TY - JOUR
T1 - Longitudinal analysis of quality-of-life outcomes in children during treatment for acute lymphoblastic leukemia
T2 - A report from the Children's Oncology Group AALL0932 trial
AU - Zheng, Daniel J.
AU - Lu, Xiaomin
AU - Schore, Reuven J.
AU - Balsamo, Lyn
AU - Devidas, Meenakshi
AU - Winick, Naomi J.
AU - Raetz, Elizabeth A.
AU - Loh, Mignon L.
AU - Carroll, William L.
AU - Sung, Lillian
AU - Hunger, Stephen P.
AU - Angiolillo, Anne L.
AU - Kadan-Lottick, Nina S.
N1 - Funding Information:
Supported by grants from the National Institutes of Health to the Children’s Oncology Group, including U10CA98543 (Chair’s Grant), U10CA180886 (National Clinical Trials Network Group Operations Center Grant), U10CA180899 (National Clinical Trials Network Statistics and Data Center), and UG1CA189955 (Community Oncology Research Program Grant for Cancer Control Studies); a Community Clinical Oncology Research Program grant (U10CA095861) from the Division of Cancer Prevention at the National Cancer Institute to the Children’s Oncology Group; and a grant from the St. Baldrick’s Foundation.
Funding Information:
Daniel J. Zheng received funding from a Yale Medical Student 1-year research fellowship for work performed as part of the current study. Reuven J. Schore received grants and nonfinancial support from the Children’s Oncology Group/National Institutes of Health for work performed as part of the current study; grants from Amgen, Merck Sharp & Dohme Corporation, Takeda Pharmaceuticals International, and the National Cancer Institute for work performed outside of the current study; and personal fees and nonfinancial support from Baxalta Incorporated and Shire Pharmaceuticals for work performed outside of the current study.
Funding Information:
Daniel J. Zheng received funding from a Yale Medical Student 1-year research fellowship for work performed as part of the current study. Reuven J. Schore received grants and nonfinancial support from the Children's Oncology Group/National Institutes of Health for work performed as part of the current study; grants from Amgen, Merck Sharp & Dohme Corporation, Takeda Pharmaceuticals International, and the National Cancer Institute for work performed outside of the current study; and personal fees and nonfinancial support from Baxalta Incorporated and Shire Pharmaceuticals for work performed outside of the current study. Supported by grants from the National Institutes of Health to the Children's Oncology Group, including U10CA98543 (Chair's Grant), U10CA180886 (National Clinical Trials Network Group Operations Center Grant), U10CA180899 (National Clinical Trials Network Statistics and Data Center), and UG1CA189955 (Community Oncology Research Program Grant for Cancer Control Studies); a Community Clinical Oncology Research Program grant (U10CA095861) from the Division of Cancer Prevention at the National Cancer Institute to the Children's Oncology Group; and a grant from the St. Baldrick's Foundation.
Publisher Copyright:
© 2017 American Cancer Society
PY - 2018/2/1
Y1 - 2018/2/1
N2 - BACKGROUND: Children with average-risk acute lymphoblastic leukemia (AR-ALL) face many challenges that can adversely affect their quality of life (QOL). However, to the authors' knowledge, patterns and predictors of QOL impairment during therapy have not been well characterized to date. METHODS: Patients with AR-ALL who were enrolled on the Children's Oncology Group AALL0932 trial were offered participation in this prospective cohort study if they were aged ≥4 years at the time of diagnosis and had an English-speaking parent. At approximately 2 months, 8 months, 17 months, 26 months, and 38 months (boys only) after diagnosis, parents completed the Pediatric Quality of Life Inventory Generic Core Scales Version 4.0 (PedsQL4.0) and McMaster Family Assessment Device instruments for QOL (physical, emotional, and social functioning) and family functioning, respectively. The proportions of individuals scoring in the impaired range (2 standard deviations below the population mean) were calculated at each time point. Longitudinal impairment patterns and predictors were examined. RESULTS: A total of 594 participants with AR-ALL were diagnosed at a mean age of 6.0 years (standard deviation, 1.6 years). At 2 months, a substantial proportion of participants had impaired scores for physical (36.5%; 95% confidence interval [95% CI], 32.3%-40.8%) and emotional (26.2%; 95% CI, 22.5%-30.2%) functioning compared with population norms of 2.3%. These elevations persisted at 26 months. Emotional impairment at 2 months (odds ratio, 3.4; 95% CI, 1.5-7.7) was found to significantly predict emotional impairment at 26 months. In repeated measures analysis with multivariate modeling, unhealthy family functioning (odds ratio, 1.5; 95% CI, 1.1-2.1) significantly predicted emotional impairment controlling for age and sex. QOL outcomes were similar between sexes at the end of therapy (26 months for girls and 38 months for boys). CONCLUSIONS: Many children with AR-ALL experience physical and emotional functioning impairment that begins early in treatment and persists. Early screening may identify high-risk patients who might benefit from family-based interventions. Cancer 2018;124:571-9.
AB - BACKGROUND: Children with average-risk acute lymphoblastic leukemia (AR-ALL) face many challenges that can adversely affect their quality of life (QOL). However, to the authors' knowledge, patterns and predictors of QOL impairment during therapy have not been well characterized to date. METHODS: Patients with AR-ALL who were enrolled on the Children's Oncology Group AALL0932 trial were offered participation in this prospective cohort study if they were aged ≥4 years at the time of diagnosis and had an English-speaking parent. At approximately 2 months, 8 months, 17 months, 26 months, and 38 months (boys only) after diagnosis, parents completed the Pediatric Quality of Life Inventory Generic Core Scales Version 4.0 (PedsQL4.0) and McMaster Family Assessment Device instruments for QOL (physical, emotional, and social functioning) and family functioning, respectively. The proportions of individuals scoring in the impaired range (2 standard deviations below the population mean) were calculated at each time point. Longitudinal impairment patterns and predictors were examined. RESULTS: A total of 594 participants with AR-ALL were diagnosed at a mean age of 6.0 years (standard deviation, 1.6 years). At 2 months, a substantial proportion of participants had impaired scores for physical (36.5%; 95% confidence interval [95% CI], 32.3%-40.8%) and emotional (26.2%; 95% CI, 22.5%-30.2%) functioning compared with population norms of 2.3%. These elevations persisted at 26 months. Emotional impairment at 2 months (odds ratio, 3.4; 95% CI, 1.5-7.7) was found to significantly predict emotional impairment at 26 months. In repeated measures analysis with multivariate modeling, unhealthy family functioning (odds ratio, 1.5; 95% CI, 1.1-2.1) significantly predicted emotional impairment controlling for age and sex. QOL outcomes were similar between sexes at the end of therapy (26 months for girls and 38 months for boys). CONCLUSIONS: Many children with AR-ALL experience physical and emotional functioning impairment that begins early in treatment and persists. Early screening may identify high-risk patients who might benefit from family-based interventions. Cancer 2018;124:571-9.
KW - acute lymphoblastic leukemia
KW - emotional functioning
KW - family functioning
KW - health-related quality of life
KW - pediatric
UR - http://www.scopus.com/inward/record.url?scp=85040821349&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040821349&partnerID=8YFLogxK
U2 - 10.1002/cncr.31085
DO - 10.1002/cncr.31085
M3 - Article
C2 - 29112230
AN - SCOPUS:85040821349
SN - 0008-543X
VL - 124
SP - 571
EP - 579
JO - Cancer
JF - Cancer
IS - 3
ER -