title: Systematic review and meta-analysis of health-related quality of life in pediatric CNS tumor survivors.
abstract: BACKGROUND
  Pediatric central nervous system (CNS) tumor survivors are at high risk for numerous late effects including decreased health-related quality of life (HRQOL). Our objective was to summarize studies describing HRQOL in pediatric CNS tumor survivors and compare HRQOL outcomes in studies that included a comparison group.
  
  
  METHODS
  EMBASE, MEDLINE, and PsychINFO were used to identify relevant articles published until August, 2016. Eligible studies reported outcomes for pediatric CNS tumor survivors diagnosed before age 21, at least 5 years from diagnosis and/or 2 years off therapy and used a standardized measure of HRQOL. All data were abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0.
  
  
  RESULTS
  Of 1,912 unique articles identified, 74 were included in this review. Papers described 29 different HRQOL tools. Meta-analyses compared pediatric CNS tumor survivors to healthy comparisons and other pediatric cancer survivors separately. HRQOL was significantly lower for CNS (n = 797) than healthy comparisons (n = 1,397) (mean difference = -0.54, 95% confidence interval [CI] = -0.72 to -0.35, P < 0.001, I2= 35%). HRQOL was also significantly lower for CNS (n = 244) than non-CNS survivors (n = 414) (mean difference = -0.56, 95% CI = -0.73 to -0.38, P < 0.00001, I2= 0%).
  
  
  CONCLUSIONS
  Pediatric CNS tumor survivors experience worse HRQOL than healthy comparisons and non-CNS cancer survivors. Future HRQOL work should be longitudinal, and/or multisite studies that examine HRQOL by diagnosis and treatment modalities.
authors.affiliation: Departments of Oncology and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Haematology, Oncology and Transplant Program, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Schulte
authors.affiliation: Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.|Departments of Oncology and Psychology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: K Brooke
authors.initials: KB
authors.lastname: Russell
authors.affiliation: Loretto Heights School of Nursing, Regis University, Denver, Colorado.
authors.forename: Patricia
authors.initials: P
authors.lastname: Cullen
authors.affiliation: Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Leanne
authors.initials: L
authors.lastname: Embry
authors.affiliation: Departments of Oncology and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Taryn
authors.initials: T
authors.lastname: Fay-McClymont
authors.affiliation: Department of Haematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Johnston
authors.affiliation: Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Abby R
authors.initials: AR
authors.lastname: Rosenberg
authors.affiliation: Department of Haematology/Oncology, SickKids Hospital, Toronto, Ontario, Canada.
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D016543:Central Nervous System Neoplasms / Q000150:complications*; D002648:Child; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011788:Quality of Life; D017741:Survivors
keywords: CNS tumors; late effects of cancer treatment; pediatric oncology; psychosocial; quality of life