Quality of survival in children and adolescents after treatment for childhood cancer: the influence of reported late effects on health related quality of life

Abstract

Background: Considering the high survival rates of childhood cancer physical and psychosocial long term effects (LF) as well as the estimation of Quality of Life (QoL) are becoming a new focus of clinical research. Thus, disease related as well as age related variables have to be taken into account. This paper evaluates the physical long term effects of childhood cancer survivors. In addition differences of QoL of the survivors in comparison to children and adolescents of the same age are estimated if present and correlated to somatic late effects.

Patients and methods: 36 survivors of childhood cancer who are followed at the University Children's Hospital Duesseldorf, with an age range of 8-18 years participate in the evaluation. Together with a clinical examination somatic long term effects and sociodemographic information are documented. QoL is evaluated with a standardized questionnaire (PEDQOL) including the domains physical function, emotion, cognition, autonomy, social function (family, friends and body image). Quality of Life data are compared with data of 319 unselected healthy controls of comparable age groups.

Results: 24 of 36 patients show various LF: skeletal deformities, scars, impairment of organ function, infectious complication, hormonal failures. Patients with solid tumors develop more and more frequently severe LF (11/14 pat.) compared to patients with leukaemia and lymphoma (11/22 pat.). Nevertheless health status can be objectively rated as satisfying in comparison to children of the same age. Most patients rate the QoL better than their controls. Patients with severe LF show impairment in the domains body image, emotional and physical functioning and cognition compared to patients without or with minor somatic LF.

Conclusion: Our results underline the influence of objective long term effects and subjective QoL on the Quality of Survival. Prospective evaluation will lead to new and important information with respect to the onset of somatic and psychosocial LF and possible coping strategies. These information will establish additional possibilities for initiation of primary and secondary rehabilitation processes.