Health-Related Quality of Life in Pediatric Patients with Leukemia in Singapore: A Cross-Sectional Pilot Study

Health-related quality of life of children with developmental disabilities in Singapore and associated factors: A broad-based examination

The study investigates the health-related quality of life (HRQoL) of elementary-aged children with developmental disabilities in Singapore, focusing on the influences of individual and family factors. Data from 113 students from special education schools was examined, with data collected from parents, teachers, and direct assessments of the children. The Pediatric Quality of Life Inventory (PedsQL) was used to measure HRQoL across four domains: physical, emotional, social, and school functioning. Results showed that children with developmental disabilities generally experience lower HRQoL compared to typically developing peers, with the social functioning domain presenting the greatest challenges. Executive functioning difficulties emerged as the most significant predictor of overall HRQoL, affecting all domains, particularly social and school functioning. Parental psychological well-being was also significantly associated with children's emotional functioning, highlighting the broader influence of family factors on children's well-being. This study contributes to the literature by examining a broad-based sample in a multicultural Asian context. Results underscores the importance of addressing both child-specific challenges, such as executive functioning, and family-centered interventions to improve parental mental wellbeing. In the pursuit of positive quality of life for children with developmental disabilities across multiple domains, this study's findings highlight the need for a multi-component approach. Limitations and future directions, including the use of proxy reports and the need for culturally relevant interventions, are discussed.

Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore

Introduction

Childhood cancer survivors (CCS) are at risk of experiencing psychological distress years after completing cancer treatments. We aimed to assess the prevalence and associated risk factors affecting psychological distress and health-related quality of life (HRQOL) among CCS in Singapore, and compare with their siblings without a history of or existing cancer as control.

Method

We recruited 143 young adult CCS aged ≥18 years attending survivorship clinics at KK Women's and Children's Hospital in Singapore who were in remission for ≥5 years and treatment-free for ≥2 years, and 57 siblings. CCS and siblings were matched at a 1:1 ratio based on sociodemographic factors yielding 46 pairs for comparison. Among CCS participants, 79 (55.2%) were male, 86 (60.1%) had leukaemia, 29 (20.3%) had solid tumours, 15 (10.5%) had lymphoma and 13 (9.1%) had brain tumours. All participants completed the Brief Symptom Inventory-18 (BSI-18) and Medical Outcomes Short Form-36 (MOS SF-36) questionnaires from August 2021 to July 2022.

Results

There were 35 (24.5%) CCS who reported psychological distress in the BSI-18 Global Severity Index. Five (3.5%) and 31 (21.7%) CCS reported low HRQOL in the physical and mental composite scores, respectively. Mean scores between CCS and their siblings were not statistically significant across all domains of the BSI-18 and MOS SF-36. Associated risk factors for psychological distress and low HRQOL among CCS were history of psychiatric illness after cancer diagnosis and mood affected by the COVID-19 pandemic.

Conclusion

CCS reported significant psychological distress and low HRQOL although they were not statistically different from their siblings. A holistic and risk factor-centric follow-up programme can aid early detection and mitigation of psychological late effects for CCS and their families.

Health related quality of life in pediatric hematological malignancies patients and survivors: A meta-analysis of comparative studies

BACKGROUND

Pediatric patients with hematologic malignancies (HM) and survivors are at high risk for numerous negative effects including decreased health-related quality of life (HRQOL). In order to understand the association between HM and QOL, we conducted this meta-analysis to systematically compare QOL between pediatric HM patients and survivors and controls.

METHOD

The PubMed, EMBASE, Web of Science and the Cochrane Library databases were systematically searched. Data were analyzed using the random-effects model.

RESULTS

Of 6586 unique articles identified, 30 were included in this meta-analysis. Studies described 12 different HRQOL tools. Different QOL measures varied in their association with quality of life. When compared with Non-HM group, the Pediatric Quality of Life Inventory (PedsQL) has a moderate effect size (standard mean difference, SMD = 0.50, 95% CI: 0.32, 0.68; P < 0.001). When compared with health controls, it has a large effect size (SMD = -1.00, 95% CI: -1.47, -0.53; P < 0.001). In addition, Health utilities index mark (HUI), and the Pediatric Oncology Quality of Life Scale (POQOLS) have a large (SMD = -0.81, 95% CI: -1.29, -0.33; P = 0.001) and a small (SMD = -0.10, 95% CI: -0.42, 0.22; P = 0.534) effect sizes when comparing overall controls.

CONCLUSION

Pediatric HM patients and survivors had lower QOL compared with healthy controls and higher QOL compared with Non-HM controls in most domains. Considering the negative impact of poor QOL on daily life and functional outcomes, future research should focus on proposing effective measures to improve QOL of this population.

Cognitive behavioral therapy for anxiety and depression in cancer survivors: a meta-analysis

This study aimed to investigate the effects of cognitive behavioral therapy (CBT) on anxiety and depression in cancer survivors. The PubMed, Embase, PsycINFO, and Cochrane Library databases were searched. Randomized controlled trials that evaluated the effects of CBT in cancer survivors were included. The standardized mean difference (SMD) was used as an effect size indicator. Fifteen studies were included. For the depression score, the pooled results of the random effects model were as follows: pre-treatment versus post-treatment, SMD (95% confidence interval [CI]) = 0.88 (0.46, 1.29), P < 0.001; pre-treatment versus 3-month follow-up, 0.83 (0.09, 1.76), P = 0.08; pre-treatment versus 6-month follow-up, 0.92 (0.27, 1.58), P = 0.006; and pre-treatment versus 12-month follow-up, 0.21 (- 0.28, 0.70), P = 0.40. For the anxiety score, the pooled results of the random effects model were as follows: pre-treatment versus post-treatment, 0.97 (0.58, 1.36), P < 0.001; pre-treatment versus 3-month follow-up, 1.45 (- 0.82, 3.72), P = 0.21; and pre-treatment versus 6-month follow-up, 1.00 (0.17, 1.83), P = 0.02). The pooled result of the fixed effects model for the comparison between pre-treatment and the 12-month follow-up was 0.10 (- 0.16, 0.35; P = 0.45). The subgroup analysis revealed that the geographical location, treatment time and treatment form were not sources of significant heterogeneity. CBT significantly improved the depression and anxiety scores of the cancer survivors; such improvement was maintained until the 6-month follow-up. These findings support recommendations for the use of CBT in survivors of cancer.

The psychological, psychosocial and emotional wellbeing of children and young people with leukaemia

BACKGROUND

Leukaemia is the most common childhood cancer, and with the success of current treatment, it has an overall survival rate of up to 92%. Despite this, treatment does not come without consequences. As a result, it is no surprise that recent research has examined the long-term implications of this treatment.

METHODS

An integrative review was conducted to capture a broad range of primary research studies from both quantitative and qualitative perspectives. Four electronic databases were searched, displaying 3239 articles, of which nine met all the inclusion criteria. This integrative review explores these studies, using thematic analysis, with the purpose of identifying the impact this disease has on the psychological, psychosocial and emotional wellbeing of children and young people (CYP) diagnosed with leukaemia.

RESULTS

The review highlighted the vast impact that a leukaemia diagnosis can have on CYP and five main trends emerged: experienced emotions; relationships with peers; relationships with family; academic challenges; and differentiating factors.

DISCUSSION

As a result of the findings, it is recommended that CYP receive psychological support from diagnosis, with a regular reassessment throughout treatment. Parents and carers require support to enable them to efficiently care for their children. It is evident from this review that further research in this area would be beneficial to address some gaps in the literature.

Adverse experiences of social adaptation in children with leukaemia: a qualitative study from China

AIM AND OBJECTIVE

This study aimed to build an indepth and comprehensive understanding of the social maladaptation experience of Chinese children with leukaemia of different ages.

METHODS

The purposive sampling method was adopted to conduct semistructured interviews with 20 Chinese children with leukaemia or their main caregivers and Colaizzi's method for qualitative research was used to organise and analyse the data. The study followed the guiding principles of the Standards for Reporting Qualitative Research.

RESULTS

The existing social adaptation problems of children with leukaemia of different ages were assessed. In terms of psychological maladjustment, children with leukaemia aged 2-7 years showed fear and excessive attachment, while children aged 8-18 years were characterised by impatience, irritability and anxiety. In terms of behavioural maladjustment, children aged 2-7 years presented less independent behaviour and dependence on electronics, while children aged 8-18 years showed learning obstruction and indulgence in mobile games.

CONCLUSIONS

Targeted intervention strategies should be developed based on the physical and mental characteristics of children with leukaemia of different ages to improve existing social adaptation problems.

RELEVANCE TO CLINICAL PRACTICE

Early intervention for social adaptation of children with leukaemia should be considered. Children's social adaptation should be improved to prevent more adaptation problems so that they can return to their families and to the society without difficulty and improve their quality of life in the long term.

Social adjustment across the lifespan in survivors of pediatric acute lymphoblastic leukemia (ALL): a systematic review

PURPOSE

The objectives of this review were to (1) summarize studies that described social adjustment in survivors of pediatric ALL across the lifespan, (2) summarize social adjustment outcomes reported across studies, and (3) examine associations between social adjustment and disease/treatment- and non-treatment-related factors.

METHODS

Searched databases included EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (EBSCO Information Services), and Web of Science (Thomson Reuters). Eligible studies included: (1) original research; (2) published in English; (3) a diagnosis of cancer between 0 and 21 years; (4) survivors at least 5 years from diagnosis and/or 2 years from therapy completion; and (5) quantitative assessment of social adjustment.

RESULTS

The literature search yielded 3698 articles of which 43 were included in the final review. Risk of bias was assessed using domains adapted from the Cochrane risk-of-bias tool. Quality of evidence was evaluated following the Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. There was some evidence that school-aged and adolescent/young adult survivors experienced worse social adjustment compared to controls. There was some evidence suggesting cranial radiation therapy (CRT) is associated with social adjustment difficulties among young adult survivors. Inconsistent evidence was found for relapse, age at diagnosis and study, sex, and late effects in relation to social adjustment.

CONCLUSION

Survivors of pediatric ALL were at higher risk of social adjustment difficulties compared to controls. However, evidence for treatment and non-treatment risk and resilience factors require stronger evidence.

IMPLICATIONS FOR CANCER SURVIVORS

Information on modifiable factors that modulate social adjustment may influence targets of intervention and follow-up guidelines.

Social adjustment in survivors of acute lymphoblastic leukemia without cranial radiation therapy

OBJECTIVE

To evaluate group differences in social adjustment in survivors of pediatric acute lymphoblastic leukemia (ALL) compared to survivor siblings and controls; identify disease-related predictors of social adjustment in survivors; and explore whether executive functioning explained differences in social adjustment across groups and between disease-related predictors.

METHODS

Survivors of pediatric ALL (n = 38, average age at diagnosis = 4.27 years [SD = 1.97]; average time off treatment = 4.83 years [SD = 1.52]), one sibling (if available, n = 20), and one parent from each family were recruited from a long-term survivor clinic. Healthy age- and sex-matched controls (n = 38) and one parent from each family were recruited from the community. Parents completed the Behavioral Assessment System for Children, Parent Rating Scale (BASC-3) Social Withdrawal subscale as a measure of social adjustment, and the Behavior Rating Inventory of Executive Functions (BRIEF-2) as a measure of executive function for each of their children. Multilevel modeling and mediation analysis were used to achieve the study aims.

RESULTS

Parents reported that survivors had significantly worse social adjustment compared to controls (b = 6.34, p = .004), but not survivor siblings. Among survivors, greater time off treatment (b = 2.06, p = .058) and poorer executive functioning (b = 0.42, p = .006) were associated with worse social adjustment. Executive function did not mediate differences in social withdrawal between survivors and controls or the relationship between time off treatment and social withdrawal among survivors.

CONCLUSIONS

Survivors of pediatric ALL presenting to follow-up programs should be screened for difficulties with social adjustment. Future research should examine treatment- and nontreatment-related factors contributing to poorer social outcomes.

The Quality of Life and Influencing Factors in Turkish Children Receiving Cancer Treatment

PURPOSE

This study was conducted to determine the quality of life and the influencing factors in children aged 8-12 years who are treated for cancer in Turkey.

DESIGN AND METHODS

The cross-sectional and descriptive study was conducted on 300 children with cancer and their parents. The data were collected using the Questionnaire Form and the Pediatric Quality of Life Inventory PedsQL (4.0) Child and Parent Form. Descriptive statistics, the independent t-test, univariate and multiple binary logistic regression analysis were used for the evaluation.

RESULTS

The mean age of the children was 8.92 ± 0.98 years and the quality of life scores in all sub-dimensions and in total (36.26 ± 5.23) were found to be low. According to the univariate binary logistic regression analysis, the father being unemployed, the house being heated with a stove, and development of extravasation during the chemotherapy treatment process created a risk of decreasing the children's quality of life score (7.15 units, 41.29 units, and 44.47 units, respectively) (p < 0.05).

CONCLUSIONS

The father's unemployment, heating the house with a stove, and the development of extravasation during treatment were found to affect the children's quality of life negatively in the study. Inter-institutional cooperation, taking the necessary measures to decrease the frequency of extravasation development, and ensuring nurses continue family-centered care during these processes are recommended to support the families.

PRACTICE IMPLICATIONS

Interventions for early detection and prevention of the negative changes related to the quality of life in children with cancer need to be planned.

Health-Related Quality of Life of Nurses Caring for Hospitalised Children and Their Families: A National Cross-Sectional Study

PURPOSE

Health-related quality of life (HRQoL) continues to be understudied among nurses in developing countries. This study aimed to assess (1) the HRQoL of nurses in Malawi caring for hospitalised children and their families, and (2) the nurses' demographic characteristics associated with their HRQoL.

DESIGN AND METHODS

The cross-sectional study was carried out at 23 hospitals in Malawi, and 203 nurses participated, resulting in a 96% response rate. The Medical Outcomes Study 36-Item Short Form Health Survey was used to collect data. The physical and mental health component scores were evaluated and compared with those in a Cyprus study as the population norm. Both univariate and multivariate analyses were performed, with the significance level set at 0.05.

RESULTS

The nurses' HRQoL was moderately impaired; however, the mean scores of both the physical and the mental health components of the nurses in the Cyprus study were statistically lower than those of the Malawian nurses (t = 36.541, p < 0.001 and t = 19.477, p < 0.001, respectively). Age was independently associated with a better physical health status (β = 29.949, p = 0.038), while female nurses were more likely to report a negative physical health status compared with male nurses (β = -97.481, p = 0.002).

CONCLUSION

The findings suggested that the Malawian nurses were affected by work-related stress, which affected their mental and physical health status. The current findings represent preliminary data, and as such further studies on the association between work-related factors and HRQoL are needed.

PRACTICE IMPLICATIONS

Knowledge of HRQoL from the perspective of nurses can help healthcare organisations to develop interventions to limit the negative impacts of work-related stress on nurses caring for children.

French-language adaptation of the 16D and 17D Quality of Life measures and score description in two Canadian pediatric samples

PURPOSE

The Health state descriptive system includes standardized self-administered instruments for measuring Health-Related Quality of Life (HRQoL) respectively among adolescents, and children. The objectives of the current study were: (1) to translate and adapt the pediatric-adolescent version 16D and 17D from English into French (Canada), (2) to demonstrate their feasibility in pediatric conditions.

METHODS

The translation methodology combined forward and back translations, and cognitive debriefing with eight adolescents and eight children. Four bilingual translators were involved in the process. We administered the translated versions to two clinical samples, being treated for Primary immunodeficiency (PID, n = 48, aged 14.1 years, 20 girls), and having recovered from pediatric Acute Lymphoblastic Leukemia (ALL, n = 153, aged 14.7 years, 77 girls).

RESULTS

Cognitive debriefing indicated that that the instructions, items, and response options were clear, easy to understand, and easy to answer. Adjustments were made for clarity. Translated versions were highly usable (measurement completion >90%). HRQoL levels were high for both samples (range 0.85-0.96). Participants reported lower levels if they were adolescents, particularly if they were girls. Older boys with PID reported a lower HRQoL than their counterparts with a history of ALL. PID and ALL patients mainly reported issues with discomfort and pain, concentration/learning, physical appearance, and psychological distress and sleeping, although to a different degree.

CONCLUSION

The French-language versions of the 16D and 17D are easy to administer and may be used to identify problematic domains. Greater availability of translated versions of short evaluation tools may facilitate broader uptake of screening practices in pediatric care.

The effects of acceptance and commitment therapy on the psychological and physical outcomes among cancer patients: A meta-analysis with trial sequential analysis

OBJECTIVE

The current study used meta-analysis and trial sequential analysis to estimate the effects of Acceptance and Commitment Therapy (ACT) on the psychological and physical distress of cancer patients, and to identify potential moderators in this body of research.

METHODS

A search of multiple databases in February 2020 identified 25 independent trials (17 randomized controlled trials, 8 non-randomized controlled trials; 2256 participants) on the effects of ACT among cancer patients. Trial sequential analysis (TSA) was used to determine whether the available evidence is sufficient to draw strong conclusions.

RESULTS

ACT significantly reduced cancer patients' psychological distress (g = 0.88), and improved psychological flexibility (g = 0.58), quality of life (g = 1.19), and sense of hope (g = 2.17). TSA showed that there was sufficient evidence to obtain stable estimates of the effect of ACT on psychological distress and quality of life. Effect sizes for psychological distress were larger in studies conducted in eastern countries, in younger samples, and when therapy was of longer duration.

CONCLUSION

Acceptance and Commitment Therapy can effectively improve the mental health of cancer patients, and can be applied to clinical practice as an effective psychological intervention. Researchers are encouraged to take into account stage and trajectory of cancer in future studies.

New Technologies to Improve Pain, Anxiety and Depression in Children and Adolescents with Cancer: A Systematic Review

Pain, anxiety, or depression are very prevalent in children and adolescents with cancer, which is a great challenge for health professionals. Several studies pointing out the positive effect of technology on the management of symptoms have been published in recent years. Considering these studies is important in order to reduce the negative impact on the quality of life of this population. This study aimed to analyze the available evidence and to describe the benefits of the new technologies in the treatment of pain, anxiety, and depression in children and adolescents with cancer. A systematic search using six electronic databases was conducted to identify studies using technological interventions with a focus on pain, anxiety, and depression that were published from 2008 to 2018 including oncology patients from 0-18 years old. Out of the 1261 studies that were identified, five studies met the inclusion criteria for this systematic review. Robots were used in two studies, providing amusement and social interventions that showed significant improvements. Virtual reality, a mobile application, and a videogame were used in three studies and obtained beneficial results in pain and anxiety. The studies included in this review suggest that new technologies can be used as an innovative form of non-pharmacological intervention with therapeutic benefits.

Global mapping of interventions to improve quality of life of patients with depression during 1990-2018

PURPOSE

The number of patients with depressive disordered globally increased and affects people of all ages and countries and has a significant and negative impact on the quality of life (QoL). Depression if left untreated may lead to severe consequences. However, there are several types of effective treatments, but often patients need support from health staff to find suitable treatments. This study aims to examine the global trend of the publications as well as the development of interventions for depressing treatment.

METHODS

We download and analyzed 15,976 scientific research from the Web of Science from 1990 to 2018. A text mining based on Latent Dirichlet and terms' co-occurrence in titles and abstracts to identify hidden research topics and research landscapes.

RESULTS

We found that the number of papers related to non-pharmacological treatment (such as cognitive-behavioral, mindfulness, or family and social support) to improve the QoL of patients with depression has increased. The number of papers on this serious health issue in low-middle income countries (LMICs) was not as high as in high-income countries (HICs).

CONCLUSION

It is necessary to increase support of the treatment of depression in LMICs as well as applied non-pharmacological interventions to patients with depression.

Psychological Considerations in Pediatric Chronic Illness: Case Examples

Despite significant gains in survival rates for pediatric patients and adolescents/young adults (AYA) with chronic illness, patients in this vulnerable age group are also at an increased risk for developing one or more adverse effects related to their disease, treatment, or maladaptive health behaviors. Maladaptive health behaviors ultimately increase the risk for developing adverse effects, including: increased rates of morbidity and mortality, impaired physical functioning, increased fatigue, obesity, increased psychological distress, and poor quality of life. With close attention including participation in preventive and therapeutic health promotion interventions, problematic health behaviors can be mitigated and ultimately prevented over time. It is well known that improved psychological functioning and adaptive coping can result in improved health status. The present paper provides four case examples illustrating various psychological interventions in pediatric chronic illness. As evidenced in the four case examples, pediatric psychologists provide comprehensive interventions for patients with acute and chronic medical conditions through the use of health promotion interventions, adherence and self-management promotion, cognitive behavioral therapy, behavioral therapy, medical coping, parent training, and motivational interviewing. Our case series demonstrates that for the most impactful behavior change to occur, a combination of interventions is often the most effective.

Factors associated with quality of life of adult patients with acute leukemia and their family caregivers in China: a cross-sectional study

Background

Acute leukemia (AL) not only impairs the quality of life (QOL) of patients, but also affects that of their family caregivers (FCs). Studies on QOL of AL patients and their FCs are limited. This study aimed to evaluate the QOL of AL patients and their FCs, and to explore the factors associated with QOL of patients and of FCs.

Methods

A multicenter cross-sectional study was conducted. The QOL of 196 patient–FC dyads was assessed. The Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) was used for patients, and the 36-item Short-Form Health Survey (SF-36) was used for FCs. Independent-samples t-tests or one-way analysis of variance were used to compare QOL subscale scores between groups with different sociodemographic/clinical characteristics. Multiple regression analysis was conducted to identify the factors associated with QOL of AL patients and their FCs.

Results

The total FACT-Leu score for AL patients was 76.80 ± 16.44, and the physical component summary (PCS) and mental component summary (MCS) scores for FCs were 64.67 ± 15.44 and 52.50 ± 13.49, respectively. All QOL subscales for patients (t = 12.96–34.73, p < 0.001) and FCs (t = 2.55–14.36, p < 0.05), except role emotional (t = − 0.01, p = 0.993), were lower than those reported in previous studies. Sex, employment, and chemotherapy were significantly associated with total FACT-Leu score in AL patients (p < 0.05). Age, sex, marital status, education, employment, and relationship to patients were significantly associated with SF-36 PCS or MCS (p < 0.05).

Conclusions

AL patients and their FCs both have lower QOL than the population in previous studies. These findings suggest that not only AL patients’ physical and mental health but also overall family QOL should be assessed. Interventions supporting patient–FC dyads should be developed to improve their QOL.