Effect of dexamethasone on quality of life in children with acute lymphoblastic leukaemia: a prospective observational study.
BACKGROUND
Glucocorticoids are important in the treatment of childhood acute lymphoblastic leukaemia (ALL). However, cyclic administration of high dose glucocorticoids may cause rapid and substantial changes in quality of life (QoL). The maintenance phase of the Dutch ALL-9 protocol consisted of alternating two weeks on and five weeks off dexamethasone (6 mg/m(2)/day). The present study was performed to assess the effect of dexamethasone on QoL during treatment for ALL according to this protocol.


METHODS
In a multicentre prospective cohort study, QoL was assessed halfway (T1) and at the end of the two-year treatment (T2). A generic (Child Health Questionnaire) and disease specific (PedsQL cancer version) QoL questionnaire were used to assess QoL in two periods: on and off dexamethasone, respectively.


RESULTS
41 children (56% males) were evaluated, mean age at diagnosis was 5.6 years. The CHQ physical and psychosocial summary scores were significantly lower than population norms. At T1 and T2, overall QoL showed no significant change. However, regarding specific domains (pain, cognitive functioning, emotion/behaviour and physical functioning) QoL decreased over time. QoL was significantly more impaired during periods on dexamethasone.


CONCLUSIONS
Dexamethasone was associated with decreased QoL. At the end of treatment, reported QoL during dexamethasone deteriorated even more on certain scales (pain, cognitive functioning, emotion/behaviour and physical functioning). Knowledge of the specific aspects of QoL is essential to improve counselling and coping in paediatric oncology. Adverse effects of specific drugs on QoL should be taken into account when designing treatment protocols.
de Vries
Machteld A G
MA
Department of Paediatrics and Division of Oncology-Haematology, VU University Medical Centre, Amsterdam, The Netherlands. machteld_99@hotmail.com
van Litsenburg
Raphaële R L
RR
Huisman
Jaap
J
Grootenhuis
Martha A
MA
Versluys
A Birgitta
AB
Kaspers
Gert Jan L
GJ
Gemke
Reinoud J B J
RJ
D000293:Adolescent; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D019370:Observation; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011446:Prospective Studies; D011788:Quality of Life; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
D018931:Antineoplastic Agents, Hormonal; D003907:Dexamethasone