Patient-reported quality of life in adolescents and young adults with cancer who received radiation therapy

Abstract

Background: Radiation therapy (RT) is a common treatment for adolescents and young adults (AYAs, 15-39 years old) with cancer; however, it may cause toxicities that affect health-related quality-of-life (HRQOL). Thus, we assessed HRQOL in AYAs before, during, and after RT.

Methods: We identified 265 AYAs who completed HRQOL PROMIS® surveys before (n = 87), during (n = 84), or after (n = 94) RT. Higher PROMIS® score represents more of the concept. Mean scores were compared to the general US population and minimally important differences (MIDs) were used to evaluate the impact of cancer on HRQOL. Linear regression modeling was used to evaluate the effect of clinical and demographic factors on PROMIS scores.

Results: Median [IQR] age was 26 [20-31] years. Cancer types varied; most had sarcoma (26%) or CNS malignancy (23%). Compared to the general US population, the before RT cohort had worse anxiety (mean score 55.2 vs. 50, MID 3, p < 0.001) and the during RT cohort had worse global physical health (mean score 44.9 vs. 50, MID 5, p < 0.001). In the during RT cohort, patients with regional/distant disease had significantly worse pain (B = 15.94, p < 0.01) and fatigue (B = 14.20, p = 0.01) than patients with localized disease. In the after RT cohort, adolescents (15-18 years) and young adults (26-39 years) had worse global physical health (B = -6.87, p < 0.01, and B = -7.87, p < 0.01, respectively) and global mental health (B = -6.74, p < 0.01, and B = -5.67, p = 0.01, respectively) than emerging adults (19-25 years).

Conclusions: AYAs with cancer receiving RT experience impairments in various domains of HRQOL. Advanced cancer stage may contribute to poorer short-term HRQOL and developmental stage may contribute to differing long-term HRQOL.

Keywords: adolescents and young adults; cancer; health-related quality of life; patient-reported outcomes; radiation therapy.

FIGURE 1

Violin plots to indicate distribution of PROMIS health‐related quality of life scores in the (A) before, (B) during, and (C) after RT cohorts. Higher score indicates better function for global physical health, global mental health, social roles, and cognitive function. Higher score indicates worse function for pain interference, fatigue, sleep disturbance, anxiety, and depression. Black solid line indicates median score. Black dotted lines indicate 25% and 75% quartile scores. Red dotted line indicates the score threshold for mild (social roles [45], cognitive function [45], pain [55], fatigue [55], sleep disturbance [55], anxiety [55], and depression [55]) or fair (global physical health [42], global mental health [40]) or worse severity as established by T‐score distribution maps. PROMIS, Patient‐Reported Outcomes Measurement Instrument System®.

FIGURE 2

PROMIS health‐related quality of life scores with linear regression significant relationship that demonstrate meaningful clinical impact in the (A) during and (B) after RT cohorts. Black solid line indicates mean score. Higher score indicates better function for global physical health and global mental health. Higher score indicates worse function for fatigue and pain interference. RT, Radiation therapy; PROMIS, Patient‐Reported Outcomes Measurement Instrument System®.