Health-related quality of life among child and adolescent survivors of childhood cancer

Abstract

Purpose: The main objective was to compare parent-reported health-related quality of life (HRQL) of child and adolescent survivors of childhood cancer to that of controls who had no history of cancer.

Methods: We assessed HRQL of 800 child and adolescent survivors younger than 16 years and 923 randomly selected, age- and sex-matched controls from the general population in a national multicenter retrospective cohort study using the Child Health Questionnaire parent report. Participation was 69% among survivors and 57% among controls.

Results: Survivors had means that were consistently lower than controls on the HRQL physical summary (PH; 49.9 v 55.3; P <.005), psychosocial summary (PS; 49.4 v 52.6; P < .005), and all but one of the eight subscale scores. Clinically important survivor-control differences in means on PH were found for survivors of CNS tumors, bone tumors, lymphoma, leukemia, soft tissue sarcoma and Wilms' tumor (differences: -8.7, -7.0, -6.3, -5.4, -4.4, -3.8/100, respectively); on PS, survivors of CNS tumors were most compromised (-6.1/100). Survivor-control differences in both PH and PS were also large for survivors treated with radiation only (-5.8 and -11.9/100, respectively), or radiation combined with surgery (-6.6 and -5.9/100, respectively), or radiation combined with both surgery and chemotherapy (-7.8 and -5.1/100, respectively). Cranial radiation was associated with the most compromised HRQL.

Conclusion: According to parents, HRQL for survivors was somewhat poorer, overall, than for controls. Survivors of CNS tumors, lymphoma, and leukemia and those patients treated with cranial radiation were reported to have poorest HRQL. These findings support development of guidelines for levels of follow-up care for particular groups of survivors.