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Health-Related Quality of Life Among Child and Adolescent Survivors of Childhood Cancer

Kathy N. Speechley, Maru Barrera, Amanda K. Shaw, Howard I. Morrison, Elizabeth Maunsell

From the Departments of Pediatrics and Epidemiology and Biostatistics, University of Western Ontario and Children's Health Research Institute, London; Department of Psychology, Population Health Science Research Institute, Hospital for Sick Children and University of Toronto, Toronto; Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa; Department of Social and Preventive Medicine, Université Laval, Laval, Canada

Address reprint requests to K.N. Speechley, PhD, Pediatrics, Children's Hospital of Western Ontario, Westminster Tower E6-203, 800 Commissioners Rd E, London, ON Canada N6C 2V5; e-mail: kathy.speechley{at}lhsc.on.ca

PURPOSE: The main objective was to compare parent-reported health-related quality of life (HRQL) of child and adolescent survivors of childhood cancer to that of controls who had no history of cancer.

METHODS: We assessed HRQL of 800 child and adolescent survivors younger than 16 years and 923 randomly selected, age- and sex-matched controls from the general population in a national multicenter retrospective cohort study using the Child Health Questionnaire parent report. Participation was 69% among survivors and 57% among controls.

RESULTS: Survivors had means that were consistently lower than controls on the HRQL physical summary (PH; 49.9 v 55.3; P <.005), psychosocial summary (PS; 49.4 v 52.6; P < .005), and all but one of the eight subscale scores. Clinically important survivor-control differences in means on PH were found for survivors of CNS tumors, bone tumors, lymphoma, leukemia, soft tissue sarcoma and Wilms' tumor (differences: –8.7, –7.0, –6.3, –5.4, –4.4, –3.8/100, respectively); on PS, survivors of CNS tumors were most compromised (–6.1/100). Survivor-control differences in both PH and PS were also large for survivors treated with radiation only (–5.8 and –11.9/100, respectively), or radiation combined with surgery (–6.6 and –5.9/100, respectively), or radiation combined with both surgery and chemotherapy (–7.8 and –5.1/100, respectively). Cranial radiation was associated with the most compromised HRQL.

CONCLUSION: According to parents, HRQL for survivors was somewhat poorer, overall, than for controls. Survivors of CNS tumors, lymphoma, and leukemia and those patients treated with cranial radiation were reported to have poorest HRQL. These findings support development of guidelines for levels of follow-up care for particular groups of survivors.

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

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

Related Editorial

• Quality of Life Among Long-Term Adolescent and Adult Survivors of Childhood Cancer
  Elizabeth Maunsell, Lisa Pogany, Maru Barrera, Amanda K. Shaw, and Kathy N. Speechley
  JCO 2006 24: 2527-2535 [Abstract] [Full Text]

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