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Tran Thi TH, Lin CY, Huang MC. Agreement between quality of life assessed using family proxy and child self-reports among children with hematologic malignancy. Eur J Pediatr 2024; 183:3377-3388. [PMID: 38755309 DOI: 10.1007/s00431-024-05613-4] [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: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
Evidence-based literature recognizes that the different degrees of agreement between a child self-report and a proxy-report depend on the characteristics of the domains, the child's age and illness, the proxy's own perspective on QoL, and family attendance during the child's hospitalization. This study aims to determine the degree of agreement between proxy-reports and child self-reports on quality of life (QoL) for children with hematologic malignancy ranging in age from 5 to 18 years who are undergoing treatment. We retrieved clinical QoL data from a study titled "Dynamic change in QoL for Vietnamese children with hematologic malignancy" from April 2021 to December 2022. To evaluate the magnitude of agreement between self-reports and proxy-reports, intraclass correlation coefficients (ICCs) for 259 pairs of measurements were quantified. Using independent t tests, the mean differences between self-reports and proxy-reports were tested. Moderate agreement was consistent through all age groups for five subscales, including physical, psychosocial, pain, nausea, and procedural anxiety (ICCs ranged from 0.53 to 0.74). The weakest agreement appeared in two groups, subjects aged 5-7 years and 13-18 years on six domains (school, treatment anxiety, worry, cognitive problems, perceived physical appearance, and communication) (-0.01 to 0.49). Child self-rating was consistently higher than that of proxies for the physical, emotional, and nausea domains among children aged 5-7 years and for procedural anxiety, treatment anxiety, and cognitive problems among children aged 8-12 years. Conclusion: The agreement level of self-reports and proxy-reports was differently distributed by child age and the PedsQL domains. The proxy children agreement on QoL among children with hematologic malignancy was divergent according to the different age groups, which could potentially be explained by proxy-child bonding at different stages of childhood development. Our recommendation for future studies is to explore children's age as a potential factor influencing proxy agreement on QoL among children with cancer. What is Known: • Children and their proxies may think differently about quality of life (QoL). • Comparing two sources of data (i.e., child and proxy) on aspects of QoL can help identify the discrepancies between children's perceptions of their QoL and their parents' perceptions. This can be useful in terms of identifying potential areas for improvement or concern and may also be helpful in making decisions about treatment and care. What is New: • Our study results demonstrated that proxies who comprised children aged 5-7 years or 13-18 years reported differently among domains that cannot be expressed verbally or with body language, including cognitive problems, perceived physical appearance, and communication. • Children generally perceived their QoL to be better than their proxies. Therefore, a more comprehensive understanding of children's QoL may require the consideration of multiple sources of data from various perspectives.
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Affiliation(s)
- Thu Hang Tran Thi
- Faculty of Nursing and Medical Technology, The Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mei-Chih Huang
- National Tainan Junior College of Nursing, No. 78, Sec. 2, Minzu Rd, Tainan, 700007, Taiwan.
- Department of Nursing, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701401, Taiwan.
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Cheung SYA, Hay JL, Lin YW, de Greef R, Bullock J. Pediatric oncology drug development and dosage optimization. Front Oncol 2024; 13:1235947. [PMID: 38348118 PMCID: PMC10860405 DOI: 10.3389/fonc.2023.1235947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/29/2023] [Indexed: 02/15/2024] Open
Abstract
Oncology drug discovery and development has always been an area facing many challenges. Phase 1 oncology studies are typically small, open-label, sequential studies enrolling a small sample of adult patients (i.e., 3-6 patients/cohort) in dose escalation. Pediatric evaluations typically lag behind the adult development program. The pediatric starting dose is traditionally referenced on the recommended phase 2 dose in adults with the incorporation of body size scaling. The size of the study is also small and dependent upon the prevalence of the disease in the pediatric population. Similar to adult development, the dose is escalated or de-escalated until reaching the maximum tolerated dose (MTD) that also provides desired biological activities or efficacy. The escalation steps and identification of MTD are often rule-based and do not incorporate all the available information, such as pharmacokinetic (PK), pharmacodynamic (PD), tolerability and efficacy data. Therefore, it is doubtful if the MTD approach is optimal to determine the dosage. Hence, it is important to evaluate whether there is an optimal dosage below the MTD, especially considering the emerging complexity of combination therapies and the long-term tolerability and safety of the treatments. Identification of an optimal dosage is also vital not only for adult patients but for pediatric populations as well. Dosage-finding is much more challenging for pediatric populations due to the limited patient population and differences among the pediatric age range in terms of maturation and ontogeny that could impact PK. Many sponsors defer the pediatric strategy as they are often perplexed by the challenges presented by pediatric oncology drug development (model of action relevancy to pediatric population, budget, timeline and regulatory requirements). This leads to a limited number of approved drugs for pediatric oncology patients. This review article provides the current regulatory landscape, incentives and how they impact pediatric drug discovery and development. We also consider different pediatric cancers and potential clinical trial challenges/opportunities when designing pediatric clinical trials. An outline of how quantitative methods such as pharmacometrics/modelling & simulation can support the dosage-finding and justification is also included. Finally, we provide some reflections that we consider helpful to accelerate pediatric drug discovery and development.
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The impact of CNS-directed treatment on quality of life in childhood cancer survivors. Qual Life Res 2022; 31:817-829. [PMID: 34455525 PMCID: PMC8882709 DOI: 10.1007/s11136-021-02984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Pediatric cancer survivors may have lower quality of life (QoL), but most research has assessed outcomes either in treatment or long-term survivorship. We focused on early survivorship (i.e., 3 and 5 years post-diagnosis), examining the impact of CNS-directed treatment on child QoL, as well as sex and age at diagnosis as potential moderators. METHODS Families of children with cancer (ages 5-17) were recruited at diagnosis or relapse (N = 336). Survivors completed the PedsQL at 3 (n = 96) and 5 years (n = 108), along with mothers (101 and 105, respectively) and fathers (45 and 53, respectively). The impact of CNS treatment, sex, and age at diagnosis on child QoL was examined over both time since diagnosis and time since last treatment using mixed model analyses. RESULTS Parent-report of the child's total QoL was in the normative range and stable between 3 and 5 years when examining time since diagnosis, while child reported QoL improved over time (p = 0.04). In terms of time since last treatment, mother and child both reported the child's QoL improved over time (p = 0.0002 and p = 0.0006, respectively). Based on parent-report, males with CNS-directed treatment had lower total QoL than females and males who did not receive CNS-directed treatment. Age at diagnosis did not moderate the impact of treatment type on total QoL. CONCLUSIONS Quality of life (QoL) in early survivorship may be low among males who received CNS-directed treatment. However, this was only evident on parent-report. Interventions to improve child QoL should focus on male survivors who received CNS-directed treatment, as well as females regardless of treatment type.
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Yousef B, Abdelkarim M, AwadElseed R, Alsanosi M, Badi S, Abdulraheem M, Nasser N. Assessment of quality of life among pediatric patients with cancer in khartoum oncology hospital: A cross-sectional pilot study. MATRIX SCIENCE MEDICA 2022. [DOI: 10.4103/mtsm.mtsm_17_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Phiri PGMC, Malunga SS, Phiri LS. Health-Related Quality of Life of Nurses Caring for Hospitalised Children and Their Families: A National Cross-Sectional Study. J Pediatr Nurs 2021; 61:157-165. [PMID: 34090080 DOI: 10.1016/j.pedn.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Health-related quality of life (HRQoL) continues to be understudied among nurses in developing countries. This study aimed to assess (1) the HRQoL of nurses in Malawi caring for hospitalised children and their families, and (2) the nurses' demographic characteristics associated with their HRQoL. DESIGN AND METHODS The cross-sectional study was carried out at 23 hospitals in Malawi, and 203 nurses participated, resulting in a 96% response rate. The Medical Outcomes Study 36-Item Short Form Health Survey was used to collect data. The physical and mental health component scores were evaluated and compared with those in a Cyprus study as the population norm. Both univariate and multivariate analyses were performed, with the significance level set at 0.05. RESULTS The nurses' HRQoL was moderately impaired; however, the mean scores of both the physical and the mental health components of the nurses in the Cyprus study were statistically lower than those of the Malawian nurses (t = 36.541, p < 0.001 and t = 19.477, p < 0.001, respectively). Age was independently associated with a better physical health status (β = 29.949, p = 0.038), while female nurses were more likely to report a negative physical health status compared with male nurses (β = -97.481, p = 0.002). CONCLUSION The findings suggested that the Malawian nurses were affected by work-related stress, which affected their mental and physical health status. The current findings represent preliminary data, and as such further studies on the association between work-related factors and HRQoL are needed. PRACTICE IMPLICATIONS Knowledge of HRQoL from the perspective of nurses can help healthcare organisations to develop interventions to limit the negative impacts of work-related stress on nurses caring for children.
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Affiliation(s)
| | | | - Lophina Sitima Phiri
- PACHA Malawi, College of Medicine, Pediatric Department, Queen Elizabeth Hospital, Malawi
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Zheng F, Dou X, Zhang L, Jin J, Zhang Y, Liu B, Meng L, Zhu X, Lu Z, Jia Y, Liu H, Lin H, Zhou L, Zhao X, Yang W, Sun H, Qian S, Ma H, Wu R, Zhang L, Jiang Q. Health-related quality of life in children with chronic myeloid leukemia in the chronic phase. J Cancer Res Clin Oncol 2021; 148:341-350. [PMID: 34714411 DOI: 10.1007/s00432-021-03832-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to explore the health-related quality of life (HRQoL) and associated variables in children with chronic myeloid leukemia in the chronic phase (CML-CP) receiving tyrosine kinase inhibitors (TKIs). METHODS A cross-sectional questionnaire was given to children with CML and their parents, who were < 18 years at diagnosis of CML and < 19 years at study. The questionnaire comprised three parts, including demographic information, clinical information, and the Chinese version of Pediatric Quality of Life Inventory™ (PedsQL™) Cancer Module 3.0 as HRQoL questionnaire. RESULTS A total of 240 respondents data were analyzed. Multivariate analysis showed that children with symptoms had worse pain (- 10.2; P < 0.001), nausea (- 17.3; P = 0.001), more treatment anxiety (- 7.2; P = 0.005), worse self-assessment appearance (- 7.1; P = 0.001), communication problems (- 6.4; P = 0.001), and worse HRQoL (- 7.0; P < 0.001). Children with mothers having low educational qualifications had worse pain (- 6.0; P = 0.014), more worried about future (- 5.4; P = 0.042), worse cognition problems (- 7.1; P = 0.002), worse communication problems (- 5.5; P = 0.008), and worse HRQoL (- 4.3; P = 0.005). Younger age children at study had more procedural anxiety (2.7; P = 0.001), treatment anxiety (- 1.7; P = 0.014) and cognition problem (3.6; P < 0.001), as well as worse HRQoL (1.8; P = 0.008). However, older age children at diagnosis were more worried about future (- 2.8; P = 0.001), worse self-assessment appearance (- 1.1; P = 0.042) and worse HRQoL (- 1.8; P = 0.007). Other variables significantly associated with worse HRQoL included female gender, rural household registration and their father's low education level. Parents reported more gastrointestinal disorders, were worried about the future and had less concern about appearance than their children. CONCLUSIONS Female gender, older age at diagnosis, younger age at study, lower mother's education level, and TKI-related symptoms are significantly associated with worse HRQoL in Children with CML. Children and their parents have different priorities in the HRQoL.
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Affiliation(s)
- Fangyuan Zheng
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Xuelin Dou
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Liqiang Zhang
- Hematology and Oncology Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Jie Jin
- Department of Hematology, Zhejiang University First Affiliated Hospital, Zhejiang, China
| | - Yanli Zhang
- Department of Hematology, Henan Cancer Hospital, Henan, China
| | - Bingcheng Liu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Institute of Hematology and Blood Diseases Hospital, Tianjin, China
| | - Li Meng
- Department of Hematology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Hubei, China
| | - Xiaofan Zhu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Institute of Hematology and Blood Diseases Hospital, Tianjin, China
| | - Zesheng Lu
- Guangdong Provincial People's Hospital, Guangdong Provincial Geriatrics Institute Guangzhou, Guangdong, China
| | - Yueping Jia
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Huilan Liu
- Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China: Anhui Provincial Hospital, Anhui, China
| | - Hai Lin
- Department of Hematology and Oncology, Jilin University First Hospital, Jilin, China
| | - Li Zhou
- Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai Institute of Hematology, Shanghai, China
| | - Xielan Zhao
- Department of Hematology, Xiangya Hospital Central South University, Hunan, China
| | - Wei Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Liaoning, China
| | - Hui Sun
- Department of Hematology, Zhengzhou University First Affiliated Hospital, Henan, China
| | - Sixuan Qian
- Department of Hematology, Nanjing Medical University Affiliated Nanjing Hospital: Nanjing First Hospital, Jiangsu, China
| | - Hongxia Ma
- Department of Hematology, The Third People's Hospital of Zhengzhou, Suzhou, Henan, China
| | - Runhui Wu
- Hematology and Oncology Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Leping Zhang
- Department of Pediatrics, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China.
| | - Qian Jiang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No. 11 Xizhimen South Street, Beijing, 100044, China. .,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
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Lyon ME, Cheng YI, Needle J, Friebert S, Baker JN, Jiang J, Wang J. The intersectionality of gender and poverty on symptom suffering among adolescents with cancer. Pediatr Blood Cancer 2021; 68:e29144. [PMID: 34061435 PMCID: PMC8406702 DOI: 10.1002/pbc.29144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND To determine if the intersectionality of gender and poverty is associated with health disparities among adolescents with cancer. We hypothesized unobserved latent classes of patients exist with respect to cancer-related symptoms; and class classification varies by gender-poverty combinations. PROCEDURE Cross-sectional data were collected among adolescents with cancer and families (N = 126 dyads) at four tertiary pediatric hospitals. Adolescents were aged 14-21 years, English speaking, cancer diagnosis, not developmentally delayed, psychotic, homicidal, suicidal, or severely depressed. Latent class analysis and multinomial logit models were used for analysis. Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric symptom measures, Short forms, evaluated anxiety, depressive symptoms, pain interference, and fatigue. Family-reported household income used 2016 Federal Poverty Level (FPL) guidelines. RESULTS Three distinct groups of patients were identified using PROMIS symptom patterns: High Distress-25%; High Physical/Low Psychological Distress-14%; and Low Distress-62%. Female adolescents living in households with incomes at or below the 2016 FPL had 30 times the odds of being classified in the High Distress class (higher probabilities of experiencing anxiety, depressive symptoms, pain interference, and fatigue) compared to those in the High Physical/Low Psychological Distress class (female and poverty: AOR = 30.27, 95% CI 1.23, 735.10), and this was statistically significant (β = 3.41, 95% CI 0.21, 6.60; p = .04) but not compared to those in Low Distress. CONCLUSION Adolescent females with cancer with households in poverty had significantly greater odds of experiencing high symptom distress, compared to those with high physical but low psychological distress. More comprehensive screening and intervention, as needed, may decrease disparities.
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Affiliation(s)
- Maureen E. Lyon
- Division of Adolescent and Young Adult Medicine, Children’s National Hospital, Washington, District of Columbia, USA
- Center for Translational Research/Children’s National Research Institute, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Yao I. Cheng
- Division of Biostatistics and Study Methodology, Center for Translational Research/Children’s National Research Institute, Children’s National Hospital, Washington, District of Columbia, USA
- RELI Group, Inc., Baltimore, Maryland, USA
| | - Jennifer Needle
- Department of Pediatrics and Center for Bioethics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio, USA
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio, USA
| | - Justin N. Baker
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jiji Jiang
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Jichuan Wang
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Division of Biostatistics and Study Methodology, Center for Translational Research/Children’s National Research Institute, Children’s National Hospital, Washington, District of Columbia, USA
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Otmani N, Hattad S. Clinical Outcome in Children with Chemotherapy-Induced Mucositis. Semin Oncol Nurs 2021; 37:151160. [PMID: 34088558 DOI: 10.1016/j.soncn.2021.151160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study was conducted to assess the impact of oral mucositis on nutrition and performance status in pediatric cancer patients treated by chemotherapy. DATA SOURCES A total of 46 children were followed for mucositis episode, and their mean Oral Assessment Guide score was 20.2. Main concomitant disorders were hematological changes (86.9%), loss of appetite (60.7%), vomiting (28.3%), and diarrhea (10.9%). CONCLUSION Anthropometric changes were highlighted by a decrease in body mass index (P = .03) and a decrease of Waterlow score (P = .007). Most patients had a low Lansky Play Performance Scale (LPPS) ≤40 (86.9%). High mucositis grades (P = .007) and long hospital stay (P = .005) were associated with a significant reduction in Lansky Play Performance Scale. Patient's follow-up showed need for hospitalization (84.8%), delay in chemotherapy treatment (71.7%), use of opioides (34.8%), and use of parenteral nutrition (26.1%). Death occurred in 10.9% of the cases. IMPLICATIONS FOR NURSING PRACTICE These findings illustrate the impact of mucositis on nutrition and performance status in children undergoing chemotherapy, which considerable affected their outcome.
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Affiliation(s)
- Naïma Otmani
- Pediatric Hematology and Oncology Unit, Children Hospital's, Rabat, Morocco.
| | - Siham Hattad
- Pediatric Hematology and Oncology Unit, Children Hospital's, Rabat, Morocco
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Andriastuti M, Halim PG, Kusrini E, Bangun M. Correlation of Pediatric Palliative Screening Scale and Quality of Life in Pediatric Cancer Patients. Indian J Palliat Care 2020; 26:338-341. [PMID: 33311876 PMCID: PMC7725190 DOI: 10.4103/ijpc.ijpc_197_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 05/14/2020] [Indexed: 11/04/2022] Open
Abstract
Context Palliative care in children is used to be only intended for those in near end-of-life phase. Ideally, palliative intervention should be given since the first time of cancer diagnosis. Palliative care is introduced from the beginning of the treatment by acknowledging that it helps to ensure an ongoing focus on the quality of life (QOL) so that children still can enjoy their life. Several approaches have been used to identify children with the need of palliative care. Aims The aim was to describe the use of Paediatric Palliative Screening Scale (PaPaS Scale) and its depiction to the QOL of children with malignancies. Settings and Design A cross-sectional study was conducted in sixty children age 2-18 years with malignancies, who were consulted to the palliative team. Subjects and Methods Sixty participants were recruited randomly during the study. PaPaS Scale and QOL (using PedsQL™ cancer module 3.0) were assessed at the same time. Cutoff points of 67 for parent-proxy report and 68.9 for self-report were used, those who have scores <67 and <68.9 were grouped as low QOL group. PaPaS scale was divided into three groups: (1) no palliative care needs (score 10-14), (2) considered palliative care (15-24), and (3) need for palliative (≥25). Statistical Analysis Differences between palliative score and QOL were analyzed using Chi-square and Fisher test. Results Children who have lower QOL based on parent-proxy report (<67) included 25 children; they consist of 16 children (64%) with score 10-14, four children (16%) with score 15-24, and five children (20%) with score ≥25. Children with higher QOL (16 children) consist of ten children (62.5%) with score 10-14, four children (25%) scores 15-24, and two children (12.5%) with score ≥25. In the self-report, children with low QOL (eight children) consist of four children (50%) with score 10-14, four children (50%) with score 15-24, and no children with score ≥ 25. Children with higher QOL (11 children) consist of eight children (72.2%) with score 10-14, two children (18.2%) with scores 15-24, and one child (9.1%) with score ≥25. Statistical analysis showed no correlation between PaPaS score and QOL of children with malignancies in parent-proxy report (P = 0.89) and self-report (P = 0.37). Conclusions This study showed that children with malignancies already had lower QOL despite the low PaPaS scale they had. The results of this study support the provision of early palliative intervention, starting with a small proportion of intervention to improve the QOL of cancer child.
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Affiliation(s)
- Murti Andriastuti
- Department of Child Health, Faculty of Medicine Indonesia University, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Pricilia Gunawan Halim
- Department of Child Health, Faculty of Medicine Indonesia University, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Eny Kusrini
- Pediatric Nurse, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Meidiana Bangun
- Pediatric Nurse, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Bult MK, van Bindsbergen KLA, Schepers SA, de Ridder-Sluiter HG, Verhaak CM, van Litsenburg RRL, Merks JHM, van Noesel MM, Grootenhuis MA. Health-Related Quality of Life of Adolescents with Cancer During the First Year of Treatment. J Adolesc Young Adult Oncol 2019; 8:616-622. [PMID: 31268387 DOI: 10.1089/jayao.2019.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose: Adolescents with cancer (aged 12-18 years) are at risk for impaired health-related quality of life (HRQoL). Little is known about this population during treatment. This study aimed to (1) determine the HRQoL of adolescents with cancer during the first year of treatment and compare them with age-matched peers and (2) obtain insight into cancer-specific HRQoL of adolescents during the first year of treatment. Methods: Participants were part of a larger study focused on routine monitoring of electronic reported outcomes in standard pediatric oncology care. Adolescents completed the pediatric quality of life inventory (PedsQL) 4.0 and the PedsQL Cancer Module 3.0. Mean generic HRQoL scale scores were compared between the groups using multivariate analysis of covariance. Cancer-specific item scores were dichotomized and percentages were calculated to determine the proportion of adolescents reporting presence or absence of problems. Results: A total of 73 (mean [M]age = 14.71, standard deviation [SD] = 1.85) adolescents with cancer (Mage = 14.71, SD = 1.85, Mtimesincediagnosis = 3.51 months, SD = 2.8) and 268 healthy peers (Mage = 14.23, SD = 1.51) participated. Adolescents with cancer reported significantly lower generic HRQoL scores on all domains than their peers (p's <0.05, η2 = 0.01-0.42). Most frequently reported cancer-specific HRQoL problems were pain (hurt joint/muscle, 42.9%), nausea (during medical treatments [47.1%]; food not tasting good [54.3%]; food and smells [61.4%]), worry (about relapse [45.7%]; about side effects [52.9%]), cognitive problems (paying attention [47.1%]), and physical appearance (not good looking [47.1%]). Conclusions: Adolescents with cancer showed impaired HRQoL during treatment on both physical and psychosocial domains. Close monitoring of physical and psychosocial symptoms during treatment is, therefore, important.
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Affiliation(s)
- Maureen K Bult
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Sasja A Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | | | - Chris M Verhaak
- Amalia Children's Hospital/Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raphaële R L van Litsenburg
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Choo CC, Chew PKH, Tan P, Choo JQ, Choo AMH, Ho RC, Quah TC. Health-Related Quality of Life in Pediatric Patients with Leukemia in Singapore: A Cross-Sectional Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122069. [PMID: 31212740 PMCID: PMC6617504 DOI: 10.3390/ijerph16122069] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/17/2022]
Abstract
There has been a paradigm shift in health service delivery to a more holistic approach, which considers Quality of Life (QoL) and overall functioning. Health-Related Quality of Life (HRQoL) is a multidimensional construct that encompasses physical functioning as well as psychosocial aspects of emotional and social functioning. This study explored factors related to HRQoL in Asian pediatric patients with leukemia in Singapore. The available variables included: age, treatment duration, household income, gender, ethnicity, religion, diagnosis, and phase of treatment. It is hypothesized that the relationships will be significant. In the current study, there were 60 patients (60% males) with leukemia; their ages ranged from 1 to 21 years (Mean = 8.03, Standard Deviation = 4.55). The hypothesis was partially supported. Age had a significant positive relationship with physical functioning, r(60) = 0.28, p < 0.05, physical health, r(60) = 0.28, p < 0.05, and the total HRQoL score, r(60) = 0.29, p < 0.05. Treatment duration had a positive relationship with school functioning, r(60) = 0.28, p < 0.05. All other correlations were statistically non-significant. The effects of the available psychosocial variables of gender, ethnicity, and religion were examined on scores from the Pediatric Quality of Life Inventory (PedsQL). Ethnicity had a significant effect on social functioning, U = 292.00, p < 0.05, r = 0.3 (medium effect size). Specifically, Chinese (Median = 85.00, n = 33) had significantly higher scores on social functioning than others (Median = 70.00, n = 27). The remaining comparisons were statistically non-significant. The current findings added to QoL research, and provided an impetus for more research in the area of HRQoL for children with leukemia in Singapore.
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Affiliation(s)
- Carol C Choo
- Department of Psychology, College of Healthcare Sciences, James Cook University, Singapore 387380, Singapore.
| | - Peter K H Chew
- Department of Psychology, College of Healthcare Sciences, James Cook University, Singapore 387380, Singapore.
| | - Pinhong Tan
- Department of Pediatrics, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.
| | - Jessica Q Choo
- Department of Pediatrics, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.
| | - Amanda M H Choo
- Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP, UK.
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 117599, Singapore.
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam.
- Faculty of Education, Huaibei Normal University, 100 Dongshan Road, Huaibei 235000, China.
| | - Thuan Chong Quah
- Department of Pediatrics, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.
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Coça KL, Bergmann A, Carrara de Angelis E, Ferman S, Ribeiro MG. Health‐related quality of life of Brazilian children and adolescents with benign and malignant solid tumours: A prospective cohort study during the first year after hospital admission. Eur J Cancer Care (Engl) 2019; 28:e13102. [DOI: 10.1111/ecc.13102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 03/08/2019] [Accepted: 04/08/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Kaliani Lima Coça
- Section of Speech‐language Pathology Instituto Nacional de Câncer (INCA) Rio de Janeiro Brazil
| | - Anke Bergmann
- Molecular Carcinogenesis Program Instituto Nacional de Câncer (INCA) Rio de Janeiro Brazil
| | | | - Sima Ferman
- Pediatric Oncology Service Instituto Nacional de Câncer (INCA) Rio de Janeiro Brazil
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13
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Shin H, Bartlett R, De Gagne JC. Health-Related Quality of Life Among Survivors of Cancer in Adolescence: An Integrative Literature Review. J Pediatr Nurs 2019; 44:97-106. [PMID: 30683287 DOI: 10.1016/j.pedn.2018.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
PROBLEM Adolescence is a critical developmental period, but little research is available on the quality of life for individuals ages 10-19, especially those who have faced a life-threatening illness. This integrative review examines factors related to quality of life among survivors of a childhood cancer that occurred during adolescence. ELIGIBILITY CRITERIA The Garrard Matrix Method guided this review of studies that were conducted from 1990 to 2017. Studies were eligible if participants were diagnosed with cancer during adolescence, the studies followed survivorship from cancer diagnosis to treatment completion, and health-related quality of life measures were taken. SAMPLE Fifteen articles met the inclusion criteria. RESULTS Most survivors of a childhood cancer that occurred during adolescence reported physical and psychological health-related quality of life scores similar to, or higher than, healthy controls. Risk factors for poorer quality of life were type of cancer, type of treatment, late effects, and time since diagnosis. Factors for better quality of life were older age, positive feelings such as happiness and optimism, social support, and coping strategies. Most studies used the Short Form-36 and the PedsQL Generic Core Scales to measure quality of life. CONCLUSIONS Protective factors such as social support and subjective feelings positively affected quality of life. IMPLICATIONS In order to promote the best patient outcomes, relevant protective factors that improve quality of life should be incorporated in long-term care plans for survivors of a childhood cancer that occurred during adolescence.
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Affiliation(s)
- Hyewon Shin
- Clemson University School of Nursing, Greenville, SC, USA.
| | - Robin Bartlett
- University of North Carolina-Greensboro, Greensboro, NC, USA
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14
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Ribeiro ILA, Limeira RRT, Dias de Castro R, Ferreti Bonan PR, Valença AMG. Oral Mucositis in Pediatric Patients in Treatment for Acute Lymphoblastic Leukemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121468. [PMID: 29182564 PMCID: PMC5750887 DOI: 10.3390/ijerph14121468] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 01/10/2023]
Abstract
Oral mucositis in oncologic patients is the most undesirable event of the chemotherapeutic treatment. This study aimed to identify damage to the oral cavity resulting from chemotherapy in pediatric patients with acute lymphoblastic leukemia (ALL). This is a prospective study with a sample of 42 children and adolescents evaluated for 10 consecutive weeks after diagnosis. The modified Oral Assessment Guide (OAG) was used, and data were analyzed by Spearman’s rank correlation coefficient (α = 5%). Changes to the normal lips and saliva were positively related to an increase in the OAG score during all 10 weeks of evaluation. Alterations to the labial mucosa were correlated with an increase in the OAG score from the 2nd to 10th week, which was also found for changes in the tongue and in the swallowing function in Weeks 1, 6, 8, 9, and 10 and for gum changes from the 5th to 7th week. No significant vocal changes were correlated with the total OAG score at any point during the monitoring period. Changes in lips, cheek and/or palatal mucosa, labial mucosa, and gum areas and in swallowing function were positively correlated with an increase in the severity of oral mucositis in patients with ALL after beginning chemotherapeutic treatment.
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Affiliation(s)
- Isabella Lima Arrais Ribeiro
- Post-Doctorate Researcher in Post-Graduate Program in Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba 5045, Brazil.
| | | | - Ricardo Dias de Castro
- Department of Clinical and Social Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba 5045, Brazil.
| | - Paulo Rogério Ferreti Bonan
- Department of Clinical and Social Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba 5045, Brazil.
| | - Ana Maria Gondim Valença
- Department of Clinical and Social Dentistry, Universidade Federal da Paraíba, João Pessoa, Paraíba 5045, Brazil.
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Bosworth A, Goodman EL, Wu E, Francisco L, Robison LL, Bhatia S. The Minneapolis-Manchester Quality of Life Instrument: reliability and validity of the Adult Form in cancer survivors. Qual Life Res 2017; 27:321-332. [PMID: 28770428 DOI: 10.1007/s11136-017-1671-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Childhood cancer survivors are at risk for deficits in health-related quality of life (HRQL) as they age. Youth (8-12 years) and adolescent (13-20 years) versions of the Minneapolis-Manchester Quality of Life Instrument (MMQL) have been developed to address survivor-specific issues and are currently in use; the MMQL-Adult Form has now been developed to assess HRQL in childhood cancer survivors aged 21-55 years. METHODS The MMQL-Adult Form was administered to 499 adults: 65 cancer patients on-therapy, 107 off-therapy, and 327 healthy controls. Forty-four percent of patients were under 30 years old at cancer diagnosis. Principal components analysis was performed. We evaluated internal consistency reliability, stability (re-administration of the MMQL-Adult Form 2 weeks later), construct validity (concurrent administration of the SF-36), and known-groups validity (score comparisons across the three groups). RESULTS Principal components analysis resulted in retention of 44 items across six scales: social functioning, physical functioning, cognitive functioning, outlook on life, body image, and psychological functioning. Internal consistency (Cronbach's α) was 0.80-0.90 for individual scales and 0.95 overall. Strong intraclass correlations (0.98 overall) indicated high stability. The MMQL-Adult Form distinguished between known groups; healthy controls scored better than patients on four of six scales. The MMQL-Adult Form scales correlated highly with similar SF-36 scales, demonstrating construct validity. CONCLUSIONS The MMQL-Adult Form is a reliable and valid self-report instrument for measuring multidimensional HRQL in cancer survivors. Development of this instrument ensures availability of a tool enabling cross-sectional and longitudinal assessment of HRQL in childhood cancer survivors as they age.
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Affiliation(s)
- Alysia Bosworth
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | | | - Eric Wu
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA.
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