Institute of the Children's Hospital of Wisconsin, Milwaukee, WI
| | - Julie Panepinto
- Pediatric Hematology/Oncology, Medical College of Wisconsin/Children's Research Institute of the Children's Hospital of Wisconsin, Milwaukee, WI
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Yoshida S, Amano K, Ohta H, Kusuki S, Morita T, Ogata A, Hirai K. A comprehensive study of the distressing experiences and support needs of parents of children with intractable cancer. Jpn J Clin Oncol 2014; 44:1181-8. [PMID: 25249378 DOI: 10.1093/jjco/hyu140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The primary endpoints of this study were: (1) to explore the distressing experiences of parents of patients with intractable pediatric cancer in Japan from disclosure of poor prognosis to the present and (2) to explore support they regarded as necessary. METHODS A multi-center questionnaire survey was conducted that included 135 bereaved parents of patients with pediatric cancer in Japan. RESULTS The top five distressing experiences shared by over half of the bereaved parents were: 'Realize that the child's disease was getting worse' (96.7%), 'Witness the child's suffering' (96.7%), 'Make many decisions on the basis that the child will die in the not-so-distant future' (83.6%), 'Feel anxious and nervous about the child's acute deterioration' (82.0%) and 'Realize that there was nothing that I could do for the child' (78.7%). The top five support regarded as necessary were: 'Visit the room and speak to the sick child every day' (90.2%), 'Provide up-to-date information' (80.3%), 'Sufficiently explain the disadvantages of each treatment option' (80.3%), 'Show a never-give-up attitude until the end' (78.7%) and 'Make arrangements to allow the sick child to spend time with his/her siblings' (73.8%). CONCLUSIONS This study identified the common distressing experiences of parents and the support regarded as necessary by them. To provide efficient support with limited manpower in pediatric setting, healthcare professionals should recognize these tasks as high priorities when engage parents of intractable pediatric cancer patients.
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Affiliation(s)
- Saran Yoshida
- Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo
| | - Koji Amano
- Department of Clinical Laboratory, Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka
| | - Hideaki Ohta
- Department of Pediatrics, Higashitoyonaka Watanabe Hospital, Toyonaka City, Osaka
| | | | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka
| | - Akiko Ogata
- Graduate School of Education, Hiroshima University, Higashi-Hiroshima City, Hiroshima
| | - Kei Hirai
- Support Office for Large-Scale Education and Research Projects, Osaka University, Suita City, Osaka, Japan
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Abstract
BACKGROUND Enucleation (eye removal) is often the only curative treatment for the childhood eye cancer retinoblastoma, yet parental refusal of enucleation commonly contributes to treatment delay and poor survival globally. METHODS Physicians who treat retinoblastoma were surveyed to glean underlying reasons for treatment refusal. RESULTS Refusal rates were higher when less time was spent with parents explaining retinoblastoma/enucleation, and where fewer support services were available. Reasons for refusal included parental belief in alternative treatments, culture, and social stigma. CONCLUSIONS We suggest strategies to increase parental compliance with enucleation and save the lives of children with retinoblastoma.
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Affiliation(s)
| | - Helen Dimaras
- b Department of Ophthalmology and Vision Science , University of Toronto .,c The Division of Visual Science , Toronto Western Research Institute , and.,d The Department of Ophthalmology & Vision Sciences , The Hospital for Sick Children , Toronto , Ontario , Canada
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van Litsenburg RRL, Huisman J, Pieters R, Verhaak C, Kaspers GJL, Gemke RJBJ. Determinants of quality of life during induction therapy in pediatric acute lymphoblastic leukemia. Support Care Cancer 2014; 22:3235-42. [PMID: 25011520 DOI: 10.1007/s00520-014-2349-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 06/29/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Improvement in survival of pediatric acute lymphoblastic leukemia (ALL) has increased the attention to quality of life (QoL) . QoL is impaired during maintenance treatment, but little is known about QoL during induction therapy. Identification of patients with poor QoL during induction will provide opportunities for early interventions, and may subsequently improve future QoL. This national multi-center study aimed to assess QoL and its determinants during ALL induction treatment. METHODS Proxy reports of the Child Health Questionnaire (CHQ) and the PedsQL cancer version were collected. Child, treatment, and parental characteristics were analyzed as potential determinants in a multiple regression model. RESULTS One hundred thirty parents of children participated (response rate 82 %), median child age was 5.7 years and 48 % were female. QoL, as measured with the CHQ, was significantly lower than the norm, the effect sizes were large, and the differences were clinically relevant. Physical QoL was more often affected than psychosocial QoL. Regression models could be constructed for 4/ 10 CHQ scales and 6/ 8 PedsQL cancer scales, accounting for 7 to 36 % of the variance in scores. Impaired QoL was most often associated with older children, girls, and time since diagnosis. Also, father respondents seem to have a lower QoL perception compared to mother respondents although this needs to be confirmed in future research. CONCLUSIONS Specific counseling for subsets of patients with a higher risk of low QoL during the early phases of therapy is warranted.
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Affiliation(s)
- Raphaële R L van Litsenburg
- Department of Pediatrics, VU University Medical Center Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands,
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Heidemann CH, Lauridsen HH, Kjeldsen AD, Faber CE, Johansen ECJ, Godballe C. Caregiver Quality of Life and Daily Functioning in Relation to Ventilating Tube Treatment. Otolaryngol Head Neck Surg 2014; 151:341-7. [PMID: 24732686 DOI: 10.1177/0194599814529911] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/11/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Caregiver quality of life and daily functioning may improve after ventilating tube treatment in children with otitis media. The aims of this study are to assess possible changes in caregiver quality of life and daily functioning in relation to ventilating tube treatment and to investigate possible predictors for clinical success. STUDY DESIGN Longitudinal observational study. SETTING Secondary care units. METHODS Four hundred ninety-one families were enrolled in the study. The Caregiver Impact Questionnaire was applied in the assessment of caregiver quality of life. Caregivers completed questionnaires at baseline and at 1, 3, 6, 12, and 18 months' follow-up. Variables on caregiver daily functioning comprised 4 weeks' history of number of interrupted nights, absenteeism, cancelled social activities, and doctor visits as a result of otitis media in the child. RESULTS Response rates ranged from 96% to 79%. Significant improvements in disease-specific quality of life were seen after treatment. The poorest baseline quality of life was found in caregivers of children with recurrent acute otitis media. Significant improvements were found on all variables on daily functioning. Predictors for caregiver-perceived clinical success included child sex, number of interrupted nights, doctor visits, absenteeism, and cancelled social activities. CONCLUSION Results of this study support the notion that caregivers of children with otitis media with defined surgical indications improve their quality of life and daily functioning after ventilating tube treatment. Factors related to caregiver functioning and disease severity were found to be associated with caregivers experiencing important improvements after treatment.
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Affiliation(s)
- Christian Hamilton Heidemann
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Henrik Hein Lauridsen
- Research Unit for Clinical Biomechanics, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Anette Drøhse Kjeldsen
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Christian Emil Faber
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | | | - Christian Godballe
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
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Do parents and children agree? Quality-of-life assessment of children with inflammatory bowel disease and their parents. J Pediatr Gastroenterol Nutr 2014; 58:481-5. [PMID: 24663034 DOI: 10.1097/mpg.0000000000000236] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Multi-item measures of inflammatory bowel disease (IBD) activity based on clinical, laboratory, and/or endoscopic variables do not take into consideration the impact on the patients' emotional aspects and adaptation to the disease. The aim of the present study was to evaluate concordance between parent and child ratings of health-related quality of life on the IMPACT-III questionnaire in children with IBD. METHODS The IMPACT-III questionnaire was used to measure quality of life in 27 patients (mean age 14.2 ± 3 years, 40% girls) and one of their parents (82% mothers). Most of the patients had inactive disease at the time of the study. Differences between parent-proxy ratings and child ratings on the IMPACT-III were compared via paired-samples t tests, intraclass correlation coefficients, and standardized difference scores. RESULTS Parent-proxy and patient ratings were similar on total IMPACT-III and its related domains (bowel symptoms, systemic symptoms, social functioning, body image, treatment/interventions), except that significant differences on emotional functioning ratings were found (P = 0.003). Intraclass correlation coefficients showed medium-to-large effect sizes (range 0.52-0.88) and standardized difference scores showed varying degrees of bias depending on the domain measured (range -0.64 to 0.32). CONCLUSIONS Parents served as a good proxy for quality-of-life ratings in this population of pediatric patients with IBD. The degree of concordance between parent and child scores, however, varied, as observed in the present study in which parents underreported their child's health-related quality of life on the IMPACT-III emotional functioning domain.
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Heidemann CH, Godballe C, Kjeldsen AD, Johansen ECJ, Faber CE, Lauridsen HH. Otitis Media and Caregiver Quality of Life: Psychometric Properties of the Modified Danish Version of the Caregiver Impact Questionnaire. Otolaryngol Head Neck Surg 2014; 151:142-9. [PMID: 24687943 DOI: 10.1177/0194599814528245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/26/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Otitis media in children may have a considerable impact on caregiver quality of life. The disease-specific Caregiver Impact Questionnaire is designed to assess caregiver quality of life in relation to child otitis media. Assessment of the psychometric properties of this instrument is limited. This study assesses the psychometric properties of this instrument including validity, reproducibility, responsiveness, and interpretability. STUDY DESIGN Longitudinal validation study. SETTING Secondary care units. METHODS Analyses were based on data from 435 families. Validity was assessed using confirmatory factor analysis, internal consistency, and hypothesis testing. Test-retest reliability and measures of smallest detectable change were investigated in the assessment of reproducibility. Responsiveness was investigated by means of hypothesis testing and receiver operating characteristic analysis. An anchor-based distribution method was applied for determining minimal important change as perceived by the respondent. RESULTS Factor analysis confirmed the hypothesized 1-factor structure with an acceptable fit. Cronbach's alpha was .90. In the analysis of construct validity, 88.9% of the hypothesized correlations were correctly predicted. Intraclass correlation coefficient was 0.87 and smallest detectable change corresponded to approximately one-fourth of the scale. Responsiveness was found to be good and a change score of 13.8 represented minimal important change. CONCLUSION The modified Danish version of the Caregiver Impact Questionnaire is a valid and reproducible measurement tool that is also sensitive to measuring change in the current setting. A change score representing minimal important change as perceived by the respondent is proposed. Results of this study support the use of this instrument.
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Affiliation(s)
- Christian Hamilton Heidemann
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Christian Godballe
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Anette Drøhse Kjeldsen
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | | | - Christian Emil Faber
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Henrik Hein Lauridsen
- Research Unit for Clinical Biomechanics, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
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Rafii F, Oskouie F, Shoghi M. Caring for a child with cancer: impact on mother's health. Asian Pac J Cancer Prev 2014; 15:1731-8. [PMID: 24641400 DOI: 10.7314/apjcp.2014.15.4.1731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The life of a mother undergoes a dramatic change after a child is diagnosed with cancer. The present study aimed to determine effects on the everyday life process and health status of mothers with children suffering from leukemia. This qualitative study was based on a grounded theory approach with sixteen mothers. The results indicate that after onset of disease in their children, they marginalized their own health and tied their identities to taking care of the child and keeping the child healthy by ignoring themselves, becoming imprisoned in a taking-care-of-the-child position, and trying very hard for seek balance and stability Enduring physical pressures on the one hand, and constantly attempting to achieve balance and stability in family processes on the other hand, gradually cause exhaustion. It seems that health care providers and nurses should pay much more attention to the health status of this group of mothers.
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Affiliation(s)
- Forugh Rafii
- Center for Nursing Care Research and School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran E-mail :
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Hildenbrand AK, Alderfer MA, Deatrick JA, Marsac ML. A mixed methods assessment of coping with pediatric cancer. J Psychosoc Oncol 2014; 32:37-58. [PMID: 24428250 DOI: 10.1080/07347332.2013.855960] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to describe child coping and parent coping assistance with cancer-related stressors during treatment. Fifteen children (age 6-12) with cancer and their parents (N = 17) completed semistructured interviews and self-report measures to assess coping and coping assistance. Results suggest families utilized a broad array of approach and avoidance strategies to manage cancer and its treatment. Quantitative and qualitative assessments provided complementary and unique contributions to understanding coping among children with cancer and their parents. Using a mixed methods approach to assess coping provides a richer understanding of families' experiences, which can better inform clinical practice.
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Affiliation(s)
- Aimee K Hildenbrand
- a Center for Injury Research & Prevention , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
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Abu-Saad Huijer H, Sagherian K, Tamim H. Quality of life and symptom prevalence as reported by children with cancer in Lebanon. Eur J Oncol Nurs 2013; 17:704-10. [DOI: 10.1016/j.ejon.2013.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/27/2013] [Accepted: 09/17/2013] [Indexed: 11/29/2022]
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Williams NA, Fournier J, Coday M, Richey PA, Tylavsky FA, Hare ME. Body esteem, peer difficulties and perceptions of physical health in overweight and obese urban children aged 5 to 7 years. Child Care Health Dev 2013; 39:825-34. [PMID: 22882115 PMCID: PMC3499634 DOI: 10.1111/j.1365-2214.2012.01401.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether there is an association between body mass index (BMI) and body esteem in young overweight and obese urban children, and to test peer relationship difficulties and perceived physical health as mediators of this relationship. METHODS Child self-reported body esteem, and parent-reported child peer relationship difficulties (being bullied by peers and peer rejection) and physical health perceptions were obtained from 218 overweight and obese children aged 5-7 years (81% racial/ethnic minority, M BMI = 25.3) and their primary caregivers. RESULTS Higher BMI was associated with lower body esteem for both girls and boys. This relation was mediated by poor physical health for boys but not for girls. Peer relationship difficulties did not mediate the observed association between BMI and body esteem in either group; however, girls with higher BMI experienced more bullying and being bullied by peers was associated with lower body esteem in girls. CONCLUSIONS Intervening with perceptions of physical health may buffer overweight and obese boys from developing low body esteem in early childhood.
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Affiliation(s)
| | - J. Fournier
- Department of Preventive Medicine; University of Tennessee Health Science Center
| | - M. Coday
- Department of Preventive Medicine; University of Tennessee Health Science Center
| | - P. A. Richey
- Department of Preventive Medicine; University of Tennessee Health Science Center
| | - F. A. Tylavsky
- Department of Preventive Medicine; University of Tennessee Health Science Center
| | - M. E. Hare
- Departments of Pediatrics and Preventive Medicine; University of Tennessee Health Science Center; Memphis; TN; USA
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Impact of functional constipation on health-related quality of life in preschool children and their families in Xi'an, China. PLoS One 2013; 8:e77273. [PMID: 24130872 PMCID: PMC3795078 DOI: 10.1371/journal.pone.0077273] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/31/2013] [Indexed: 02/07/2023] Open
Abstract
Aim Functional constipation (FC) is one of the common diseases among children. The aim of this study was to investigate the health-related quality of life (HRQOL) in preschool children diagnosed with FC and the impact of the condition on affected families. Methods In this cross-sectional, case-control study, 152 children aged 3–6 years with FC, 176 healthy children aged 3–6 years without FC, and their primary caregivers were selected. Chinese versions of the PedsQLTM 4.0 Generic Core Scale and the Family Impact Module (FIM) were used to assess childhood HRQOL and the impact of FC on family members, respectively. HRQOL scores were compared between children with FC and healthy children. In addition, a multiple step-wise regression with demographic variables of children and their caregivers, family economic status, duration and symptoms of FC, as independent variables, was used to determine factors that influenced HRQOL in children and had impacted caregivers. Results Scores of physical, emotional, social and school functions, and summary scales were significantly lower in children with FC than in healthy children (p < 0.05). Physical, emotional, social, cognitive, and communication scores for caregivers, as well as daily activities and relationships for families of children with FC, were significantly lower than those of caregivers and families with healthy children (p < 0.05). Children’s ages, duration of FC, symptoms of FC, the child-caregiver relationship, family economic status, and caregiver education level emerged as the main factors influencing HRQOL in children, caregivers, and family members. Conclusions FC had a significant impact on HRQOL of affected children and their caregivers, as well as their family functions. Social characteristics of children and caregivers, duration and symptoms of FC and family economic status significantly affected HRQOL of children and caregivers, as well as family functions of children with FC.
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Anthony SJ, Selkirk E, Sung L, Klaassen RJ, Dix D, Scheinemann K, Klassen AF. Considering quality of life for children with cancer: a systematic review of patient-reported outcome measures and the development of a conceptual model. Qual Life Res 2013; 23:771-89. [PMID: 23907613 DOI: 10.1007/s11136-013-0482-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES An appraisal of pediatric cancer-specific quality-of-life (QOL) instruments revealed a lack of clarity about what constitutes QOL in this population. This study addresses this concern by identifying the concepts that underpin the construct of QOL as determined by a content analysis of all patient-reported outcome (PRO) instruments used in childhood cancer research. METHODS A systematic review was performed of key databases (i.e., MEDLINE, CINAHL, PsychINFO) to identify studies of QOL in children with cancer. A content analysis process was used to code and categorize all items from generic and cancer-specified PRO instruments. Our objective was to provide clarification regarding the conceptual underpinnings of these instruments, as well as to help inform the development of theory and contribute to building a conceptual framework of QOL for children with cancer. RESULTS A total of 6,013 English language articles were screened, identifying 148 studies. Ten generic and ten cancer-specific PRO instruments provided 957 items. Content analysis led to the identification of four major domains of QOL (physical, psychological, social, and general health), with 11 subdomains covering 98 different concepts. While all instruments reflected items relating to the broader domains of QOL, there was substantial heterogeneity in terms of the content and variability in the distribution of items. CONCLUSIONS This systematic review and the proposed model represent a useful starting point in the critical appraisal of the conceptual underpinnings of PRO instruments used in pediatric oncology and contribute to the need to place such tools under a critical, yet reflective and analytical lens.
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Abstract
OBJECTIVE Health-related quality of life (HRQoL) has become an increasingly important measure of research and treatment outcomes across all medical specialties. However, to date, there has not been an in-depth review of research relevant specifically to HRQoL in the populations of children and adolescents with cancer. In this review, the authors examine the effects of cancer on HRQoL from diagnosis to remission/survivorship and the end of life. DESIGN A literature search was conducted using Medline and PsycINFO for articles published from 2002 to 2011. Studies included patients from diagnosis to remission and also the terminally ill. Twenty-nine studies specifically addressing HRQoL were selected after reaching consensus and study quality check. RESULTS Children who are newly diagnosed with cancer and are undergoing treatment or are terminally ill have impaired HRQoL. Survivors of childhood cancer have high HRQoL (with the exception of those who experienced medical comorbidity or PTSD). The authors found that demographic differences, cancer types, and treatment regimens, all significantly influence the negative impact of cancer on patients' HRQoL. CONCLUSIONS There are specific and identifiable impacts of childhood cancer on patients' HRQoL that are significant and complex across the span of the illness. There is a need for continued research in many areas related to this population, especially related to those with terminal illness in order to improve patient care.
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Arabiat DH, Al Jabery MA. Health related quality of life in paediatric chronic health conditions: A comparative study among children and adolescents in Jordan. Health (London) 2013. [DOI: 10.4236/health.2013.511a2004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Matziou V, Servitzoglou M, Vlahioti E, Deli H, Matziou T, Megapanou E, Perdikaris P. The opinion of Greek parents on the advantages and disadvantages of the outpatient pediatric oncology setting. Eur J Oncol Nurs 2012; 17:739-44. [PMID: 23246485 DOI: 10.1016/j.ejon.2012.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/12/2012] [Accepted: 11/23/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE OF THE RESEARCH The aim of this study was to assess parental opinions on the advantages and disadvantages of a pediatric oncology outpatient setting in comparison to the inpatient oncology ward. METHODS AND SAMPLE The sample of the study consisted of 104 parents whose children were diagnosed and treated for pediatric cancer. The survey took place at the Pediatric Oncology Wards, as well as their respective outpatient settings of the two General Children's Hospitals in Athens, Greece from May 2010 to August 2010. KEY RESULTS According to parents' view the outpatient setting was preferable due to the maintenance keeping of their daily routine (x(2) = 75.9, p = 0.000), maintaining the family life (x(2) = 90.1, p = 0.000) and young patients' participation in activities (x(2) = 25.6, p = 0.000). Moreover, young patients were more happy, less anxious and less scared when they were attending in the daily clinic (x(2) = 25.9, p = 0.000). CONCLUSIONS According to parents' view, the outpatient setting has many advantages. The judgment of children and parents on the services offered by the Pediatric Oncology Unit overall, in both inpatient and outpatient setting can give the necessary feedback to improve the qualitative provided care.
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Affiliation(s)
- Vasiliki Matziou
- Faculty of Nursing, National & Kapodestrian University of Athens, 123 Papadiamantopoulou Str, GR 11527 Athens, Greece.
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Parental sleep experiences on the pediatric oncology ward. Support Care Cancer 2012; 21:557-64. [PMID: 22864535 DOI: 10.1007/s00520-012-1547-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Parents of pediatric oncology patients are encouraged to sleep on the ward with their child to provide additional care throughout the night. The purpose of this study was to provide the first prevalence estimates of self-reported sleep quantity and quality among parents accommodated on the pediatric oncology ward, compared to parents of age-matched controls. METHODS Parents of children receiving in-patient cancer treatment and parents of healthy, age-matched children completed a self-report questionnaire, including validated measures of parental sleep and psychological distress, demographic, and clinical characteristics. RESULTS In total, 114 parents participated (52 parents of children with cancer; 62 control parents; over all response rate 70 %). Parents on the pediatric oncology ward reported sleeping 5.7 h (SD = 1.8) on average, in comparison to control parents who reported sleeping 7.0 h at home (SD = 1.4; t = 4.3, p < 0.001). Parents reported waking an average of 4.6 times (SD = 0.3) per night on the ward, compared to control parents who reported 2.0 (SD = 0.2) nighttime awakenings (t = 7.69, p < 0.001). Parents of children with cancer were significantly more likely to report that they had slept "badly" (67.3 versus 21.0 %; χ(2) = 21.9, p < 0.001). Significant predictors of sleep duration included anxiety (p = 0.013) and caffeine consumption (p = 0.017). Parents who slept on the ward attributed poor sleep to feelings of anxiety, environmental noise, and child-related factors. CONCLUSIONS Parents who sleep on the pediatric oncology ward experience poor sleep outcomes, including inadequate duration and frequent interruptions. The detrimental effects of sleep deprivation on parents' ability to cope during this challenging time require further investigation and intervention.
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Engelen V, van Zwieten M, Koopman H, Detmar S, Caron H, Brons P, Egeler M, Kaspers GJ, Grootenhuis M. The influence of patient reported outcomes on the discussion of psychosocial issues in children with cancer. Pediatr Blood Cancer 2012; 59:161-6. [PMID: 22271750 DOI: 10.1002/pbc.24089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 12/30/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study investigates the effect of using patient reported outcomes (PROs) about health-related quality of life (HRQOL) in clinical practice on the type and amount of psychosocial topics discussed during a paediatric oncology consultation. PROCEDURE Children (N = 193) with cancer participated in a sequential cohort intervention study, with a control (no PRO was used) and intervention group (a PRO was used). For each child three consecutive consultations with the paediatric oncologist were audio recorded in order to assess the discussed psychosocial topics. One third of the audio recordings were qualitatively analysed. RESULTS The type of the discussed psychosocial topics in the control and intervention group did not differ from each other. However, the discussion of psychosocial topics increased in the intervention group compared to the control group. In both groups, topics within the social domain occurred most frequently and topics regarding the emotional domain had the lowest incidence. CONCLUSIONS PROs do not change the psychosocial content of communication. Paediatric oncologists already address psychosocial issues during the consultation, regardless of the use of a PRO. However, with a PRO available they address these issues more systematically and more often.
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Affiliation(s)
- Vivian Engelen
- Psychosocial Department, Academic Medical Centre, Emma Children's Hospital, Amsterdam, The Netherlands
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82
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Hildenbrand AK, Clawson KJ, Alderfer MA, Marsac ML. Coping with pediatric cancer: strategies employed by children and their parents to manage cancer-related stressors during treatment. J Pediatr Oncol Nurs 2012; 28:344-54. [PMID: 22194147 DOI: 10.1177/1043454211430823] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pediatric cancer patients and their families face significant physical, emotional, and psychosocial challenges. Few studies have investigated how children manage these challenges and how parents may help in the process. This qualitative study aimed to explore common cancer-related stressors for children and to examine child coping and parental assistance in coping with these stressors during treatment. Fifteen children undergoing cancer treatment and their parents participated in semistructured interviews. Four themes emerged capturing cancer-related stressors: cancer treatment/side effects, distressing emotions, disruption in daily routines, and social challenges. Six themes emerged regarding child coping strategies that were classified within an approach/avoidance coping framework. Approach coping strategies included the following: cognitive restructuring, relaxation, practical strategies, seeking social support, and emotional expression. Distraction was the only avoidant coping strategy. Parents tended to encourage approach coping strategies (eg, cognitive restructuring, social support). Within families, few coping strategies were reported (child: M = 1.47, SD = 0.99; parent: M = 3.33, SD = 1.18), suggesting that early family-based interventions teaching coping techniques for cancer-related stressors may be beneficial.
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83
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Yağci-Küpeli B, Akyüz C, Küpeli S, Büyükpamukçu M. Health-related quality of life in pediatric cancer survivors: a multifactorial assessment including parental factors. J Pediatr Hematol Oncol 2012; 34:194-9. [PMID: 22441710 DOI: 10.1097/mph.0b013e3182467f5f] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM We aimed to evaluate the health-related quality of life (HRQOL) and the effect of associated factors such as cancer type, treatment strategies, sex, age, and parental factors like education and psychopathology in pediatric cancer survivors and make a comparison with healthy children. PATIENTS AND METHODS "Pediatric Quality of Life Inventory (PedsQL) 4.0 TM, Generic Core Scale" for children and parents, and "Brief Symptom Inventory" for parents were used. Three hundred and two survivors without major mental or motor deficit and 272 healthy controls of 8 to 18 years of age were enrolled to study. RESULTS Comparison of scores according to child self-report between survivor and control groups revealed lower points in physical and school subscale of survivor group (P<0.01 and P<0.001, respectively). Female survivors had reported significantly worse HRQOL in physical and emotional subscales of PedsQL than male survivors (P<0.001). Female survivors of ≥16 years of age had reported worse scores in school subscale than females of younger age groups and male survivors of same age group. Parents of control group reported better results in school subscales (P<0.001) and social functioning subscales (P<0.05) than parents of survivor group. Brief Symptom Inventory score had significant effect on child self-report and parent proxy-report of physical functioning (P<0.001), emotional functioning (P<0.001), social functioning (P<0.001), and school subscales (P<0.001) of PedsQL. Significantly better scores of physical functioning subscale in the survivors whose parents are university graduate than the survivors whose parents are primary school graduate were detected (P<0.001). The survivors with central nervous system tumors had reported lower scores in the social, emotional, physical, and school functioning subscales of PedsQL than patients with non-Hodgkin and Hodgkin lymphoma (P<0.001). Child self-report school subscale scores were lower in survivors treated with radiotherapy in combination or as sole therapy than survivors in whom radiotherapy was not given (P<0.001). CONCLUSIONS Our study has provided evidence about less-studied determinants of HRQOL like parental factors such as psychopathology or educational level in childhood cancer survivors. Future research can build on this evidence to obtain additional factors other than well-known medical and treatment-related factors.
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Affiliation(s)
- Begül Yağci-Küpeli
- Department of Pediatric Oncology, Hacettepe University, Institute of Oncology, Sihhiye, Ankara, Turkey.
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84
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Sabbah I, Sabbah H, Sabbah S, Akoum H, Droubi N, Mercier M. Measurement Properties of the Arabic Lebanon Version of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales for Young Child (5 - 7 years), and Child Aged 8 - 12 Years: Quality of Life of in Urban and Rural Children in Lebanon. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ce.2012.326146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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85
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Klassen AF, Dix D, Papsdorf M, Klaassen RJ, Yanofsky R, Sung L. Impact of caring for a child with cancer on single parents compared with parents from two-parent families. Pediatr Blood Cancer 2012; 58:74-9. [PMID: 21254372 DOI: 10.1002/pbc.22952] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 11/08/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is currently unknown how the intensive and often prolonged treatment of childhood cancer impacts on the lives of single parents. Our aims were to determine whether single parents differ from parents from two-parent families in terms of caregiver demand (the time and effort involved in caregiving), and health-related quality of life (HRQL). PROCEDURES Forty single parents and 275 parents from two-parent families were recruited between November 2004 and February 2007 from five pediatric oncology centers in Canada. Parents were asked to complete a questionnaire booklet composed of items and scales to measure caregiver demand and HRQL (SF-36). The booklet also measured the following constructs: background and context factors, child factors, caregiving strain, intrapsychic factors, and coping factors. RESULTS Single parents did not differ from parents from two-parent families in caregiving demand and physical and psychosocial HRQL. Compared with Canadian population norms for the SF-36, both groups reported clinically important differences (i.e., worse health) in psychosocial HRQL (effect size ≥ -2.00), while scores for physical HRQL were within one standard deviation of population norms. CONCLUSION Our findings suggest that the impact of caregiving on single parents, in terms of caregiving demand and HRQL is similar to that of parents from two-parent families.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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A detailed prospective longitudinal assessment of health status in children with brain tumors in the first year after diagnosis. J Pediatr Hematol Oncol 2011; 33:592-9. [PMID: 21768887 DOI: 10.1097/mph.0b013e31821388c0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare health status (HS) in children with brain tumors at 1 (t1), 6 (t6), and 12 (t12) months after diagnosis with "normal" controls. To assess the relationship between parent-report and self-report HS for patients at t12. METHODS HS was assessed using the Health Utilities Index Mark III parent-report at all time points and self-report at t12. Twenty-nine patients and 32 controls were included in analysis of parent-report, and 21 patients and 22 controls in self-report HS at t12. Nonparametric analyses were used. RESULTS Patients scored significantly lower than controls for global overall HS at all time points for parent-report and at t12 for self-report (Pmax=0.009). For parent-report, patients scored significantly lower than controls in the attributes of emotion, cognition, and pain at t1 and t6, in ambulation at t1 and in dexterity at t6. At t12, the difference was statistically significant for parent-report cognition only (all P<0.01). No attributes reached significance for self-report at t12. For patients, correlations between parent-report and self-report were good (rs>0.73) for all Health Utilities Index Mark 3 scores with the exception of emotion and pain. CONCLUSION HS is significantly compromised in children with brain tumors over the first year after diagnosis, but improves with time. Parent-report and self-report differ, and both should be considered in assessing outcomes or defining interventions.
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Klassen AF, Gulati S, Granek L, Rosenberg-Yunger ZRS, Watt L, Sung L, Klaassen R, Dix D, Shaw NT. Understanding the health impact of caregiving: a qualitative study of immigrant parents and single parents of children with cancer. Qual Life Res 2011; 21:1595-605. [DOI: 10.1007/s11136-011-0072-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2011] [Indexed: 11/27/2022]
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Differences in mothers' and fathers' health-related quality of life after pediatric SCT: a longitudinal study. Bone Marrow Transplant 2011; 47:855-9. [PMID: 21946382 DOI: 10.1038/bmt.2011.190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to examine longitudinally health-related quality of life (HRQOL) and related factors in mothers and fathers of children who undergo SCT, before, and 1 and 2 years after SCT. A total of 84 parents (49 mothers/35 fathers) of patients diagnosed mainly with leukemia completed a HRQOL measure before SCT, 46 at 1 year (26 mothers/20 fathers) and 50 parents (31 mothers/19 fathers) at 2 years post SCT. Physical and psychosocial HRQOL summary scores are reported. Parents' age and gender, child's diagnosis, radiation history, age, behavior and physical health were examined. Linear mixed models for repeated measures with a covariate structure were used for analysis. Physical HRQOL did not differ between mothers and fathers or over time. Maternal and paternal psychosocial HRQOL scores improved by 2 years post SCT. Child's behavior problems and poor health, and maternal age (younger) predicted poor maternal psychosocial HRQOL 2 years post SCT. Child's behavior problems, diagnosis and treatment severity predicted poor paternal psychosocial HRQOL. These findings identify similar (child's poor behavior) and differential risk factors (parental young age, disease and treatment severity, and child's poor health status) for poor HRQOL for mothers and fathers. These findings can guide comprehensive family-care interventions before, during and after pediatric SCT.
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The impact of educating parents of leukemic children on the patients' quality of life. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:550-5. [PMID: 22737526 PMCID: PMC3371991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 05/09/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND The quality of life of children with leukemia is reduced by fear and anxiety of parents after diagnosis, lack of information about the disease, treatments, and care of the child. This study aims to evaluate the effect of educating parents of leukemic children on the patients' quality of life. METHODS In this interventional study, sixty parents of ALL children who met inclusion criteria were selected using simple random sampling method, and assigned to the experimental and control groups. The study tool included a valid and reliable questionnaire (TNO-AZL), that was filled in through interview by parents before and two months after the intervention for both groups. The first part of the questionnaire included demographic items and the second part (7 dimensions, each with 8 sections) contained questions related to the quality of life. The scores could range between 56 and 280 and a higher score represented a better quality of life. The intervention included three one-hour classes composed of lecture and question-answer sessions which were held for groups of 4-6 participants, accompanied by a booklet. RESULTS Before the intervention, the quality of life score in the experimental and control groups was 180.83±14.43 and 174.28±20.72, respectively; after the intervention, these figures changed to 226.9±11.76 and 174.41±20.42 respectively. Paired samples T-test proved a significant increase in the quality of life in the experimental group. CONCLUSION Parent education successfully increased the quality of life of leukemic children; therefore, parental consultation sessions and educational programs are recommended.
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90
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Klassen AF, Anthony SJ, Khan A, Sung L, Klaassen R. Identifying determinants of quality of life of children with cancer and childhood cancer survivors: a systematic review. Support Care Cancer 2011; 19:1275-87. [PMID: 21611865 DOI: 10.1007/s00520-011-1193-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 05/16/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE This paper describes a systematic review conducted to identify factors that have been investigated as explanations of variability in the quality of life of children with cancer and childhood cancer survivors. Our purpose was to build an evidence base that could be used to guide and direct future research. METHODS MEDLINE, CINAHL, EMBASE, PsycINFO, Cancerlit, and Sociological Abstracts were searched from the inception of each database to June 15, 2009 using the following search terms: "quality of life," "health-related quality of life," "quality adjusted life years," "health status," "functional status," "well-being," or "patient-reported outcome." Sample characteristics and information about the relationship between a quality of life domain or total scale score and at least one factor (e.g., child gender or age, coping skills, family income) were extracted from eligible studies. RESULTS Nine cancer-specific and nine generic QOL questionnaires were used in 58 publications described 239 factors (50 unique factors). The large number of cancer, treatment, child, and family variables considered indicates that extensive research activity has occurred. However, most of the variables identified were examined in only a few studies and most represent medical and treatment variables with less research attention paid to child and family variables. CONCLUSIONS Our study has compiled evidence about determinants of QOL for children with cancer and childhood cancer survivors from the existing literature. Future research can build on this evidence base to expand the range of factors studied as most research to date has focused on medical and treatment factors.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, HSC 3N27, 1200 Main Street West, Hamilton, ON, L8S 4J9, Canada.
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Engelen V, Koopman HM, Detmar SB, Raat H, van de Wetering MD, Brons P, Anninga JK, Abbink F, Grootenhuis MA. Health-related quality of life after completion of successful treatment for childhood cancer. Pediatr Blood Cancer 2011; 56:646-53. [PMID: 21298753 DOI: 10.1002/pbc.22795] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 07/20/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous studies have assessed health-related quality of life (HRQOL) during several treatment stages in children with cancer, but there is limited knowledge about HRQOL shortly after completing therapy. This study determined HRQOL of children with cancer shortly after the end of successful treatment compared with normative values. PROCEDURE Several age-specific HRQOL questionnaires were administered: the ITQOL (generic, proxy-report, 0-4 years), CHQ PF 50 (generic, proxy-report, 5-7 years), Kidscreen (generic, self-report, 8-18 years) and Disabkids (chronic generic, self-report, 8-18 years). RESULTS Children with cancer (N = 191, mean age 9.25, SD 5.06, 47.1% female) participated. Physical well-being was affected for all ages. Compared to normative values 0- to 7-year-olds were rated significantly lower on the majority of the scales. In addition, 12- to 18-year-olds had significantly better HRQOL than the norm on social scales. Compared to chronically ill norms, 8- to 18-year-olds demonstrated no differences, except for 12- to 18-year-olds who experienced significantly more physical limitations. Additionally, we found that HRQOL of parents of 0- to 7-year-olds was poorer than the norm. CONCLUSION HRQOL in children with cancer and their parents can be impaired compared with the norm. Therefore, HRQOL should be monitored in clinical practice to make paediatric oncologists aware of these problems. For young children, we recommend checking whether certain HRQOL problems can be explained by parental worries. For older children and adolescents, paediatric oncologists need to consider social desirability and the child's adaptive style.
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Affiliation(s)
- V Engelen
- Psychosocial Department, Academic Medical Centre/Emma Children's Hospital, Amsterdam, the Netherlands.
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92
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Klassen AF, Raina P, McIntosh C, Sung L, Klaassen RJ, O'Donnell M, Yanofsky R, Dix D. Parents of children with cancer: which factors explain differences in health-related quality of life. Int J Cancer 2010; 129:1190-8. [PMID: 21064097 DOI: 10.1002/ijc.25737] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 09/21/2010] [Indexed: 11/11/2022]
Abstract
Research with parents of children with cancer has identified factors related to their adjustment and coping, but it is not fully understood why some parents do well and others do not. Guided by a stress process model, we examined the interrelationships among a comprehensive set of factors to identify the most important determinants of health-related quality of life (HRQoL) in parents of children in active treatment for cancer. A cross-sectional survey of 411 parents (80% response rate) of children receiving cancer treatment in Canada was conducted between November 2004 and February 2007. The following constructs were measured: background and context factors, child characteristics, family-centered service delivery, caregiver strain, intrapsychic factors, coping/supportive factors and parental HRQoL. The model was evaluated using structural equation modeling. Analysis was stratified by time since diagnosis (i.e., <12 months and ≥12 months). For those within 12 months of their child's diagnosis, family-centred service provision, caregiver strain, and self-perception accounted for 58% of the variation in psychosocial health, whereas caregiver strain and social support explained 50% of the variation in physical health. For parents in the >12 month group, caregiving strain was the only factor with a direct relationship with parental psychosocial and physical health, accounting for 66% and 55% of the variance in these constructs, respectively. Our findings reinforce the need for health professionals to be particularly attuned to family caregivers in the early stages of treatment and identify potential areas for interventions to promote parental health.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, ON, Canada.
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93
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Liu YM, Yeh CH. Pediatric oncology: the use of cluster analysis to examine maternal concerns. Oncol Nurs Forum 2010; 37:E304-11. [PMID: 20591794 DOI: 10.1188/10.onf.e304-e311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine data from mothers whose children have cancer and to identify the characteristics of uncertainty and distress that they reported. The objectives were (a) to use cluster analysis to identify subgroups of maternal uncertainty and distress, (b) to examine whether the subgroups differed based on demographics and children's illness-related variables, and (c) to explore whether mothers in the subgroups differed on quality of life (QOL) and hope. DESIGN Descriptive, correlational study. SETTING Pediatric oncology units in northern Taiwan. SAMPLE 200 mothers of children with cancer. METHODS Participants completed the Parental Perception of Uncertainty Scale, the Symptom Checklist-35-Revised, the Short-Form 36 Health Survey, the Herth Hope Index, and a demographic questionnaire. Cluster analyses were used to identify subgroups of mothers regarding maternal perceived uncertainty and distress. Differences in demographic variables, disease characteristics, and outcome measures were evaluated with descriptive statistics, analysis of variance, and chi-square analysis. MAIN RESEARCH VARIABLES Subgroup, maternal uncertainty, distress, QOL, and hope. FINDINGS Four subgroups were identified by the cluster analyses: high uncertainty and high distress, moderate uncertainty and moderate distress, low uncertainty and low distress, and high uncertainty and low distress. CONCLUSIONS The subgroup of mothers who reported low uncertainty and low distress reported the highest QOL and hope. IMPLICATIONS FOR NURSING The findings of this study provide insight for pediatric oncology clinicians and offer issues related to uncertainty, distress, and QOL that such professionals can discuss with the mothers of their patients.
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Affiliation(s)
- Ying-Mei Liu
- Institute of Clinical Medical Sciences, Chang Gung University, Taiwan.
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94
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Witt WP, Litzelman K, Wisk LE, Spear HA, Catrine K, Levin N, Gottlieb CA. Stress-mediated quality of life outcomes in parents of childhood cancer and brain tumor survivors: a case-control study. Qual Life Res 2010; 19:995-1005. [PMID: 20473638 DOI: 10.1007/s11136-010-9666-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine if caring for a child with cancer or a brain tumor affects parental health and mental health and if and to what extent stress mediates the relationship between case status and parental quality of life. METHODS In person interviewer-assisted surveys were administered to 74 case dyads (children diagnosed with cancer or a brain tumor and their parents) and 129 control dyads (children without health problems and their parents from a community sample) to assess health-related quality of life and perceived levels of stress. RESULTS Parents of children with cancer or a brain tumor had significantly worse health-related quality of life, including worse overall mental health. Overall physical health was no different between cases and controls. Staged multivariate analysis revealed that worse health-related quality of life is completely mediated by perceived stress in these parents. CONCLUSIONS The experience of caring for a child with cancer is not in itself related to poor quality of life, but is related to an increased level of stress that may adversely impact parental mental health and quality of life.
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Affiliation(s)
- Whitney P Witt
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792-4108, USA.
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Eilertsen MEB, Kristiansen K, Reinfjell T, Rannestad T, Indredavik MS, Vik T. Professional collaboration – support for children with cancer and their families – focus group interview – a source of information and knowledge – professionals' perspectives. J Interprof Care 2009; 23:355-68. [DOI: 10.1080/13561820902881726] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Huang IC, Thompson LA, Chi YY, Knapp CA, Revicki DA, Seid M, Shenkman EA. The linkage between pediatric quality of life and health conditions: establishing clinically meaningful cutoff scores for the PedsQL. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:773-81. [PMID: 19508660 PMCID: PMC4299816 DOI: 10.1111/j.1524-4733.2008.00487.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To link pediatric health-related quality of life (HRQOL) and health conditions by establishing clinically meaningful cutoff scores for an HRQOL instrument, the Pediatric Quality of Life Inventory (PedsQL). METHODS We conducted telephone interviews with 1745 parents whose children were between 2 and 18 years old and enrolled in the Florida KidCare program and Children's Medical Services Network in 2006. Two anchors, the Children with Special Health Care Needs (CSHCN) Screener and the Clinical Risk Groups (CRGs), were used to identify children with special health-care needs or chronic conditions. We established cutoff scores for the PedsQL's physical, emotional, social, school, and total functioning using the areas under the curves (AUCs) to determine the discriminative property of the PedsQL referring to the anchors. RESULTS The discriminative property of the PedsQL was superior, especially in total functioning (AUC > 0.7), between children with special health-care needs (based on the CSHCN Screener) and with moderate and major chronic conditions (based on the CRGs) as compared to healthy children. For children <8 years, the recommended cutoff scores for using total functioning to identify CSHCN were 83, 79 for moderate, and 77 for major chronic conditions. For children ≥8 years, the cutoff scores were 78, 76, and 70, respectively. CONCLUSIONS Pediatric HRQOL varied with health conditions. Establishing cutoff scores for the PedsQL's total functioning is a valid and convenient means to potentially identify children with special health-care needs or chronic conditions. The cutoff scores can help clinicians to conduct further in-depth clinical assessments.
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Affiliation(s)
- I-Chan Huang
- Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL, USA.
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97
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Vrijmoet-Wiersma CMJ, Hoekstra-Weebers JEHM, Margreet de Peinder WMG, Koopman HM, Tissing WJE, Treffers PDA, Bierings MB, Jansen NCA, Grootenhuis MA, Egeler RM. Psychometric qualities of the Dutch version of the Pediatric Inventory for Parents (PIP): a multi-center study. Psychooncology 2009; 19:368-75. [DOI: 10.1002/pon.1571] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Reinfjell T, Lofstad GE, Nordahl HM, Vikan A, Diseth TH. Children in remission from acute lymphoblastic leukaemia: mental health, psychosocial adjustment and parental functioning. Eur J Cancer Care (Engl) 2009; 18:364-70. [PMID: 19473372 DOI: 10.1111/j.1365-2354.2008.00954.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Children in remission from acute lymphoblastic leukaemia: mental health, psychosocial adjustment and parental functioningThe objective of this study is to assess the mental health and psychosocial adjustment of children in remission from acute lymphoblastic leukaemia (ALL), and parental functioning compared to healthy controls. A cross-sectional study of 40 children treated for ALL (mean age 11.8 years, range 8.5-15.4) and healthy controls (n = 42) (mean age 11.8 years, range 8.11-15.0) were assessed by the Child Behaviour Checklist (CBCL), the Youth Self-Report (YSR) and the Strength and Difficulties Questionnaire (SDQ). The parent's own mental health was assessed by the General Health Questionnaire (GHQ-30). Children treated for ALL showed on average significantly more symptoms as measured by the CBCL Total Behaviour Score for mother's report (P = 0.005), and for father's report (P = 0.004) compared with healthy children. Fathers reported more anxiety (P = 0.03) and depression (P = 0.02) as measured by the GHQ-30 compared with healthy controls. Children in remission from ALL showed on average significantly more problems regarding mental health and psychosocial adjustment, as reported by their parents, compared with healthy controls. Adequate rehabilitation and follow-up programmes should be implemented for children in remission from ALL. The results indicate the need to pay attention to the mental health of fathers during the rehabilitation phase.
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Affiliation(s)
- T Reinfjell
- Department of Neuroscience (INM), Regional Centre for Child and Adolescent Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
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de Vries MAG, van Litsenburg RRL, Huisman J, Grootenhuis MA, Versluys AB, Kaspers GJL, Gemke RJBJ. Effect of dexamethasone on quality of life in children with acute lymphoblastic leukaemia: a prospective observational study. Health Qual Life Outcomes 2008; 6:103. [PMID: 19036151 PMCID: PMC2640370 DOI: 10.1186/1477-7525-6-103] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 11/26/2008] [Indexed: 11/30/2022] Open
Abstract
Background Glucocorticoids are important in the treatment of childhood acute lymphoblastic leukaemia (ALL). However, cyclic administration of high dose glucocorticoids may cause rapid and substantial changes in quality of life (QoL). The maintenance phase of the Dutch ALL-9 protocol consisted of alternating two weeks on and five weeks off dexamethasone (6 mg/m2/day). The present study was performed to assess the effect of dexamethasone on QoL during treatment for ALL according to this protocol. Methods In a multicentre prospective cohort study, QoL was assessed halfway (T1) and at the end of the two-year treatment (T2). A generic (Child Health Questionnaire) and disease specific (PedsQL™ cancer version) QoL questionnaire were used to assess QoL in two periods: on and off dexamethasone, respectively. Results 41 children (56% males) were evaluated, mean age at diagnosis was 5.6 years. The CHQ physical and psychosocial summary scores were significantly lower than population norms. At T1 and T2, overall QoL showed no significant change. However, regarding specific domains (pain, cognitive functioning, emotion/behaviour and physical functioning) QoL decreased over time. QoL was significantly more impaired during periods on dexamethasone. Conclusion Dexamethasone was associated with decreased QoL. At the end of treatment, reported QoL during dexamethasone deteriorated even more on certain scales (pain, cognitive functioning, emotion/behaviour and physical functioning). Knowledge of the specific aspects of QoL is essential to improve counselling and coping in paediatric oncology. Adverse effects of specific drugs on QoL should be taken into account when designing treatment protocols.
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Affiliation(s)
- Machteld A G de Vries
- Department of Paediatrics and Division of Oncology-Haematology, VU University Medical Centre, Amsterdam, The Netherlands.
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Klassen AF, Klaassen R, Dix D, Pritchard S, Yanofsky R, O'Donnell M, Scott A, Sung L. Impact of caring for a child with cancer on parents' health-related quality of life. J Clin Oncol 2008; 26:5884-9. [PMID: 19029424 DOI: 10.1200/jco.2007.15.2835] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To compare the health-related quality of life (QOL) of parents of children who are undergoing treatment for cancer with that of Canadian population norms and to identify important parent and child predictors of parental QOL. PATIENTS AND METHODS A total of 411 respondents of 513 eligible parents were recruited from five pediatric oncology centers in Canada between November 2004 and February 2007. Parents were asked to complete a questionnaire booklet that included a measure of adult QOL (SF-36), a measure of child health status (functional status IIR), and questions to assess health-promoting self-care actions (eg, sleep, diet, and exercise habits) and characteristics of the child with cancer (eg, relapse status, time since diagnosis, prognosis, treatment intensity). RESULTS Compared with population norms, parents of children with cancer reported poorer physical and psychosocial QOL in all psychosocial domains (effect sizes range, -0.71 to -1.58) and in most physical health domains (effect sizes range, -0.08 to -0.63). Parent characteristics associated with better parental QOL included better eating, exercise and sleep habits, younger age, and higher income. Child characteristics associated with better parental QOL included better child health status (functional status IIR scores), lower treatment intensity, and longer time since diagnosis. CONCLUSION Parents of children with cancer report poorer QOL compared with population norms. Interventions directed at parents should be included as part of the treatment plan for a child with cancer. Modifiable variables associated with poorer parental QOL, such as sleep quality and diet and exercise habits, indicate those parents most likely to experience poor QOL and may be potential areas for intervention.
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Affiliation(s)
- Anne F Klassen
- DPhil, Department of Pediatrics, McMaster University, 3A, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.
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