title: Children with minimal chance for cure: parent proxy of the child's health-related quality of life and the effect on parental physical and mental health during treatment.
abstract: To assess health-related quality of life (HRQOL) from the time of diagnosis until disease progression in a cohort of children with diffuse intrinsic pontine glioma (DIPG). The assessment was collected from the perspectives of the child and their parents and evaluated the effect of the child's HRQOL on their parents' physical and mental well-being, thus providing insight into the optimal timing of palliative consultation, including anticipatory grief and bereavement services. This longitudinal study assessed 25 parents and their children, ages 2-17 years of age with DIPG across five time-points, baseline and weeks 2, 4, 6, 16, 24. Assessments included the PedsQL 4.0 Core Scales, PedsQL 3.0 Brain Tumor Scale, and Short-Form 36. HRQOL instruments were completed by the child (age ≥5 years) and parent-proxy (ages 2-17 years), with the parent completing the SF-36. Children's reports and parents' proxy of their child's HRQOL indicated poor physical functioning and increased anxiety at the initiation of therapy. A trending improvement in the children's HRQOL was reported by children and parents from baseline to week 6, with a decline at week 16. The childs' parent proxy reported cognitive problems, procedural anxiety and lower overall brain tumor HRQOL were assoicated with poorer self-reported parental mental status. Palliative care consultation should be initiated at the time of diagnosis and is supported in the high physical and emotional symptom burden reported by our patients, with heightened involvement initiated at 16 weeks. Prompt palliative care involvement, mitigating anxiety associated with clinic visits and procedures, management of brain tumor specific symptoms, advanced care planning, anticipatory grief and bereavement services, and care coordination may maximize HRQOL for patients and ensure positive long-term outcomes for parents of children with DIPG.
authors.affiliation: Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 728, Memphis, TN, 38105-2794, USA. belinda.mandrell@stjude.org.
authors.forename: Belinda N
authors.initials: BN
authors.lastname: Mandrell
authors.affiliation: Department of Oncology, Division of Quality of Life and Palliative Care, Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Baker
authors.affiliation: Department of Oncology, Division of Quality of Life and Palliative Care, Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Deena
authors.initials: D
authors.lastname: Levine
authors.affiliation: Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 728, Memphis, TN, 38105-2794, USA.
authors.forename: Jami
authors.initials: J
authors.lastname: Gattuso
authors.affiliation: Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 728, Memphis, TN, 38105-2794, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: West
authors.affiliation: Department of Biostatics, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: April
authors.initials: A
authors.lastname: Sykes
authors.affiliation: Department of Oncology, Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Gajjar
authors.affiliation: Department of Oncology, Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Broniscer
mesh_terms: D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019727:Proxy / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Diffuse intrinsic pontine glioma; Palliative care; Pediatric brain tumor; Quality of life