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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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Zimmerman JAO, Fang M, Pufall MA. PI3Kδ Inhibition Potentiates Glucocorticoids in B-lymphoblastic Leukemia by Decreasing Receptor Phosphorylation and Enhancing Gene Regulation. Cancers (Basel) 2023; 16:143. [PMID: 38201570 PMCID: PMC10778422 DOI: 10.3390/cancers16010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Glucocorticoids are the cornerstone of B-lymphoblastic leukemia (B-ALL) therapy. Because response to glucocorticoids alone predicts overall outcomes for B-ALL, enhancing glucocorticoid potency should improve treatment. We previously showed that inhibition of the lymphoid-restricted PI3Kδ with idelalisib enhances glucocorticoid activity in B-ALL cells. Here, we show that idelalisib enhances glucocorticoid potency in 90% of primary B-ALL specimens and is most pronounced at sub-saturating doses of glucocorticoids near the EC50. Potentiation is associated with enhanced regulation of all glucocorticoid-regulated genes, including genes that drive B-ALL cell death. Idelalisib reduces phosphorylation of the glucocorticoid receptor (GR) at PI3Kδ/MAPK1 (ERK2) targets S203 and S226. Ablation of these phospho-acceptor sites enhances sensitivity to glucocorticoids with ablation of S226 in particular reducing synergy. We also show that phosphorylation of S226 reduces the affinity of GR for DNA in vitro. We propose that PI3Kδ inhibition improves glucocorticoid efficacy in B-ALL in part by decreasing GR phosphorylation, increasing DNA binding affinity, and enhancing downstream gene regulation. This mechanism and the response of patient specimens suggest that idelalisib will benefit most patients with B-ALL, but particularly patients with less responsive, including high-risk, disease. This combination is also promising for the development of less toxic glucocorticoid-sparing therapies.
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Affiliation(s)
- Jessica A. O. Zimmerman
- Division of Pediatric Hematology/Oncology, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA;
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA;
| | - Mimi Fang
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA;
- Department of Biochemistry and Molecular Biology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Miles A. Pufall
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA;
- Department of Biochemistry and Molecular Biology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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David AL, Darlington AS, Griffiths HC. Experiences of Parenting a Child Receiving Dexamethasone During Maintenance Chemotherapy for Acute Lymphoblastic Leukemia. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:411-419. [PMID: 37194310 DOI: 10.1177/27527530221147877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background: The purpose of this research was to understand the experience of parenting a child receiving dexamethasone during maintenance chemotherapy for acute lymphoblastic leukemia (ALL). Previous research has shown that dexamethasone's high level of toxicity causes many physical, behavioral, and emotional side effects, which reduce the quality of life during ALL treatment. Less is known about the experience of parenting a child receiving dexamethasone and the impact on the parent-child relationship. Methods: In-depth semi-structured interviews were conducted with 12 parents and data was analyzed using Interpretative Phenomenological Analysis. Results: Four superordinate themes emerged: "a child on steroids is not your child": the behavioral and emotional changes in the child and their relationships; "you have to do what you have to do": adapting parenting to manage dexamethasone; "it breaks your heart … it's a horrible medicine": the emotional impact of parenting a child on dexamethasone; and, "it's the worst week ever": finding ways to cope with the challenges of dexamethasone. Discussion A preparatory intervention for parents beginning the dexamethasone journey focused on likely challenges, managing boundary setting and discipline, and their own emotional struggles, could be beneficial. Research into the impact on siblings could further understand the systemic influence of dexamethasone and help develop further interventions.
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Affiliation(s)
- Annabel L David
- Children's Psychological Medicine, Oxford Children's Hospital, Oxford, UK
| | | | - Helen C Griffiths
- Children's Psychological Medicine, Oxford Children's Hospital, Oxford, UK
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Schwartz ER, Rensen N, Steur LMH, Gemke R, van Eijkelenburg NKA, van der Sluis IM, Dors N, van den Bos C, Tissing WJE, Grootenhuis MA, Kaspers GJL, Van Litsenburg RRL. Health-related quality of life and its determinants during and after treatment for paediatric acute lymphoblastic leukaemia: a national, prospective, longitudinal study in the Netherlands. BMJ Open 2023; 13:e070804. [PMID: 37899146 PMCID: PMC10619055 DOI: 10.1136/bmjopen-2022-070804] [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: 12/08/2022] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Health-related quality of life (HRQoL) is impaired in paediatric patients with acute lymphoblastic leukaemia (ALL). Over the past decades, ALL treatment has successfully been adjusted to the risk of relapse, which is now reflected by the stratification of patients into three risk groups who receive treatment of differing intensities. This study is the first to evaluate the longitudinal course of HRQoL in light of these adjustments and identify determinants of HRQoL. DESIGN Two prospective, national cohort studies (add-on studies within the two most recent treatment protocols for children with ALL (ALL-10 and ALL-11)). SETTING Dutch paediatric oncology hospitals between October 2006 and October 2009 (ALL-10) and between August 2013 and July 2017 (ALL-11). PARTICIPANTS Patients with ALL (2-18 years) are treated according to the ALL-10 or ALL-11 treatment protocol. Patients treated according to the ALL-10 protocol only completed a cancer-specific QoL measure and patients treated according to the ALL-11 protocol completed both a cancer-specific and generic QoL measure (see below). OUTCOME MEASURES HRQoL, assessed with parent-proxy questionnaires (PedsQL Generic and Cancer module) within the first 5 months (T0), at 1 year (T1), 2 years (T2) and 3 years (T3) after diagnosis. The proportion of patients with clinically relevant generic HRQoL impairment was compared with healthy norm values. Multivariable mixed model analyses were used to evaluate the development of HRQoL over time and its medical and sociodemographic determinants (collected on enrolment). RESULTS Of the ALL-10 cohort, 132 families participated and of the ALL-11 cohort, 136 families participated (268 total). Thus, cancer-specific HRQoL assessments were available for 268 patients (median age 5.3 years (IQR 6.15), 56.0% boys, 69.0% medium-risk ALL), and generic HRQoL assessments for 136 patients (median age 4.8 years (IQR 6.13), 60.3% boys, 75.0% medium-risk ALL). Generic HRQoL improved between timepoints T0 and T3 (total score B 16.1, 95% CI 12.2 to 20.1, p<0.001), but did not restore to normal 1 year after the end of treatment: 28.0% of children remained impaired compared with 16% in the general population (p=0.003). Cancer-specific HRQoL generally improved from T0 to T2 (Pain B 11.3, 95% CI 7.1 to 15.5; Nausea B 11.7, 8.4 to 15.1; Procedural Anxiety B 19.1, 14.8 to 23.4; Treatment Anxiety B 12.8, 9.5 to 16.0; Worry B 3.5, 0.6 to 6.3; Communication B 8.5, 5.0 to 11.9; all p<0.001 except for Worry (p=0.02)), while Physical Appearance and Cognitive Functioning remained stable. Higher treatment intensity and experiencing pain or simultaneous chronic illness were associated with lower HRQoL over time for multiple subscales. CONCLUSIONS HRQoL impairment is prevalent during and after ALL treatment. Patients with standard-risk ALL and reduced treatment intensity have better HRQoL than patients in higher risk groups. Systematic monitoring of HRQoL is of utmost importance in order to provide timely psychosocial interventions and supportive care.
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Affiliation(s)
- Emily R Schwartz
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Niki Rensen
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Lindsay M H Steur
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Reinoud Gemke
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | | | - Inge M van der Sluis
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Natasja Dors
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Cor van den Bos
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Martha A Grootenhuis
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Raphaele R L Van Litsenburg
- Department of Pediatric Oncology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Hematology-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Zimmerman JA, Fang M, Pufall MA. PI3Kδ inhibition potentiates glucocorticoids in B-lymphoblastic leukemia by decreasing receptor phosphorylation and enhancing gene regulation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.10.527869. [PMID: 36798391 PMCID: PMC9934697 DOI: 10.1101/2023.02.10.527869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Glucocorticoids, including dexamethasone and prednisone, are the cornerstone of B-lymphoblastic leukemia (B-ALL) therapy. Because response to glucocorticoids alone predicts overall outcomes for B-ALL, enhancing glucocorticoid potency is a route to improving outcomes. However, systematic toxicities prevent the use of higher dose and more potent glucocorticoids. We therefore took a functional genomic approach to identify targets to enhance glucocorticoid activity specifically in B-ALL cells. Here we show that inhibition of the lymphoid-restricted PI3Kδ, signaling through the RAS/MAPK pathway, enhances both prednisone and dexamethasone activity in almost all ex vivo B-ALL specimens tested. This potentiation is most synergistic at sub-saturating doses of glucocorticoids, approaching the EC50. Potentiation correlates with global enhancement of glucocorticoid-induced gene regulation, including regulation of effector genes that drive B-ALL cell death. Idelalisib reduces phosphorylation of the glucocorticoid receptor (GR) at MAPK1/ERK2 targets S203 and S226, and ablation of these phospho-acceptor sites enhances glucocorticoid potency. We further show that phosphorylation of S226 reduces the affinity of GR for DNA in vitro, which impairs DNA binding. We therefore propose that PI3Kδ inhibition improves glucocorticoid efficacy in B-ALL in part by decreasing GR phosphorylation, increasing DNA binding affinity, and enhancing downstream gene regulation. The overall enhancement of GR function suggests that idelalisib will provide benefit to most patients with B-ALL by improving outcomes for patients whose disease is less responsive to glucocorticoid-based therapy, including high-risk disease, and allowing less toxic glucocorticoid-sparing strategies for patients with standard-risk disease.
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Affiliation(s)
- Jessica A.O. Zimmerman
- Division of Pediatric Hematology/Oncology, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Mimi Fang
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
- Department of Biochemistry and Molecular Biology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Miles A. Pufall
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
- Department of Biochemistry and Molecular Biology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Sociodemographic and Medical Determinants of Quality of Life in Long-Term Childhood Acute Lymphoblastic Leukemia Survivors Enrolled in EORTC CLG Studies. Cancers (Basel) 2021; 14:cancers14010152. [PMID: 35008314 PMCID: PMC8750449 DOI: 10.3390/cancers14010152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Long-term quality of life and its potential risk factors in childhood acute lymphoblastic leukemia (ALL) patients remain uncertain. In this cross-sectional study, we investigated daily life quality and life challenges in adult survivors of ALL using multiple self-report questionnaires. Furthermore, risk factors, including gender, age at diagnosis, relapse/second neoplasm, risk group, and cranial radiotherapy, were explored in detail. Younger, female, and relapsed patients appeared to encounter more life challenges, while physical challenges occurred more often in relapsed and high-risk patients. More positive effects on socializing were found in the older patients compared to younger patients. This study provides important information for individual and specialized support. Abstract Background: due to increasing survival rates in childhood acute lymphoblastic leukemia (ALL), the number of survivors has been expanding. A significant proportion of these survivors can experience long-term emotional and psychosocial problems. However, the exact risk factors remain inconclusive. We investigated potential risk factors for decreased daily life quality and life challenges in long-term childhood ALL survivors enrolled between 1971 and 1998 in EORTC studies. Methods: self-report questionnaires were collected from 186 survivors (109 females; mean age at diagnosis 5.62 years, range 0.2–14.7; median time since diagnosis of 20.5 years (12.9–41.6)), including the Short-Form Health Survey (SF-12) and Impact of Cancer-Childhood Survivors (IOC-CS). Multivariable linear regression models were used to assess the impact of gender, age at diagnosis, relapse/second neoplasm, National Cancer Institute (NCI) risk group and cranial radiotherapy on 2 subscales of the SF-12 (physical and mental health) and five subscales of the IOC-CS (life challenges, body and health, personal growth, thinking and memory problems and socializing). Results: mental component scores of SF-12 were not significantly associated with any risk factor. Physical component scores were lower in relapsed, irradiated and NCI high-risk patients. Regarding IOC-CS negative impact subscales, life challenges was more negatively impacted by cancer in female, younger (i.e., <6 years) and relapsed patients. Regarding the positive impact scales, personal growth was more positively impacted in relapsed patients, whereas body and health, and socializing, were less positively impacted in these patients, compared to non-relapsed patients. Socializing was more positively impacted in older patients (>6 years). Conclusions: this study demonstrates that long-term outcomes can be both adverse and positive, depending on the patient’s demographic and clinical characteristics. Younger, female, and relapsed patients might encounter more life challenges years after their disease, while physical challenges could occur more often in relapsed and high-risk patients. Finally, the positive effect on socializing in the older patients sheds new light on the importance of peer interactions for this subgroup. Specific individual challenges thus need specialized support for specific subgroups.
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van de Velde ME, van den Berg MH, Kaspers GJL, Abbink FCH, Twisk JWR, van der Sluis IM, van den Bos C, van den Heuvel-Eibrink MM, Segers H, Chantrain C, van der Werff Ten Bosch J, Willems L, van Litsenburg RRL. The association between vincristine-induced peripheral neuropathy and health-related quality of life in children with cancer. Cancer Med 2021; 10:8172-8181. [PMID: 34725942 PMCID: PMC8607258 DOI: 10.1002/cam4.4289] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Vincristine (VCR) is a chemotherapeutic agent used in the treatment of pediatric oncology patients, but its main toxicity is VCR‐induced peripheral neuropathy (VIPN). However, whether VIPN has an effect on health‐related quality of life (HR‐QoL) in children during treatment is unknown. Therefore, the aim of our study was to investigate the association between VIPN and HR‐QoL in children starting treatment for cancer. Methods Measurements of VIPN were performed using two tools: Common Terminology Criteria for Adverse Events (CTCAE) and pediatric‐modified Total Neuropathy Score (ped‐mTNS). Assessment of HR‐QoL was done with self‐ and proxy assessment of the Cancer and Generic module of the Pediatric Cancer Quality of Life Inventory™ (PedsQL). Results In total, N = 86 children were included. HR‐QoL of children with VIPN (n = 67%, 76%) was significantly lower in comparison with children without VIPN: estimated Total score of PedsQL Generic (proxy) 84.57; β = −8.96 and 95% confidence interval (CI) −14.48 to −3.43; p = 0.002, estimated PedsQL Generic Total score (self‐reported): 85.16, β = −8.38 (95% CI: −13.76 to −3.00); p = 0.003. Similar results were found in the Pain and Hurt domain of the PedsQL Cancer (pain: estimated score [proxy]: 85.28, β = −9.94 [95%CI: −16.44 to −3.45], p = 0.003; hurt: estimated score [self‐report] 97.57, β = −19.15 [95%CI: −26.82 to −11.48], p < 0.001). Conclusion VIPN results in a significant reduction of HR‐QoL in children under treatment for a malignancy, which means that VIPN is important for the well‐being of pediatric oncology patients. Therefore, this study underlines the importance of optimizing treatment with VCR, thereby aiming to reduce VIPN while maintaining efficacy.
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Affiliation(s)
- Mirjam E van de Velde
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, Amsterdam, The Netherlands
| | - Marleen H van den Berg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Floor C H Abbink
- Emma Children's Hospital, Amsterdam UMC, Amsterdam Medical Center, Pediatric Oncology, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Cor van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Amsterdam Medical Center, Pediatric Oncology, Amsterdam, The Netherlands
| | | | - Heidi Segers
- Department of Pediatric Hemato-Oncology, UZ Leuven, Leuven, Belgium
| | | | | | - Leen Willems
- Department of Paediatric Haematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Raphaële R L van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Rensen N, Steur LMH, Grootenhuis MA, van Eijkelenburg NKA, van der Sluis IM, Dors N, van den Bos C, Tissing WJE, Kaspers GJL, van Litsenburg RRL. Parental functioning during maintenance treatment for childhood acute lymphoblastic leukemia: Effects of treatment intensity and dexamethasone pulses. Pediatr Blood Cancer 2020; 67:e28697. [PMID: 32909677 DOI: 10.1002/pbc.28697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND During maintenance treatment, Dutch pediatric patients with medium-risk (MR) acute lymphoblastic leukemia (ALL) receive intravenous chemotherapy and cyclic dexamethasone. Dexamethasone affects child's sleep and behavior. Standard-risk (SR) patients only receive oral chemotherapy, without dexamethasone. Effects of stratified therapy on parents are not well known. This study compares parental sleep, distress and quality of life (QoL) with the general population, between MR and SR groups, and on- and off-dexamethasone (MR group). PROCEDURE One year after diagnosis, parents of MR patients completed the Medical Outcomes Study (MOS) sleep, distress thermometer for parents and Short Form-12 (SF-12) twice; once on-dexamethasone and once off-dexamethasone. SR parents completed one measurement. Sleep problems, distress and QoL scores (off-dexamethasone) were compared to reference values and between MR and SR. Score differences on- and off-dexamethasone were assessed by multilevel regression analysis. RESULTS Parents (80% mothers) of 121 patients (57% males; 75% MR, 25% SR) completed 191 measurements. Compared to reference values, parents reported more sleep disturbances, higher distress, and lower mental QoL. Additionally, MR parents reported clinical distress (score ≥ 4), whereas SR parents (on average) did not (mean 4.8 ± 2.4 vs 3.5 ± 2.4, P = .02). Within the MR group, outcomes did not significantly differ on- and off-dexamethasone. CONCLUSIONS Parents of ALL patients report sleep problems, high distress, and QoL impairment. Within the MR group, parental functioning did not differ on- and off-dexamethasone. However, MR parents reported clinical distress more often than SR parents, possibly reflecting differences in prognostic estimates and treatment burden. This perhaps includes the overall strain of cyclic dexamethasone. This study highlights the need for psychosocial support throughout treatment, regardless of risk stratification.
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Affiliation(s)
- Niki Rensen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Lindsay M H Steur
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | | | - Inge M van der Sluis
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Sophia Children's Hospital, Erasmus Medical Center, Pediatric Oncology, Rotterdam, Netherlands
| | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Amalia Children's Hospital, Radboud University Medical Center, Pediatric Oncology, Nijmegen, Netherlands
| | - Cor van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Pediatric Oncology, Amsterdam, Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,University of Groningen, University Medical Center Groningen, Pediatric Oncology, Groningen, Netherlands
| | - Gertjan J L Kaspers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands.,Dutch Childhood Oncology Group, Utrecht, Netherlands
| | - Raphaële R L van Litsenburg
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
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Staub Y, Suga Y, Ikawa Y, Tsubouchi K, Hashimoto M, Kawagishi A, Shimada T, Sai Y, Nishimura K, Matsushita R. Detailed assessment and risk factor analysis of corticosteroid-induced psychiatric disorders in pediatric, adolescent, and young adult patients undergoing induction or consolidation therapy for hematologic malignancy. J Oncol Pharm Pract 2019; 26:1041-1051. [PMID: 31635550 DOI: 10.1177/1078155219879992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Corticosteroid-induced psychiatric disorders (CIPDs) represent an adverse effect that can cause severe emotional and behavioral problems. The aim of the present study was to assess the incidence and risk factors of CIPDs. METHODS A retrospective analysis of 92 pediatric and young adult patients with hematologic malignancies was conducted. RESULTS The incidence of CIPDs in patients receiving a treatment regimen with prednisolone or dexamethasone was 64.9% and 77.5%, respectively, both of which were significantly higher than that in patients not receiving corticosteroids. Independent risk factors and adjusted odds ratios (95% confidence intervals) related to severe CIPD were 2.15 (1.11-4.18) for dexamethasone (using prednisolone as the reference) and 0.81 (0.75-0.87) for age, suggesting that the odds increase with decreasing age. Frequently observed symptoms, respectively in terms of behavioral and emotional problems were defiance, crying, psychomotor excitement, dysphoria, irritability, and depression. To our knowledge, this is the first report to mention the risk factors and characteristics for clinical symptoms of CIPDs during the developmental process. CONCLUSIONS Healthcare professionals should predict and prepare for psychiatric adverse events prior to chemotherapy in the clinical settings, especially in patients in younger age and receiving a treatment regimen with dexamethasone.
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Affiliation(s)
- Yukiko Staub
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yukio Suga
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yasuhiro Ikawa
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Kiyotaka Tsubouchi
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Mikie Hashimoto
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Atsufumi Kawagishi
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Tsutomu Shimada
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Yoshimichi Sai
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryo Matsushita
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
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10
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Jankowska‐Polańska B, Sliwiński M, Świątoniowska N, Butrym A, Mazur G. Quality of life in children with acute lymphoblastic leukaemia. Scand J Caring Sci 2019; 34:380-389. [DOI: 10.1111/scs.12739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Beata Jankowska‐Polańska
- Faculty of Health Sciences, Department of Clinical Nursing Wroclaw Medical University Wroclaw Poland
| | - Maciej Sliwiński
- Student Scientific Societies of Clinical Nursing, Public Health Department Wroclaw Medical University Wroclaw Poland
| | - Natalia Świątoniowska
- Faculty of Health Sciences, Department of Clinical Nursing Wroclaw Medical University Wroclaw Poland
| | - Aleksandra Butrym
- Faculty of Medicine, Department of Cancer Prevention and Therapy Wroclaw Medical University Wroclaw Poland
| | - Grzegorz Mazur
- Faculty of Medicine, Department and Clinic of Internal and Occupational Diseases and Hypertension Wroclaw Medical University Wroclaw Poland
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11
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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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12
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Eiser C, Stride CB, Vora A, Goulden N, Mitchell C, Buck G, Adams M, Jenney MEM. Prospective evaluation of quality of life in children treated in UKALL 2003 for acute lymphoblastic leukaemia: A cohort study. Pediatr Blood Cancer 2017; 64. [PMID: 28475268 DOI: 10.1002/pbc.26615] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 03/19/2017] [Accepted: 03/27/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) from diagnosis until end of treatment for children with acute lymphoblastic leukaemia was investigated, examining effects of age, gender, risk-stratified treatment regimen, and therapy intensity (one vs. two 'delayed intensifications' [DIs]). METHOD In a multi-centre prospective study, parents reported their child's generic and disease-specific HRQoL and their own care-giving burden at five time points. From 1,428 eligible patients, 874 parents completed questionnaires at least once during treatment. RESULTS At each time point, generic HRQoL was significantly lower than equivalent norm scores for healthy children. HRQoL decreased significantly at the start of treatment, before recovering gradually (but remained below pre-treatment levels). Parents reported that older children worried more about side effects and their appearance, but showed less procedural anxiety than younger children. Concern for appearance was greater among girls than boys. Compared to Regimen B (i.e. additional doxorubicin during induction and additional cyclophosphamide and cytarabine during consolidation chemotherapy), patients receiving Regimen A had fewer problems with pain and nausea. There were no statistically significant differences in HRQoL by number of DI blocks received. INTERPRETATION HRQoL is compromised at all stages of treatment, and is partly dependent on age. The findings increase understanding of the impact of therapy on children's HRQoL and parental care-giving burden, and will contribute to the design of future trials.
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Affiliation(s)
- C Eiser
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - C B Stride
- Department of statistics, Management School, Conduit Road, University of Sheffield, Sheffield, United Kingdom
| | - A Vora
- Department of Paediatric Haematology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, United Kingdom
| | - N Goulden
- Department of paediatric haematology, Great Ormond Street Hospital, London, United Kingdom
| | - C Mitchell
- Department of Paediatric Haematology/Oncology, John Radcliffe Hospital, Oxford, United Kingdom
| | - G Buck
- Clinical Trial Service Unit, University of Oxford, Oxford, United Kingdom
| | - M Adams
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
| | - M E M Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
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13
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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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14
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Factors associated with health-related quality of life among children with cancer from the standpoint of patients and caregivers. J Public Health (Oxf) 2017. [DOI: 10.1007/s10389-017-0791-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Pépin AJ, Cloutier-Bergeron A, Malboeuf-Hurtubise C, Achille M, Krajinovic M, Laverdière C, Lippé S, Marcoux S, Sinnett D, Sultan S. Adverse neuropsychological effects associated with cumulative doses of corticosteroids to treat childhood acute lymphoblastic leukemia: A literature review. Crit Rev Oncol Hematol 2016; 107:138-148. [PMID: 27823641 DOI: 10.1016/j.critrevonc.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/11/2016] [Accepted: 09/06/2016] [Indexed: 01/07/2023] Open
Abstract
Corticosteroids (CS) are an essential component of childhood acute lymphoblastic leukemia treatments (cALL). Although there is evidence that daily doses of CS can have neuropsychological effects, few studies have investigated the role of cumulative doses of CS in short- and long-term neuropsychological effects in cALL. The aims of this review were to identify the measures used for documenting adverse neuropsychological effects (ANEs) of CS treatment and to study the association between cumulative doses of CS and the presence of ANEs. Twenty-two articles met the inclusion criteria. A variety of measures were used to evaluate outcomes in the domains of emotion, behaviour, neurocognition, and fatigue/sleep. The results suggest that we cannot conclude in favour of an association between the cumulative dosage of CS and ANEs. Yet, several factors including the heterogeneity of measures used to evaluate outcomes and reporting biases may limit the scope of the results. We offer several recommendations that could help improve the future published evidence on ANEs in relation to CS treatment in cALL.
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Affiliation(s)
- A J Pépin
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada.
| | | | | | | | - M Krajinovic
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - C Laverdière
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - S Lippé
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - S Marcoux
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - D Sinnett
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - S Sultan
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada.
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16
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Steur LMH, Kolk RHE, Mooij F, de Vries R, Grootenhuis MA, Kaspers GJL, Van Litsenburg RRL. The prevalence and risk factors of sleep problems in pediatric oncology: its effect on quality of life during and after cancer treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23809000.2016.1168265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Lindsay M. H. Steur
- Department of pediatric oncology-hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Roos H. E. Kolk
- Department of pediatric oncology-hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Floor Mooij
- Department of pediatric oncology-hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Martha A. Grootenhuis
- Psychosocial department, Emma Childrens’ Hospital, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
- Psycho-oncology Research Group, Princess Máxima Center for pediatric oncology Utrecht, Utrecht, The Netherlands
| | - Gertjan J. L. Kaspers
- Department of pediatric oncology-hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Director of Academy, Princess Máxima Center for pediatric oncology Utrecht, Utrecht, The Netherlands
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17
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Adams M, Robling M, Grainger J, Tomlins J, Johnson A, Morris S, Velangi M, Jenney M. Quality of life Evaluation in patients receiving Steroids (the QuESt tool): initial development in children and young people with acute lymphoblastic leukaemia. Arch Dis Child 2016; 101:241-6. [PMID: 26699534 DOI: 10.1136/archdischild-2015-309139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/25/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND The powerful cytotoxic and immunomodulatory effects of corticosteroids are an important element of the success that has been achieved in the treatment of acute lymphoblastic leukaemia (ALL). In addition to physical side effects, corticosteroids can adversely influence behaviour, cognitive function and mood leading to significantly impaired quality of life (QoL). A number of tools exist for assessing QoL, but none of these specifically examines changes attributable to steroids. METHODS Children and young adults aged 8-24 years and parents of children receiving maintenance therapy for ALL from four UK centres were invited to participate. The study comprised three stages carried out over 2 years: (1) focus groups and interviews where participants were asked to describe their experiences of dexamethasone; (2) analysis of questionnaires sent to healthcare professionals and patients to evaluate the importance and relevance of the questions; and (3) cognitive interviewing. RESULTS Interpretative phenomenological analysis of focus group and interview transcripts identified that dexamethasone adversely influenced behaviour, appetite, body image, mood and family relationships. 157 electronic survey responses were analysed leading to further item development. Cognitive interviewing confirmed face validity and internal consistency. QuESt comprises 28 questions within four domains and has three age-specific versions. CONCLUSIONS QuESt is the first treatment-specific QoL measure for children and young adults receiving corticosteroids. It can be completed in 10-15 min by children aged ≥8 years. Further validity and reliability testing will be undertaken. Although the initial application is for ALL, QuESt may also be a valuable tool for understanding the impact of corticosteroids in other paediatric conditions.
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Affiliation(s)
- M Adams
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - M Robling
- Institute of Primary Care and Public Health, Cardiff University , Cardiff, UK
| | - J Grainger
- Department of Paediatric Haematology, Royal Manchester Children's Hospital, Manchester, UK
| | - J Tomlins
- Teenage and Young Adult Haematology Department, Christie Hospital, Manchester, UK
| | - A Johnson
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - S Morris
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - M Velangi
- Department of Paediatric Haematology, Birmingham Children's Hospital, Birmingham, UK
| | - M Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
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18
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Momani TG, Hathaway DK, Mandrell BN. Factors Affecting Health-Related Quality of Life in Children Undergoing Curative Treatment for Cancer: A Review of the Literature. J Pediatr Oncol Nurs 2015; 33:228-40. [PMID: 26611756 DOI: 10.1177/1043454215609585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is an important measure to evaluate a child's reported treatment experience. Although there are numerous studies of HRQoL in children undergoing curative cancer treatment, there is limited literature on factors that influence this. OBJECTIVE To review published studies that describe the HRQoL and associated factors in children undergoing curative cancer treatment. METHOD Full-text publications in English from January 2005 to March 2013 were searched in PubMed, PsychINFO, and CINAHL for children ≤18 years of age undergoing curative cancer treatment. HRQoL-associated factors were categorized as cancer diagnosis, treatment, child, family, and community. RESULTS Twenty-six studies met the inclusion criteria. The most frequently used generic and cancer-specific instruments were PedsQL (Pediatric Quality of Life Inventory) Generic and PedsQL Cancer, respectively. Cancer diagnosis and treatment were the most frequently identified variables; fewer studies measured family and community domains. Gender, treatment intensity, type of cancer treatments, time in treatment, and cancer diagnosis were correlated with HRQoL. CONCLUSION Our study highlights the need to develop interventions based on diagnosis and treatment regimen to improve the HRQoL in children undergoing curative cancer treatment.
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Affiliation(s)
- Tha'er G Momani
- St. Jude Children's Research Hospital, Memphis, TN, USA University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Belinda N Mandrell
- St. Jude Children's Research Hospital, Memphis, TN, USA University of Tennessee Health Science Center, Memphis, TN, USA
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19
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Patient-Reported Outcome Coordinator Did Not Improve Quality of Life Assessment Response Rates: A Report from the Children's Oncology Group. PLoS One 2015; 10:e0125290. [PMID: 25915772 PMCID: PMC4411136 DOI: 10.1371/journal.pone.0125290] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 03/23/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Health related quality of life (HRQL) assessments during therapy for pediatric cancer provide valuable information to better understand the patient experience. Our objective was to determine the impact of a patient-reported outcome (PRO) coordinator on HRQL questionnaire completion rates during a pediatric acute myeloid leukemia (AML) trial. METHODS AAML1031 is a multicenter Children's Oncology Group therapeutic trial for de novo AML with a secondary aim to assess HRQL of children and adolescents treated with chemotherapy and hematopoietic stem cell transplantation (HSCT). Parents/guardians are the primary respondents and four questionnaires are administered at eight time points. The questionnaires are the PedsQL 4.0 Generic Core Scales, PedsQL 3.0 Acute Cancer Module, PedsQL Multidimensional Fatigue Scale, and the Pediatric Inventory for Parents. To improve response rates, a central PRO coordinator was instituted and reminded sites about upcoming and delinquent questionnaires. The proportion of HRQL questionnaires completed were compared prior to, and following institution of the PRO coordinator. This analysis evaluated the first five assessment time points. RESULTS There were231 families who consented to participate in the HRQL aim. Overall response rates for all questionnaires were 73-83%. At time point 1, within 14 days of chemotherapy initiation, post-PRO coordinator completion rates were significantly higher for three of four questionnaires. However, the effect was not sustained and at time point 4, one month following last chemotherapy or HSCT, completion rates were significantly lower post-PRO coordinator for all four questionnaires. CONCLUSION Addition of a central PRO coordinator did not result in sustained improvement in HRQL questionnaire completion rates. Efforts to improve response rates must consider other strategies.
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20
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Poulsen HS, Urup T, Michaelsen SR, Staberg M, Villingshøj M, Lassen U. The impact of bevacizumab treatment on survival and quality of life in newly diagnosed glioblastoma patients. Cancer Manag Res 2014; 6:373-87. [PMID: 25298738 PMCID: PMC4186574 DOI: 10.2147/cmar.s39306] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Glioblastoma multiforme (GBM) remains one of the most devastating tumors, and patients have a median survival of 15 months despite aggressive local and systemic therapy, including maximal surgical resection, radiation therapy, and concomitant and adjuvant temozolomide. The purpose of antineoplastic treatment is therefore to prolong life, with a maintenance or improvement of quality of life. GBM is a highly vascular tumor and overexpresses the vascular endothelial growth factor A, which promotes angiogenesis. Preclinical data have suggested that anti-angiogenic treatment efficiently inhibits tumor growth. Bevacizumab is a humanized monoclonal antibody against vascular endothelial growth factor A, and treatment has shown impressive response rates in recurrent GBM. In addition, it has been shown that response is correlated to prolonged survival and improved quality of life. Several investigations in newly diagnosed GBM patients have been performed during recent years to test the hypothesis that newly diagnosed GBM patients should be treated with standard multimodality treatment, in combination with bevacizumab, in order to prolong life and maintain or improve quality of life. The results of these studies along with relevant preclinical data will be described, and pitfalls in clinical and paraclinical endpoints will be discussed.
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Affiliation(s)
- Hans Skovgaard Poulsen
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Urup
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Regner Michaelsen
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikkel Staberg
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Villingshøj
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrik Lassen
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark ; Phase I Unit, The Finsencenter, Copenhagen University Hospital, Copenhagen, Denmark
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21
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van Litsenburg RRL, Huisman J, Pieters R, Verhaak C, Kaspers GJL, Gemke RJBJ. Determinants of quality of life during induction therapy in pediatric acute lymphoblastic leukemia. Support Care Cancer 2014; 22:3235-42. [PMID: 25011520 DOI: 10.1007/s00520-014-2349-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 06/29/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Improvement in survival of pediatric acute lymphoblastic leukemia (ALL) has increased the attention to quality of life (QoL) . QoL is impaired during maintenance treatment, but little is known about QoL during induction therapy. Identification of patients with poor QoL during induction will provide opportunities for early interventions, and may subsequently improve future QoL. This national multi-center study aimed to assess QoL and its determinants during ALL induction treatment. METHODS Proxy reports of the Child Health Questionnaire (CHQ) and the PedsQL cancer version were collected. Child, treatment, and parental characteristics were analyzed as potential determinants in a multiple regression model. RESULTS One hundred thirty parents of children participated (response rate 82 %), median child age was 5.7 years and 48 % were female. QoL, as measured with the CHQ, was significantly lower than the norm, the effect sizes were large, and the differences were clinically relevant. Physical QoL was more often affected than psychosocial QoL. Regression models could be constructed for 4/ 10 CHQ scales and 6/ 8 PedsQL cancer scales, accounting for 7 to 36 % of the variance in scores. Impaired QoL was most often associated with older children, girls, and time since diagnosis. Also, father respondents seem to have a lower QoL perception compared to mother respondents although this needs to be confirmed in future research. CONCLUSIONS Specific counseling for subsets of patients with a higher risk of low QoL during the early phases of therapy is warranted.
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Affiliation(s)
- Raphaële R L van Litsenburg
- Department of Pediatrics, VU University Medical Center Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands,
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22
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Warris LT, van den Heuvel-Eibrink MM, den Hoed MAH, Aarsen FK, Pieters R, van den Akker ELT. Does dexamethasone induce more neuropsychological side effects than prednisone in pediatric acute lymphoblastic leukemia? A systematic review. Pediatr Blood Cancer 2014; 61:1313-8. [PMID: 24532490 DOI: 10.1002/pbc.24988] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/23/2014] [Indexed: 11/09/2022]
Abstract
Steroid-induced neuropsychological side effects impact quality of life in children with acute lymphoblastic leukemia. Dexamethasone induces more metabolic side effects than prednisone. To evaluate whether dexamethasone also leads to more neuropsychological side effects, we reviewed all available literature. Randomized controlled trials with neuropsychological function as the primary or secondary outcome did not show clinically meaningful differences between dexamethasone and prednisone on cognition, mood or behavior.
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Affiliation(s)
- L T Warris
- Department of Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatric Endocrinology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Walsh KS, Paltin I, Gioia GA, Isquith P, Kadan-Lottick NS, Neglia JP, Brouwers P. Everyday executive function in standard-risk acute lymphoblastic leukemia survivors. Child Neuropsychol 2014; 21:78-89. [PMID: 24428397 DOI: 10.1080/09297049.2013.876491] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We aimed to evaluate parent-rated executive function (EF) in pediatric standard risk acute lymphoblastic leukemia (SR-ALL) survivors compared to a healthy comparison (HC) group. We hypothesized that SR-ALL survivors would have greater reported executive dysfunction compared to HC, and that those younger at the time of treatment would demonstrate greater EF difficulties. A sample of 256 SR-ALL survivors evaluated an average nine years after treatment were compared to HC matched for gender, assessment age, and maternal education. Profile analysis was used to compare the groups across EF scales on the BRIEF. The prevalence of clinical elevations in the groups was compared via chi square, and odds ratios were calculated. Regression models were applied to examine the role of age at diagnosis and age at assessment in reported EF. Results indicated that SR-ALL survivors' mean scores of EF are similar to HC, except for flexibility and initiation. Survivors were rated as having clinical impairments with flexibility, initiation, working memory, and emotional control at rates two to three times that of HC. The risk of working memory and self-monitoring deficits was greater in survivors who were older when assessed. There was no relationship between age at diagnosis or treatment regimen on EF. These findings suggest sparing of extensive and severe EF deficits in SR-ALL survivors overall. However, a subset of survivors displays clinically significant executive dysfunction. There appears to be a heightened susceptibility to disrupted metacognitive functions as survivors age. This has implications for how we monitor neurocognitive development and functioning of SR-ALL survivors, and highlights opportunities for cognitive interventions.
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Affiliation(s)
- Karin S Walsh
- a Children's National Medical Center & The George Washington University Medical Center , Washington , DC , USA
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Johnston DL, Nagarajan R, Caparas M, Schulte F, Cullen P, Aplenc R, Sung L. Reasons for non-completion of health related quality of life evaluations in pediatric acute myeloid leukemia: a report from the Children's Oncology Group. PLoS One 2013; 8:e74549. [PMID: 24040278 PMCID: PMC3765362 DOI: 10.1371/journal.pone.0074549] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/02/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Health related quality of life (HRQL) assessments during therapy for pediatric cancer are important. The objective of this study was to describe reasons for failure to provide HRQL assessments during a pediatric acute myeloid leukemia (AML) clinical trial. METHODS We focused on HRQL assessments embedded in a multicenter pediatric AML clinical trial. The PedsQL 4.0 Generic Core Scales, PedsQL 3.0 Acute Cancer Module, PedsQL Multidimensional Fatigue Scale, and Pediatric Inventory for Parents were obtained from parent/guardian respondents at a maximum of six time points. Children provided self-report optionally. A central study coordinator contacted sites with delinquent HRQL data. Reasons for failure to submit the HRQL assessments were evaluated by three pediatric oncologists and themes were generated using thematic analysis. RESULTS There were 906 completed and 1091 potential assessments included in this analysis (83%). The median age of included children was 12.9 years (range 2.0 to 18.9). The five themes for non-completion were: patient too ill; passive or active refusal by respondent; developmental delay; logistical challenges; and poor knowledge of study processes from both the respondent and institutional perspective. CONCLUSIONS We identified reasons for non-completion of HRQL assessments during active therapy. This information will facilitate recommendations to improve study processes and future HRQL study designs to maximize response rates.
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Affiliation(s)
- Donna L. Johnston
- Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- * E-mail:
| | - Rajaram Nagarajan
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Mae Caparas
- Children’s Oncology Group, Monrovia, California, United States of America
| | - Fiona Schulte
- Departments of Oncology and Paediatrics, University of Calgary, Alberta Children's Hospital Research Institute, and Haematology, Oncology and Transplant Program, Alberta Children's, Calgary, Alberta, Canada
| | - Patricia Cullen
- Loretto Heights School of Nursing, Regis University, Denver, Colorado, United States of America
| | - Richard Aplenc
- Pediatric Oncology/Stem Cell Transplant, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Anthony SJ, Selkirk E, Sung L, Klaassen RJ, Dix D, Scheinemann K, Klassen AF. Considering quality of life for children with cancer: a systematic review of patient-reported outcome measures and the development of a conceptual model. Qual Life Res 2013; 23:771-89. [PMID: 23907613 DOI: 10.1007/s11136-013-0482-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES An appraisal of pediatric cancer-specific quality-of-life (QOL) instruments revealed a lack of clarity about what constitutes QOL in this population. This study addresses this concern by identifying the concepts that underpin the construct of QOL as determined by a content analysis of all patient-reported outcome (PRO) instruments used in childhood cancer research. METHODS A systematic review was performed of key databases (i.e., MEDLINE, CINAHL, PsychINFO) to identify studies of QOL in children with cancer. A content analysis process was used to code and categorize all items from generic and cancer-specified PRO instruments. Our objective was to provide clarification regarding the conceptual underpinnings of these instruments, as well as to help inform the development of theory and contribute to building a conceptual framework of QOL for children with cancer. RESULTS A total of 6,013 English language articles were screened, identifying 148 studies. Ten generic and ten cancer-specific PRO instruments provided 957 items. Content analysis led to the identification of four major domains of QOL (physical, psychological, social, and general health), with 11 subdomains covering 98 different concepts. While all instruments reflected items relating to the broader domains of QOL, there was substantial heterogeneity in terms of the content and variability in the distribution of items. CONCLUSIONS This systematic review and the proposed model represent a useful starting point in the critical appraisal of the conceptual underpinnings of PRO instruments used in pediatric oncology and contribute to the need to place such tools under a critical, yet reflective and analytical lens.
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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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Hinds PS, Menard JC, Jacobs SS. The child's voice in pediatric palliative and end-of-life care. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x12y.0000000035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Girard P, Auquier P, Barlogis V, Contet A, Poiree M, Demeocq F, Berbis J, Herrmann I, Villes V, Sirvent N, Kanold J, Chastagner P, Chambost H, Plantaz D, Michel G. Symptomatic osteonecrosis in childhood leukemia survivors: prevalence, risk factors and impact on quality of life in adulthood. Haematologica 2013; 98:1089-97. [PMID: 23645686 DOI: 10.3324/haematol.2012.081265] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Corticosteroid can induce osteonecrosis in children with leukemia. Few studies have been designed to assess the influence of a wide range of cumulative steroid dose on this side effect. Prevalence, risk factors of symptomatic osteonecrosis and its impact on adults' Quality of Life were assessed in 943 patients enrolled in the French "Leucémies de l'Enfant et de l'Adolescent" (LEA) cohort of childhood leukemia survivors. During each medical visit, data on previous osteonecrosis diagnosis were retrospectively collected. Patients without a history but with suggestive symptoms were investigated with magnetic resonance imaging. The total steroid dose in equivalent of prednisone was calculated for each patient and its effect on osteonecrosis occurrence was studied in multivariate models. Cumulative incidence was 1.4% after chemotherapy alone versus 6.8% after transplantation (P<0.001). A higher cumulative steroid dose, age over ten years at diagnosis, and treatment with transplantation significantly increased the risk of osteonecrosis. A higher post-transplant steroid dose and age over ten years at time of transplantation were significant factors in the transplanted group. With patients grouped according to steroid dose quartile, cumulative incidence of osteonecrosis reached 3.8% in the chemotherapy group for a dose beyond 5835 mg/m(2) and 23.8% after transplantation for a post-transplant dose higher than 2055 mg/m(2). Mean physical composite score of Quality of Life was 44.3 in patients with osteonecrosis versus 54.8% in patients without (P<0.001). We conclude that total and post-transplant cumulative steroid dose may predict the risk of osteonecrosis, a rare late effect with a strong negative impact on physical domains of Quality of Life.
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Affiliation(s)
- Pauline Girard
- Department of Pediatric Hematology-Oncology, APHM, La Timone Hospital, Aix-Marseille University, France
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Vora A, Goulden N, Wade R, Mitchell C, Hancock J, Hough R, Rowntree C, Richards S. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial. Lancet Oncol 2013; 14:199-209. [DOI: 10.1016/s1470-2045(12)70600-9] [Citation(s) in RCA: 284] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Schwartz JR, Sarvaiya PJ, Leiva LE, Velez MC, Singleton TC, Yu LC, Vedeckis WV. A facile, branched DNA assay to quantitatively measure glucocorticoid receptor auto-regulation in T-cell acute lymphoblastic leukemia. CHINESE JOURNAL OF CANCER 2012; 31:381-91. [PMID: 22739263 PMCID: PMC3777508 DOI: 10.5732/cjc.012.10044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Glucocorticoid (GC) steroid hormones are used to treat acute lymphoblastic leukemia (ALL) because of their pro-apoptotic effects in hematopoietic cells. However, not all leukemia cells are sensitive to GC, and no assay to stratify patients is available. In the GC-sensitive T-cell ALL cell line CEM-C7, auto-up-regulation of RNA transcripts for the glucocorticoid receptor (GR) correlates with increased apoptotic response. This study aimed to determine if a facile assay of GR transcript levels might be promising for stratifying ALL patients into hormone-sensitive and hormone-resistant populations. The GR transcript profiles of various lymphoid cell lines and 4 bone marrow samples from patients with T-cell ALL were analyzed using both an optimized branched DNA (bDNA) assay and a real-time quantitative reverse transcription-polymerase chain reaction assay. There were significant correlations between both assay platforms when measuring total GR (exon 5/6) transcripts in various cell lines and patient samples, but not for a probe set that detects a specific, low abundance GR transcript (exon 1A3). Our results suggest that the bDNA platform is reproducible and precise when measuring total GR transcripts and, with further development, may ultimately offer a simple clinical assay to aid in the prediction of GC-sensitivity in ALL patients.
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Affiliation(s)
- Jason R Schwartz
- Department of Biochemistry and Molecular Biology, Stanley S. Scott Cancer Center, Louisiana State University Health Science Center, New Orleans, LA 70112, USA
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Abstract
BACKGROUND The increasing survival rate of children with cancer because of more refined treatments makes necessary the investigation of psychological burden for the young patients. OBJECTIVE The aim of the study was to evaluate the development of psychological problems in children with cancer during the initial 6-month period of intensive treatment. METHODS This prospective, comparative study was conducted at one of the largest Greek pediatric oncology units in Athens. The sample comprised 132 children with cancer treated during a 30-month period and 100 children with no cancer as control group. Data were collected using the Rutter instruments for parents and teachers. For patients, it was completed by their parents at 1 (T1), 3 (T2), and 6 months (T3) from diagnosis and by teachers at T3. In the control group, the questionnaire was completed by teachers and parents once. RESULTS The comparison of total Rutter scores for patients at T1, T2, and T3, according to parents' responses, showed statistically significant difference (P < .001). The difference in scores for patients (at T3) and control subjects was also significant according to both parents' (P < .00001) and teachers' (P < .001) responses. Children with leukemia had higher score reduction during treatment (P = .009) compared with the rest. Only age had a marginal impact on score of patients at T1 (R = 0.04). CONCLUSIONS Based on parental reports, children treated for cancer develop psychological problems during the period of intensive treatment. The development and evolution of these problems depend on their age and type of cancer. IMPLICATIONS FOR PRACTICE This information can be used for relevant interventions in specific groups.
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Henriksson R, Asklund T, Poulsen HS. Impact of therapy on quality of life, neurocognitive function and their correlates in glioblastoma multiforme: a review. J Neurooncol 2011; 104:639-46. [PMID: 21468776 PMCID: PMC3170120 DOI: 10.1007/s11060-011-0565-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 03/03/2011] [Indexed: 11/30/2022]
Abstract
The maintenance of quality of life (QoL) in patients with high-grade glioma is an important endpoint during treatment, particularly in those with glioblastoma multiforme (GBM) given its dismal prognosis despite limited advances in standard therapy. It has proven difficult to identify new therapies that extend survival in patients with recurrent GBM, so one of the primary aims of new therapies is to reduce morbidity, restore or preserve neurologic functions, and the capacity to perform daily activities. Apart from temozolomide, cytotoxic chemotherapeutic agents do not appear to significantly impact response or survival, but produce toxicity that is likely to negatively impact QoL. New biological agents, such as bevacizumab, can induce a clinically meaningful proportion of durable responses among patients with recurrent GBM with an acceptable safety profile. Emerging evidence suggests that bevacizumab produces an improvement or preservation of neurocognitive function in GBM patients, suggestive of QoL improvement, in most poor-prognosis patients who would otherwise be expected to show a sudden and rapid deterioration in QoL.
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Affiliation(s)
- Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University Hospital, Umea, Sweden
- Radiumhemmet, Karolinska Hospital, Stockholm, Sweden
| | - Thomas Asklund
- Department of Radiation Sciences and Oncology, Umeå University Hospital, Umea, Sweden
| | - Hans Skovgaard Poulsen
- Radiumhemmet, Karolinska Hospital, Stockholm, Sweden
- Department of Oncology, Finsencenter, University Hospital, 9 Blegdamsvej, 2100 Copenhagen, Denmark
- Department of Radiation Biology, Section 6321, Finsencenter, University Hospital, 9 Blegdamsvej, 2100 Copenhagen, Denmark
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van Litsenburg RRL, Huisman J, Hoogerbrugge PM, Egeler RM, Kaspers GJL, Gemke RJBJ. Impaired sleep affects quality of life in children during maintenance treatment for acute lymphoblastic leukemia: an exploratory study. Health Qual Life Outcomes 2011; 9:25. [PMID: 21496357 PMCID: PMC3095992 DOI: 10.1186/1477-7525-9-25] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 04/18/2011] [Indexed: 11/28/2022] Open
Abstract
Background With the increase of pediatric cancer survival rates, late effects and quality of life (QoL) have received more attention. Disturbed sleep in pediatric cancer is a common clinical observation, but research on this subject is sparse. In general, sleep problems can lead to significant morbidity and are associated with impaired QoL. Information on sleep is essential to develop interventions to improve QoL. Methods Children (2-18 years) with acute lymphoblastic leukemia (ALL) were eligible for this multi-center study. The Children's Sleep Habits Questionnaire (CSHQ), Child Health Questionnaire (CHQ) and Pediatric Quality of Life Inventory 3.0™ Acute Cancer Version (PedsQL) were used to assess sleep and QoL halfway through maintenance therapy. Sleep and QoL were measured during and after dexamethasone treatment (on-dex and off-dex). Results Seventeen children participated (age 6.7 ± 3.3 years, 44% boys). Children with ALL had more sleep problems and a lower QoL compared to the norm. There were no differences on-dex and off-dex. Pain (r = -0.6; p = 0.029) and worry (r = -0.5; p = 0.034) showed a moderate negative association with sleep. Reduced overall QoL was moderately associated with impaired overall sleep (r = -0.6; p = 0.014) and more problems with sleep anxiety (r = -0.8; p = 0.003), sleep onset delay (r = -0.5; p = 0.037), daytime sleepiness (r = -0.5; p = 0.044) and night wakenings (r = -0.6; p = 0.017). Conclusion QoL is impaired in children during cancer treatment. The results of this study suggest that impaired sleep may be a contributing determinant. Consequently, enhanced counseling and treatment of sleep problems might improve QoL. It is important to conduct more extensive studies to confirm these findings and provide more detailed information on the relationship between sleep and QoL, and on factors affecting sleep in pediatric ALL and in children with cancer in general.
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Jakobsen JN, Hasselbalch B, Stockhausen MT, Lassen U, Poulsen HS. Irinotecan and bevacizumab in recurrent glioblastoma multiforme. Expert Opin Pharmacother 2011; 12:825-33. [DOI: 10.1517/14656566.2011.566558] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Baggott CR, Dodd M, Kennedy C, Marina N, Matthay KK, Cooper B, Miaskowski C. An evaluation of the factors that affect the health-related quality of life of children following myelosuppressive chemotherapy. Support Care Cancer 2011; 19:353-61. [PMID: 20157746 PMCID: PMC2909452 DOI: 10.1007/s00520-010-0824-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 01/18/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE The purposes of this study, in children who were assessed 1 week after the administration of myelosuppressive chemotherapy were: to compare the total and subscale scores on a generic measure of health-related quality of life (HRQOL) to normative data from healthy children and describe the relationships between demographic, clinical, and symptom characteristics of children with cancer and generic and disease-specific dimensions of HRQOL. METHODS Patients (n = 61) were predominantly male (52.5%), minority (63.9%), and 14.7 years of age. Children completed the Memorial Symptom Assessment Scale for 10- to 18-year olds, the PedsQL™ Generic and Cancer Modules, and the Karnofsky Performance Status (KPS) scale 1 week after the start of a chemotherapy cycle. RESULTS The mean number of symptoms per patient was 10.6. Compared with the normative sample, children with cancer reported significantly lower scores for the total scale and all of the subscales except emotional and social functioning. No significant differences were found between any demographic characteristics and total or subscale scores on the generic or disease-specific measures of HRQOL. Lower KPS scores were associated with poorer generic and disease-specific HRQOL scores. In addition, a higher number of symptoms was associated with poorer generic and disease-specific HRQOL scores. Finally, higher symptom distress scores were associated with poorer generic and disease-specific HRQOL scores. CONCLUSION Among the demographic, clinical, and symptom characteristics studied, poorer functional status and higher symptom burden were associated with significant decreases in HRQOL in children who received myelosuppressive chemotherapy.
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Affiliation(s)
- Christina R Baggott
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA 94143, USA.
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Sung L, Yanofsky R, Klaassen RJ, Dix D, Pritchard S, Winick N, Alexander S, Klassen A. Quality of life during active treatment for pediatric acute lymphoblastic leukemia. Int J Cancer 2011; 128:1213-20. [PMID: 20473921 DOI: 10.1002/ijc.25433] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objectives of the study were to describe quality of life (QoL), identify predictors of worse QoL and examine QoL during different phases of active therapy for acute lymphoblastic leukemia (ALL). A multiinstitutional cross-sectional study was performed in children with ALL. We included children at least 2 months from diagnosis who were receiving treatment in first remission. Parents described QoL using the PedsQL 4.0 Generic Core Scales and the PedsQL 3.0 Acute Cancer Module. The 206 children on treatment for ALL had overall [median 62.5, 95% confidence interval (CI) 34.8-94.4], physical (median 62.5, 95% CI 18.8-100.0) and psychosocial (median 65.4, 95% CI 38.3-94.2) summary scores that were one to two standard deviations lower than population norms. In high-risk ALL, girls and older children had worse QoL. In standard-risk ALL, those with lower household incomes and unmarried parents had worse QoL. QoL scores were generally constant across phases of ALL therapy. Children on therapy for ALL have lower QoL compared to healthy children. Age and gender predicted QoL in high-risk ALL, whereas socioeconomics predicted QoL in standard-risk ALL. Future efforts should focus on longitudinal studies that describe QoL over time within individual patients.
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Affiliation(s)
- Lillian Sung
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
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Labar B, Suciu S, Willemze R, Muus P, Marie JP, Fillet G, Berneman Z, Jaksic B, Feremans W, Bron D, Sinnige H, Mistrik M, Vreugdenhil G, De Bock R, Nemet D, Gilotay C, Amadori S, de Witte T. Dexamethasone compared to prednisolone for adults with acute lymphoblastic leukemia or lymphoblastic lymphoma: final results of the ALL-4 randomized, phase III trial of the EORTC Leukemia Group. Haematologica 2010; 95:1489-95. [PMID: 20378563 DOI: 10.3324/haematol.2009.018580] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Corticosteroids are a standard component of the treatment of acute lymphoblastic leukemia and lymphoblastic lymphoma. Our aim was to determine whether dexamethasone results in a better outcome than prednisolone. DESIGN AND METHODS Adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma were randomized to receive, as part of their induction therapy on days 1-8 and 15-22, either dexamethasone 8 mg/m(2) or prednisolone 60 mg/m(2). Those who reached complete remission were given two courses of consolidation therapy with high-dose cytarabine and mitoxantrone and methotrexate and asparaginase. Subsequently patients younger than 50 years, with a suitable donor, were to undergo allogeneic stem cell transplantation, whereas the others were planned to receive either an autologous stem cell transplant or high-dose maintenance chemotherapy with prophylactic central nervous system irradiation. Randomization was done with a minimization technique. The primary endpoint was event-free survival and the analyses was conducted on an intention-to-treat basis. RESULTS Between August 1995 and October 2003, 325 patients between 15 to 72 years of age were randomized to receive either dexamethasone (163 patients) or prednisolone (162 patients). After induction and the course of first consolidation therapy, 131 (80.4%) patients in the dexamethasone group and 124 (76.5%) in the prednisolone group achieved complete remission. No significant difference was observed between the two treatment groups with regards to 6-year event-free survival rates (+/-SE) which were 25.9% (3.6%) and 28.7% (3.5%) in the dexamethasone and prednisolone groups, respectively (P=0.82, hazard ratio 0.97; 95% confidence interval, 0.75-1.25). Disease-free survival after complete remission was also similar in the dexamethasone and prednisolone groups, the 6-year rates being 32.3% and 37.5%, respectively (hazard ratio 1.03; 95% confidence interval 0.76-1.40). The 6-year cumulative incidences of relapse were 49.8% and 53.5% (Gray's test: P=0.30) while the 6-year cumulative incidences of death were 18% and 9% (Gray's test: P=0.07). CONCLUSIONS In the ALL-4 trial in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma, treatment with dexamethasone did not show any advantage over treatment with prednisolone.
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Affiliation(s)
- Boris Labar
- Department of Hematology University Hospital Center Rebro, Kispatic street 12 1000 Zagreb, Croatia.
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Varni JW, Limbers CA. The pediatric quality of life inventory: measuring pediatric health-related quality of life from the perspective of children and their parents. Pediatr Clin North Am 2009; 56:843-63. [PMID: 19660631 DOI: 10.1016/j.pcl.2009.05.016] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health-related quality of life (HRQOL) has been recognized as an important outcome, some contend the most important outcome for children's health care interventions. The PedsQL Measurement Model was designed as a modular approach to measuring pediatric health-related quality of life, developed to integrate the relative merits of generic and disease-specific approaches. We suggest that part of the process of improving the quality of health care includes measuring HRQOL outcomes from the perspective of children and their parents on a routine basis, consistent with a consumer-based health care system approach.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Texas A&M University, College Station, TX 77843, USA.
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