Prospective, longitudinal assessment of quality of life in children from diagnosis to 3 months off treatment for standard risk acute lymphoblastic leukemia: Results of Children's Oncology Group study AALL0331

Hannah Rose Mitchell, Xiaomin Lu, Regina M. Myers, Lillian Sung, Lyn M. Balsamo, William L. Carroll, Elizabeth Raetz, Mignon L. Loh, Leonard A. Mattano, Naomi J. Winick, Meenakshi Devidas, Stephen P. Hunger, Kelly Maloney, Nina S. Kadan-Lottick

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Standard risk acute lymphoblastic leukemia (SR-ALL) has high cure rates, but requires 2-3 years of therapy. We aimed to (i) prospectively evaluate health-related quality of life (HRQOL) during and after SR-ALL therapy, and (ii) identify associated predictors. Parents of 160 SR-ALL patients enrolled on Children's Oncology Group (COG) therapeutic trial AALL0331 at 31 sites completed the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales (physical, emotional and social functioning) and Family Assessment Device-General Functioning (FAD-GF) at 1, 6 and 12 months after diagnosis, and 3 months post-therapy. Mean PedsQL scores in physical, emotional and social functioning were impaired 1 month after diagnosis but steadily improved. Three months post-therapy, impaired physical and social functioning was observed in 27.8 and 25.8% of patients, respectively. In repeated-measures analysis, problematic family functioning predicted emotional (OR = 1.85, 95% CI 1.03-3.34) and social (OR = 1.99, 95% CI 1.21-3.27) impairment. Larger household size was associated with social impairment (OR = 1.21, 95% CI 1.02-1.45). Adverse neurological event(s) during therapy predicted post-therapy physical (OR = 5.17, 95% CI 1.61-16.63) and social (OR = 8.17, 95% CI 1.19-56.16) impairment. HRQOL 1 month after diagnosis was not predictive of HRQOL 3 months after therapy completion. In conclusion, children with SR-ALL experience considerable impairment in HRQOL at the end of induction, but rapidly improve. However, many still experience physical and social impairment 3 months post-therapy, suggesting a role for continued family and physical functioning support. Longer follow-up is needed to determine if post-therapy deficits change over time. What's new? More than 90 percent of children with standard-risk acute lymphoblastic leukemia (SR-ALL) survive the disease, though treatment is intense and can last as many as three years. This prospective evaluation of health-related quality of life (HRQOL) of children during and after therapy for SR-ALL shows that a significant proportion of children suffer from persistent physical and social impairment three months post-therapy. Risk factors for impairment included certain family factors and adverse neurological events experienced during therapy. Further elucidation of these predictors could help clinicians identify patients at risk for impaired HRQOL and inform interventions to improve HRQOL.

Original languageEnglish (US)
Pages (from-to)332-339
Number of pages8
JournalInternational Journal of Cancer
Volume138
Issue number2
DOIs
StatePublished - Jan 15 2016

Keywords

  • acute lymphoblastic leukemia
  • childhood leukemia
  • late effects
  • physical functioning
  • quality of life

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Mitchell, H. R., Lu, X., Myers, R. M., Sung, L., Balsamo, L. M., Carroll, W. L., Raetz, E., Loh, M. L., Mattano, L. A., Winick, N. J., Devidas, M., Hunger, S. P., Maloney, K., & Kadan-Lottick, N. S. (2016). Prospective, longitudinal assessment of quality of life in children from diagnosis to 3 months off treatment for standard risk acute lymphoblastic leukemia: Results of Children's Oncology Group study AALL0331. International Journal of Cancer, 138(2), 332-339. https://doi.org/10.1002/ijc.29708