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Mogensen N, Kreicbergs U, Albertsen BK, Lähteenmäki PM, Heyman M, Harila A. Quality of life in children and adolescents after treatment for acute lymphoblastic leukemia according to the NOPHO ALL2008 protocol. Pediatr Blood Cancer 2024; 71:e31018. [PMID: 38644601 DOI: 10.1002/pbc.31018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/27/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND The improved outcome of childhood acute lymphoblastic leukemia (ALL) over the last decades has increased the importance of assessing late effects and health-related quality of life (HRQoL), particularly when evaluating and comparing outcomes in clinical trials. This study aimed to assess HRQoL in children treated for ALL according to the NOPHO ALL2008 protocol. PROCEDURE Children, aged 1 to less than 18 years at diagnosis, alive in first remission, and their parents, were asked to complete PedsQL 4.0 Generic Core Scales (self- and proxy-report) at ≥6 months after end of therapy. Data on socioeconomic factors and parent-reported toxicity were collected through a study-specific questionnaire, and the NOPHO ALL2008 database was used to identify eligible families and add additional disease- and treatment-related data. HRQoL data were collected during 2013-2019 in Sweden, Finland, and Denmark. RESULTS A total of 299 children were included. The older children (8 years and older) reported similar HRQoL scores compared to Finnish reference data, except lower scores for School Functioning in high-risk patients. Scores from the parent-proxy and self-reports from 5-7-year olds were notably lower than reference. Parent-reported toxicity was associated with lower total and physical HRQoL scores in adjusted models for younger as well as older children in the self-report and parent-proxy versions, and also with lower psychosocial score in the parent-proxy. CONCLUSIONS Self-reported HRQoL was similar to reference population. The most important determinant for HRQoL after end of ALL treatment was parent-reported toxicity during treatment. Thus, minimizing complications is an obvious focus for future treatment protocols.
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Affiliation(s)
- Nina Mogensen
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Institute of Child Health, University College London, London, England
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Turku University Hospital, University of Turku, and FICAN-West, Turku, Finland
- Swedish Childhood Cancer Registry, Karolinska Institutet, Stockholm, Sweden
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Arja Harila
- Department of Women's and Children's Health, Uppsala University and Pediatric Oncology, Uppsala University Hospital, Uppsala, Sweden
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Hernádfői MV, Koch DK, Kói T, Imrei M, Nagy R, Máté V, Garai R, Donnet J, Balogh J, Kovács GT, Párniczky A, Hegyi P, Garami M. Burden of Childhood Cancer and the Social and Economic Challenges in Adulthood: A Systematic Review and Meta-Analysis. JAMA Pediatr 2024; 178:548-566. [PMID: 38619829 PMCID: PMC11019450 DOI: 10.1001/jamapediatrics.2024.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/31/2024] [Indexed: 04/16/2024]
Abstract
Importance Significant advancements in pediatric oncology have led to a continuously growing population of survivors. Although extensive research is being conducted on the short-, medium-, and long-term somatic effects, reports on psychosocial reintegration are often conflicting; therefore, there is an urgent need to synthesize the evidence to obtain the clearest understanding and the most comprehensive answer. Objective To provide a comprehensive review and analysis of the socioeconomic attainment of childhood cancer survivors (CCSs) compared with their unaffected peers. Data Sources A systematic review and meta-analysis was conducted using data obtained from a comprehensive search of MEDLINE (via PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases on October 23, 2021; the search was updated until July 31, 2023. Study Selection Eligible articles reported on educational attainment, employment, family formation, quality of life (QoL), or health-risk behavior-related outcomes of CCSs, and compared them with their unaffected peers. Study selection was performed in duplicate by 4 blinded independent coauthors. Data Extraction and Synthesis Data extraction was performed in duplicate by 4 independent authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures were odds ratios (ORs) and mean differences with 95% CIs; data were pooled using a random-effects model. Results The search identified 43 913 articles, 280 of which were eligible for analysis, reporting data on a total of 389 502 survivors. CCSs were less likely to complete higher levels of education (OR, 0.69; 95% CI, 0.40-1.18), had higher odds of health-related unemployment (OR, 2.94; 95% CI, 1.90-4.57), and showed lower rates of marriage (OR, 0.72; 95% CI, 0.63-0.84) and parenthood (OR, 0.60; 95% CI, 0.49-0.74) compared with population-based controls. Conclusion and Relevance Study findings suggest that CCSs face several socioeconomic difficulties; as a result, the next goal of pediatric oncology should be to minimize adverse effects, as well as to provide lifelong survivorship support aimed at maximizing social reintegration.
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Affiliation(s)
- Márk Viktor Hernádfői
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Bethesda Children’s Hospital, Budapest, Hungary
| | - Dóra Kornélia Koch
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Mathematics, Department of Stochastics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Marcell Imrei
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Vanda Máté
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Réka Garai
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Jessica Donnet
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - József Balogh
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Andrea Párniczky
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Miklós Garami
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
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Shuai J, Cui Y, Zhou F, Yang W, Ma Y, Yan Y. Health related quality of life in pediatric hematological malignancies patients and survivors: A meta-analysis of comparative studies. J Psychosom Res 2024; 177:111568. [PMID: 38113797 DOI: 10.1016/j.jpsychores.2023.111568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/15/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Pediatric patients with hematologic malignancies (HM) and survivors are at high risk for numerous negative effects including decreased health-related quality of life (HRQOL). In order to understand the association between HM and QOL, we conducted this meta-analysis to systematically compare QOL between pediatric HM patients and survivors and controls. METHOD The PubMed, EMBASE, Web of Science and the Cochrane Library databases were systematically searched. Data were analyzed using the random-effects model. RESULTS Of 6586 unique articles identified, 30 were included in this meta-analysis. Studies described 12 different HRQOL tools. Different QOL measures varied in their association with quality of life. When compared with Non-HM group, the Pediatric Quality of Life Inventory (PedsQL) has a moderate effect size (standard mean difference, SMD = 0.50, 95% CI: 0.32, 0.68; P < 0.001). When compared with health controls, it has a large effect size (SMD = -1.00, 95% CI: -1.47, -0.53; P < 0.001). In addition, Health utilities index mark (HUI), and the Pediatric Oncology Quality of Life Scale (POQOLS) have a large (SMD = -0.81, 95% CI: -1.29, -0.33; P = 0.001) and a small (SMD = -0.10, 95% CI: -0.42, 0.22; P = 0.534) effect sizes when comparing overall controls. CONCLUSION Pediatric HM patients and survivors had lower QOL compared with healthy controls and higher QOL compared with Non-HM controls in most domains. Considering the negative impact of poor QOL on daily life and functional outcomes, future research should focus on proposing effective measures to improve QOL of this population.
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Affiliation(s)
- Jingliang Shuai
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yiran Cui
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Feixiang Zhou
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Wenyan Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yulan Ma
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
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Ototoxicity-induced hearing loss and quality of life in survivors of paediatric cancer. Int J Pediatr Otorhinolaryngol 2020; 138:110401. [PMID: 33152988 DOI: 10.1016/j.ijporl.2020.110401] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Hearing loss is a permanent and debilitating side-effect of a range of interventions commonly used in the treatment of childhood cancers, primarily ototoxic medications such as cisplatin. The purpose of this study was to examine the impact of hearing loss, in a population already at risk of reduced quality of life due to the cancer and treatment-related factors. METHODS This study used a questionnaire specifically designed to tap issues relevant to children with hearing loss, the Paediatric Audiology Quality of Life questionnaire (PAQL). Parents of 78 children treated for a wide range of solid tumours and leukaemias completed the PAQL, 41 of whom had sensorineural hearing loss as a result of the cancer treatment. RESULTS Significant differences between those children with hearing loss and those whose hearing remained normal were found on all four scales of the questionnaire. Children affected by ototoxicity were rated as having poorer quality of life in terms of their ability to communicate with family and peers, their independence, interactions with peers and emotional well-being. CONCLUSION These results highlight the impact of acquired hearing loss and reinforce the importance of assessing quality of life with a measure capable of tapping the issues of consequence to the population under investigation. They also have implications for the clinical management of children during and following treatment for a wide range of cancers: medically, audiologically, psychologically and educationally.
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Bharij A, Neighbors K, Alonso EM, Mohammad S. Health utility and quality of life in pediatric liver transplant recipients. Pediatr Transplant 2020; 24:e13720. [PMID: 32336002 DOI: 10.1111/petr.13720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 10/02/2018] [Accepted: 04/01/2020] [Indexed: 01/02/2023]
Abstract
To measure HU and HRQOL in pediatric liver transplant (LT) recipients, a cross-sectional study of patient-parent dyads was conducted. Direct HU were assessed in 48 adolescents ≥12 years using SG and TTO techniques. Indirect HU were measured by Health Utility Index 2 and HUI3 for subjects ≥12 years and CHU9D for ≥7 years. Patients reported HRQOL using PedsQL™ GC and PedsQL™ TM. A total of 108 dyads participated (55.6% female; 73.2% Caucasian; 42.6% biliary atresia; 35.2% living donor; 37.0% Medicaid). Mean age at survey was 13.6 ± 3.5 years, and time from LT was 8.9 ± 4.9 years. 61.2% were on monotherapy, 25 (23.2%) had acute rejection within 3 years, and 15 (13.9%) had a biliary obstruction within 5 years. Mean indirect HU and HRQOL scores by child report were lower than norms (P < .001). LRD recipients had higher PedsQL™ GC, PedsQL™ TM, and HUI3 scores (P < .01). HU in pediatric LT recipients are lower than norms. Availability of HU scores for post-transplant health states will enable measurement of quality-adjusted life years for future comparative effectiveness studies.
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Affiliation(s)
- Aashiv Bharij
- Department of Pediatrics, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katie Neighbors
- Department of Pediatrics, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Estella M Alonso
- Department of Pediatrics, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Saeed Mohammad
- Department of Pediatrics, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Ojelabi AO, Bamgboye AE, Ling J. Preference-based measure of health-related quality of life and its determinants in sickle cell disease in Nigeria. PLoS One 2019; 14:e0223043. [PMID: 31738762 PMCID: PMC6860997 DOI: 10.1371/journal.pone.0223043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/28/2019] [Indexed: 02/02/2023] Open
Abstract
Background Health-related quality of life (HRQL) and economic burden are important issues for people with sickle cell disease (SCD) owing to better survival due to medical advances. Preference-based or utility information is necessary to make informed economic decisions on treatment and alternative therapies. This study aimed to assess preference-based measures of HRQL in sickle cell patients. Methods and findings Data were collected from two SCD outpatient clinics in Ibadan, Nigeria. A standard algorithm was used to derive utility scores, and measure SF-6D from the SF-36. A multivariate regression model was used to assess predictors and their impact. A combination of socio-demographic, bio-physiological and psychosocial variables predicted utility score in people with SCD. Socio-demographic and bio-physiological factors explained 7.5% and 17.9% of the variance respectively, while psychosocial factors explained 4.9%. Women had lower utility scores with a small effect size (d = 0.17). Utility score increased with level of education but decreased with age, anxiety, frequency of pain episodes and number of co-morbidities. Conclusions Utility score in SCD was low indicating a substantial impact of the disease on HRQL of patients and the value they place on their health state due to the limitations they experienced. Interventions should include both clinical and psychosocial approach to help in improving their quality of life of the patients.
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Affiliation(s)
- Adedokun Oluwafemi Ojelabi
- University of Ibadan, Ibadan, Nigeria
- School of Nursing and Health Sciences, University of Sunderland, Sunderland, United Kingdom
- * E-mail:
| | | | - Jonathan Ling
- School of Nursing and Health Sciences, University of Sunderland, Sunderland, United Kingdom
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Health-related quality of life in paediatric patients up to five years post-treatment completion for acute lymphoblastic leukaemia: a systematic review. Support Care Cancer 2019; 27:4341-4351. [PMID: 30900055 DOI: 10.1007/s00520-019-04747-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Despite survival rates greater than 90%, treatment for paediatric acute lymphoblastic leukaemia (ALL) remains challenging for families. The early post-treatment phase is an especially unique time of adjustment. The primary aim of this review was to identify and synthesise research on health-related quality of life (HRQoL) for patients up to five years post-treatment. The secondary aim was to identify if theorised risk/resistance model factors could explain any variance in reported HRQoL. METHODS We conducted a systematic review using the PRISMA guidelines across five databases: Embase, Medline, Psychinfo, Pubmed, and Cochrane. Only studies examining HRQoL up to five years post-treatment were included. Studies were excluded if they covered periods greater than five years post-treatment or did not differentiate between patients with ALL and other cancers. After assessing the quality of each study sample size, patient characteristics, HRQoL outcomes and HRQoL correlates were extracted and summarised. RESULTS A total of 14 studies representing 1254 paediatric patients, aged 2-18 years, were found. HRQoL findings were mixed, dependent on time since completion and comparison group. Patient HRQoL was mostly lower compared to normative data, whilst higher compared to healthy control groups, patients on treatment, and patients with other types of cancers. Lower HRQoL was also found to be associated with demographic (age and sex), family dysfunction, and treatment-related factors. CONCLUSIONS Completing treatment signalled a significant improvement in HRQoL for patients compared to being on treatment. Overall, however, HRQoL was still significantly lower than the population during the early post-treatment period.
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The Impact of Hematologic Cancer and Its Treatment on Physical Activity Level and Quality of Life Among Children in Mainland China. Cancer Nurs 2018; 42:492-500. [DOI: 10.1097/ncc.0000000000000661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Health Status and Health-related Quality of Life Measurement in Pediatric Cancer Clinical Trials: An Examination of the DFCI 00-01 Acute Lymphoblastic Leukemia Protocol. J Pediatr Hematol Oncol 2018; 40:580-587. [PMID: 29901560 DOI: 10.1097/mph.0000000000001235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Health-related quality of life (HRQL) improved progressively during therapy and beyond in children treated for acute lymphoblastic leukemia on the Dana-Farber Cancer Institute (DFCI) 95-01 protocol. This study aimed to validate that trajectory in a successor study (DFCI 00-01) and to compare the HRQL of patients in the 2 studies. Children aged above 5 years were assessed during each phase of treatment (N=4) and 2 years after completion of therapy. Health status and HRQL were measured using Health Utilities Index (HUI) instruments, HUI2 and HUI3. Quality-adjusted life years (QALYs) were calculated and compared with the general population, and patients treated on DFCI 95-01. Over 5 intervals and 758 HUI assessments, mean HRQL increased progressively from remission induction to the time after treatment (P<0.001). During intensification, high-risk patients had lower HRQL than standard-risk patients (P<0.001). During remission induction, patients on DFCI 95-01 had lower HRQL than patients on DFCI 00-01. Patients on DFCI 00-01 had ~0.2 and 0.3 fewer QALYs than controls, measured by HUI2 and HUI3, respectively. QALYs for DFCI 00-01 patients during treatment were similar to those for DFCI 95-01 patients. The trajectory of improvement in HRQL during the treatment of acute lymphoblastic leukemia in children was confirmed.
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Lin JK, Lerman BJ, Barnes JI, Boursiquot BC, Tan YJ, Robinson AQL, Davis KL, Owens DK, Goldhaber-Fiebert JD. Cost Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Relapsed or Refractory Pediatric B-Cell Acute Lymphoblastic Leukemia. J Clin Oncol 2018; 36:3192-3202. [PMID: 30212291 DOI: 10.1200/jco.2018.79.0642] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The anti-CD19 chimeric antigen receptor T-cell therapy tisagenlecleucel was recently approved to treat relapsed or refractory pediatric acute lymphoblastic leukemia. With a one-time infusion cost of $475,000, tisagenlecleucel is currently the most expensive oncologic therapy. We aimed to determine whether tisagenlecleucel is cost effective compared with currently available treatments. METHODS Markov modeling was used to evaluate tisagenlecleucel in pediatric relapsed or refractory acute lymphoblastic leukemia from a US health payer perspective over a lifetime horizon. The model was informed by recent multicenter, single-arm clinical trials. Tisagenlecleucel (under a range of plausible long-term effectiveness) was compared with blinatumomab, clofarabine combination therapy (clofarabine, etoposide, and cyclophosphamide), and clofarabine monotherapy. Scenario and probabilistic sensitivity analyses were used to explore uncertainty. Main outcomes were life-years, discounted lifetime costs, discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (3% discount rate). RESULTS With an assumption of a 40% 5-year relapse-free survival rate, tisagenlecleucel increased life expectancies by 12.1 years and cost $61,000/QALY gained. However, at a 20% 5-year relapse-free survival rate, life-expectancies were more modest (3.8 years) and expensive ($151,000/QALY gained). At a 0% 5-year relapse-free survival rate and with use as a bridge to transplant, tisagenlecleucel increased life expectancies by 5.7 years and cost $184,000/QALY gained. Reduction of the price of tisagenlecleucel to $200,000 or $350,000 would allow it to meet a $100,000/QALY or $150,000/QALY willingness-to-pay threshold in all scenarios. CONCLUSION The long-term effectiveness of tisagenlecleucel is a critical but uncertain determinant of its cost effectiveness. At its current price, tisagenlecleucel represents reasonable value if it can keep a substantial fraction of patients in remission without transplantation; however, if all patients ultimately require a transplantation to remain in remission, it will not be cost effective at generally accepted thresholds. Price reductions would favorably influence cost effectiveness even if long-term clinical outcomes are modest.
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Affiliation(s)
- John K Lin
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Benjamin J Lerman
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - James I Barnes
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Brian C Boursiquot
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Yuan Jin Tan
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Alex Q L Robinson
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Kara L Davis
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Douglas K Owens
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
| | - Jeremy D Goldhaber-Fiebert
- John K. Lin, James I. Barnes, and Douglas K. Owens, Veterans Affairs Palo Alto Health Care System, Palo Alto; John K. Lin, James I. Barnes, Alex Q.L. Robinson, Douglas K. Owens, and Jeremy D. Goldhaber-Fiebert, Stanford University; and Benjamin J. Lerman, Brian C. Boursiquot, Yuan Jin Tan, and Kara L. Davis, Stanford University School of Medicine, Stanford, CA
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Health-related quality of life of survivors of childhood acute lymphoblastic leukemia: a systematic review. Qual Life Res 2018; 27:1431-1443. [DOI: 10.1007/s11136-018-1788-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 01/09/2023]
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Fardell JE, Vetsch J, Trahair T, Mateos MK, Grootenhuis MA, Touyz LM, Marshall GM, Wakefield CE. Health-related quality of life of children on treatment for acute lymphoblastic leukemia: A systematic review. Pediatr Blood Cancer 2017; 64. [PMID: 28266135 DOI: 10.1002/pbc.26489] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/09/2017] [Accepted: 01/18/2017] [Indexed: 02/01/2023]
Abstract
Children with acute lymphoblastic leukemia (ALL) undergo intense anticancer treatment. We systematically reviewed 22 studies evaluating 2,073 ALL patients' health-related quality of life (HRQL) and its clinical/demographic correlates during treatment. Overall HRQL was significantly reduced on treatment. Despite HRQL improvements over time, longitudinal studies reported a proportion of children continued to experience reduced HRQL after treatment completion. We found inconsistent associations between clinical/demographic factors and HRQL outcomes. Tentative evidence emerged for worse HRQL being associated with intensive phases of chemotherapy, corticosteroid therapy, experiencing greater toxicity, older age, and female sex. Longitudinal studies are needed to identify children at-risk of reduced HRQL.
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Affiliation(s)
- Joanna E Fardell
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Janine Vetsch
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - T Trahair
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - M K Mateos
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - M A Grootenhuis
- Psychosocial Department, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - L M Touyz
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - G M Marshall
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - C E Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
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Scaon S, Chasseigne G, Giraudeau C, Blouin P, Colombat P, Réveillère C. Éléments de qualité de vie individuelle pour une amélioration de la prise en charge en psycho-oncologie pédiatrique. PSYCHO-ONCOLOGIE 2017. [DOI: 10.1007/s11839-017-0619-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Warris LT, van den Heuvel-Eibrink MM, Aarsen FK, Pluijm SMF, Bierings MB, van den Bos C, Zwaan CM, Thygesen HH, Tissing WJE, Veening MA, Pieters R, van den Akker ELT. Hydrocortisone as an Intervention for Dexamethasone-Induced Adverse Effects in Pediatric Patients With Acute Lymphoblastic Leukemia: Results of a Double-Blind, Randomized Controlled Trial. J Clin Oncol 2016; 34:2287-93. [PMID: 27161966 DOI: 10.1200/jco.2015.66.0761] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Dexamethasone is a key component in the treatment of pediatric acute lymphoblastic leukemia (ALL), but can induce serious adverse effects. Recent studies have led to the hypothesis that neuropsychological adverse effects may be a result of cortisol depletion of the cerebral mineralocorticoid receptors. We examined whether including a physiologic dose of hydrocortisone in dexamethasone treatment can reduce neuropsychologic and metabolic adverse effects in children with ALL. PATIENTS AND METHODS We performed a multicenter, double-blind, randomized controlled trial with a crossover design. Of 116 potentially eligible patients (age 3 to 16 years), 50 were enrolled and were treated with two consecutive courses of dexamethasone in accordance with Dutch Childhood Oncology Group ALL protocols. Patients were randomly assigned to receive either hydrocortisone or placebo in a circadian rhythm (10 mg/m(2)/d) during both dexamethasone courses. Primary outcome measure was parent-reported Strength and Difficulties Questionnaire in Dutch, which assesses psychosocial problems. Other end points included questionnaires, neuropsychological tests, and metabolic parameters. RESULTS Of 48 patients who completed both courses, hydrocortisone had no significant effect on outcome; however, a more detailed analysis revealed that in 16 patients who developed clinically relevant psychosocial adverse effects, addition of hydrocortisone substantially reduced their Strength and Difficulties Questionnaire in Dutch scores in the following domains: total difficulties, emotional symptoms, conduct problems, and impact of difficulties. Moreover, in nine patients who developed clinically relevant, sleep-related difficulties, addition of hydrocortisone reduced total sleeping problems and disorders of initiating and maintaining sleep. In contrast, hydrocortisone had no effect on metabolic parameters. CONCLUSION Our results suggest that adding a physiologic dose of hydrocortisone to dexamethasone treatment can reduce the occurrence of serious neuropsychological adverse effects and sleep-related difficulties in pediatric patients with ALL.
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Affiliation(s)
- Lidewij T Warris
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands.
| | - Marry M van den Heuvel-Eibrink
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Femke K Aarsen
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Saskia M F Pluijm
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Marc B Bierings
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Cor van den Bos
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Christian M Zwaan
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Helene H Thygesen
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim J E Tissing
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Margreet A Veening
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Rob Pieters
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Erica L T van den Akker
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
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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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16
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Thorrington D, Eames K. Measuring Health Utilities in Children and Adolescents: A Systematic Review of the Literature. PLoS One 2015; 10:e0135672. [PMID: 26275302 PMCID: PMC4537138 DOI: 10.1371/journal.pone.0135672] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 07/24/2015] [Indexed: 11/19/2022] Open
Abstract
Background The objective of this review was to evaluate the use of all direct and indirect methods used to estimate health utilities in both children and adolescents. Utilities measured pre- and post-intervention are combined with the time over which health states are experienced to calculate quality-adjusted life years (QALYs). Cost-utility analyses (CUAs) estimate the cost-effectiveness of health technologies based on their costs and benefits using QALYs as a measure of benefit. The accurate measurement of QALYs is dependent on using appropriate methods to elicit health utilities. Objective We sought studies that measured health utilities directly from patients or their proxies. We did not exclude those studies that also included adults in the analysis, but excluded those studies focused only on adults. Methods and Findings We evaluated 90 studies from a total of 1,780 selected from the databases. 47 (52%) studies were CUAs incorporated into randomised clinical trials; 23 (26%) were health-state utility assessments; 8 (9%) validated methods and 12 (13%) compared existing or new methods. 22 unique direct or indirect calculation methods were used a total of 137 times. Direct calculation through standard gamble, time trade-off and visual analogue scale was used 32 times. The EuroQol EQ-5D was the most frequently-used single method, selected for 41 studies. 15 of the methods used were generic methods and the remaining 7 were disease-specific. 48 of the 90 studies (53%) used some form of proxy, with 26 (29%) using proxies exclusively to estimate health utilities. Conclusions Several child- and adolescent-specific methods are still being developed and validated, leaving many studies using methods that have not been designed or validated for use in children or adolescents. Several studies failed to justify using proxy respondents rather than administering the methods directly to the patients. Only two studies examined missing responses to the methods administered with respect to the patients’ ages.
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Affiliation(s)
- Dominic Thorrington
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Ken Eames
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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17
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van Litsenburg RRL, Kunst A, Huisman J, Ket JCF, Kaspers GJL, Gemke RJBJ. Health status utilities in pediatrics: a systematic review of acute lymphoblastic leukemia. Med Decis Making 2013; 34:21-32. [PMID: 23886678 DOI: 10.1177/0272989x13497263] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Measuring utilities and health-related quality of life (HRQL) in children is challenging due to their cognitive abilities and changing developmental stages. PURPOSE . To identify methodological issues on utility measurements in children, we performed a systematic review on utilities measured with a single instrument, the Health Utilities Index (HUI), in pediatric acute lymphoblastic leukemia (ALL). The secondary goal was to facilitate future cost-utility analyses without the need for time-consuming assessments. Data Sources. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched from inception to June 2012. Studies had to report on utility scores in pediatric ALL, either on or after treatment, to be included. RESULTS . Fifteen studies were included. Most studies had methodological shortcomings, which mainly concerned STUDY DESIGN and definition and representativeness of the study group. Utility scores were dependent on treatment variables, and there generally was an improvement in HRQL as treatment or survivorship advanced. In general, proxy-respondents were less reliable for subjective phenomena than for observable conditions. HUI2 and HUI3 scores were not interchangeable. Limitations. Studies may have been missed because no validated search method for utility studies exists, due to language bias or the exclusion of non-peer-reviewed papers. CONCLUSIONS . Most studies in this review were methodologically suboptimal. Future developments should focus on including developmentally appropriate items for the whole pediatric age group. Adding disease-specific domains may enhance the sensitivity and responsiveness of instruments. Efforts should be undertaken to elicit valuation of health states from older children and teenagers as much as possible. For now, it remains difficult to make valid and informed decisions on the financing of interventions until health state valuation in children has become more methodologically robust.
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Affiliation(s)
- Raphaële R L van Litsenburg
- Department of Pediatrics, Division of Oncology-Hematology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands (RRLVL, GJLK)
| | - Annemieke Kunst
- Department of Pediatrics, VU University Medical Center Amsterdam, Amsterdam, the Netherlands (AK, RJBJG)
| | - Jaap Huisman
- Department of Pediatric Psychology & Social Work, University Medical Center Utrecht, Utrecht, the Netherlands (JH)
| | - Johannes C F Ket
- VU University Library Amsterdam, Amsterdam, the Netherlands (JCFK)
| | - Gertjan J L Kaspers
- Department of Pediatrics, Division of Oncology-Hematology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands (RRLVL, GJLK)
| | - Reinoud J B J Gemke
- Department of Pediatrics, VU University Medical Center Amsterdam, Amsterdam, the Netherlands (AK, RJBJG)
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