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Quality of Life Among Long-Term Adolescent and Adult Survivors of Childhood Cancer

Elizabeth Maunsell, Lisa Pogany, Maru Barrera, Amanda K. Shaw, Kathy N. Speechley

From the Unité de recherche en santé des populations, Centre de recherche du Centre Hospitalier Affilié Universitaire de Québec; Département de Médecine sociale et préventive, Université Laval, Québec; Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa; Department of Psychology, Haematology/Oncology Program, Population Health Sciences, Research Institute, Hospital for Sick Children, University of Toronto, Toronto; Department of Pediatrics and Epidemiology and Biostatistics, University of Western Ontario and Children's Health Research Institute, London, Canada

Address reprint requests to Elizabeth Maunsell, PhD, Unité de recherche en santé des populations, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, Québec, QC, Canada, G1S 4L8; e-mail: elizabeth.maunsell{at}uresp.ulaval.ca

PURPOSE: We assessed effects of childhood or adolescent cancer on quality of life among adolescent and adult cancer survivors, a group who are thought to be at particular risk for adverse late effects.

PATIENTS AND METHODS: We studied 1,334 survivors and 1,477 age- and sex-matched, general population controls from across Canada using a mailed questionnaire which included the Short Form-36 (SF-36) and measures of self-esteem, optimism, and life satisfaction. General linear models and logistic regression were used. Survivor-control differences corresponding to an effect size (ES) 0.5 were considered clinically important.

RESULTS: Participants were age 15 years to 37 years. Most survivors (83.8%) were diagnosed 10 years earlier. Fewer survivors (62.1%) than controls (71.1%) reported very good or excellent general health (adjusted odds ratio, 0.6; 95% CI, 0.5 to 0.7). However, quality of life differences between survivors and controls were small, and for the most part probably not clinically important. Three clinical characteristics—having had CNS or bone cancer, more than one treatment series, and two organs with a dysfunction at treatment end—were independently associated with poorer quality of life in the physical dimensions. Only survivors with two organs with dysfunction (8.7%) reported poorer quality of life in both physical and psychosocial domains, with several clinically important ES. The largest ES for the SF-36 physical summary scores were found in the 8% of survivors with two or three of these characteristics simultaneously, compared with those survivors who had none (–0.79 and –1.13, respectively).

CONCLUSION: Overall, a sizeable majority of adolescent and adult long-term survivors of childhood cancer in Canada appear to have adapted well.

Supported by Health Canada. E.M. was a National Health Research and Development Program National Health Research Scholar and then an Investigator of the Canadian Institutes of Health Research when this study was planned, conducted, and analyzed.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Related Editorial

• Health-Related Quality of Life Among Child and Adolescent Survivors of Childhood Cancer
  Kathy N. Speechley, Maru Barrera, Amanda K. Shaw, Howard I. Morrison, and Elizabeth Maunsell
  JCO 2006 24: 2536-2543 [Abstract] [Full Text]

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