title: 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.
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.
authors.affiliation: Department of Pediatric Hematology & Oncology, Yale University School of Medicine, New Haven, CT.
authors.forename: Hannah-Rose
authors.initials: HR
authors.lastname: Mitchell
authors.affiliation: Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainsville, FL.
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Regina M
authors.initials: RM
authors.lastname: Myers
authors.affiliation: Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
authors.affiliation: Department of Pediatric Hematology & Oncology, Yale University School of Medicine, New Haven, CT.
authors.forename: Lyn M
authors.initials: LM
authors.lastname: Balsamo
authors.affiliation: Pediatric Oncology, Cancer Institute, New York University Medical Center, New York, NY.
authors.forename: William L
authors.initials: WL
authors.lastname: Carroll
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, NY.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Raetz
authors.affiliation: Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
authors.forename: Mignon L
authors.initials: ML
authors.lastname: Loh
authors.affiliation: Department of Pediatrics, University of Michigan, Ann Arbor, MI.
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Mattano
authors.affiliation: Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, TX.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Winick
authors.affiliation: Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainsville, FL.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Devidas
authors.affiliation: Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hunger
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
authors.forename: Kelly
authors.initials: K
authors.lastname: Maloney
authors.affiliation: Department of Pediatric Hematology & Oncology, Yale University School of Medicine, New Haven, CT.
authors.forename: Nina S
authors.initials: NS
authors.lastname: Kadan-Lottick
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: acute lymphoblastic leukemia; childhood leukemia; late effects; physical functioning; quality of life