title: Grandparents of children with cancer: Quality of life, medication and hospitalizations.
abstract: Grandparents can play a crucial role of providing emotional and practical support for families facing childhood cancer. Yet, many have their own healthcare needs. This controlled study systematically assesses the impact of childhood cancer on grandparents' quality of life (QOL). Our objective was to compare QOL in grandparents of children with and without cancer and to identify factors associated with grandparents' QOL.
  
  
  
  Grandparents (N = 222) completed two patient-reported outcome (PRO) measures assessing QOL: EQ-5D-5L and WHOQOL-BREF. Secondary endpoints included sleep, medications and hospitalizations. We used independent samples t-tests and multivariate linear regression to assess between-group differences and identify predictors.
  
  
  
  Grandparents of children with cancer (n = 89) reported significantly worse QOL than controls (n = 133) [mean WHOQOL-BREF score: 75.6 (SD = 17.6) vs. 81.5 (15.6), P = 0.007; mean EQ-5D-5L index value: 0.777 (0.20) vs. 0.874 (0.14), P < 0.001)]. They also reported more problems with anxiety and depression (47.2 vs. 21.8%, P < 0.001) and pain (64.8 vs. 49.6%, P = 0.031). Grandparents of children with cancer reported taking longer to fall asleep [mean: 30.4 min (55.6) vs. 18.2 (20.2), P = 0.011] and taking more medications in the last 4 weeks [mean: 2.9 (SD = 3.8) vs. 1.8 (SD = 2.3), P = 0.012]. Hospitalizations were comparable across groups. Grandmothers, those living in urban locations, and retired/unemployed grandparents experienced reduced QOL.
  
  
  
  Grandparents are significantly affected by childhood cancer. The impact appears across many domains of life and results in meaningful QOL differences. Given that four or more individuals may be affected per child, and that grandparent well-being can influence the whole family, interventions targeting at-risk grandparents are needed.
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.|Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors.forename: C E
authors.initials: CE
authors.lastname: Wakefield
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.|Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Fardell
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.|Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors.forename: E L
authors.initials: EL
authors.lastname: Doolan
authors.affiliation: Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Drew
authors.affiliation: Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia.
authors.forename: R
authors.initials: R
authors.lastname: De Abreu Lourenco
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.|Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors.forename: A L
authors.initials: AL
authors.lastname: Young
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.|Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors.forename: R J
authors.initials: RJ
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003863:Depression / Q000453:epidemiology; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D000066502:Grandparents / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: childhood cancer; grandparents, health service use, hospitalization, medication use, sleep, quality of life