Growth Hormone Treatment and Quality of Life among Survivors of Childhood Cancer

Abstract

Background: We report the health-related quality of life (QOL) of survivors of childhood cancer (acute lymphoblastic leukaemia, ALL, or central nervous system, CNS, tumour), and whether or not they had growth hormone deficiency (GHD) requiring growth hormone treatment (GHT). Method: We assessed 77 survivors of childhood ALL (n = 51) or CNS tumours (n = 26), aged between 8–18 years, and free from disease for ≧4 years. Survivors and their mothers independently rated survivors’ QOL, and mothers completed semi-structured interviews to determine their views of the benefits and disadvantages of GHT. Results: Survivors, especially those treated for a CNS tumour, reported poorer QOL compared with UK population norms. Although survivors of ALL reported better QOL than survivors of CNS tumours, there were no differences depending on whether or not they were prescribed GHT. However, mothers reported that those prescribed GHT had worse QOL than those not. All but 2 survivors were responsible for their own injections. A minority of mothers were disappointed with the child’s rate of growth, and reported that children experienced pain with injections. Conclusion: We conclude that QOL in survivors of childhood cancer is compromised compared with the normal population, especially following CNS tumours. Longitudinal studies are vital to determine whether GHT can contribute to improved QOL for cancer survivors, especially those who experience more intensive initial therapy regimes.

Identifying determinants of quality of life of children with cancer and childhood cancer survivors: a systematic review

“…The most consistent finding was that central nervous system (CNS) or brain tumor patients on treatment and survivors had poorer QOL compared with patients with either leukemia or lymphoma [12,23,25,26,38,39,59,65]. One publication showed poorer overall QOL, as well as more emotional distress and treatment discomfort on the Pediatric Oncology Quality of Life Scale (POQOLS), in a sample of solid tumor patients (including brain tumor patients) when compared with a group of patients with leukemia or lymphoma [17].…”

“…The most frequently studied variable was type of cancer, which was found to be related to child QOL in 15 [12,13,15,17,23,25,26,32,38,39,46,52,59,64,65] of 30 publications where it was assessed. The most consistent finding was that central nervous system (CNS) or brain tumor patients on treatment and survivors had poorer QOL compared with patients with either leukemia or lymphoma [12,23,25,26,38,39,59,65].…”

Does long-term GH replacement therapy in hypopituitary adults with GH deficiency normalise quality of life?

“…Reduced self-confidence has also been reported (11), as has disturbed sexual life (10), decreased physical mobility (12), dissatisfaction with body image (6) and poor memory and concentration depression, remained significantly impaired. However, to the best of our knowledge, there are only a few studies on QoL in these patients in relation to the countryspecific normative data (20,21), possibly because of the paucity of such QoL reference data. Given the known cross-country differences (22), using country-specific normative data as a reference would be both a logical and a well-established way of estimating the QoL deficit in patients.…”

The Effects of Growth Hormone Treatment on Health-Related Quality of Life in Children

“…We hypothesized that QOL would improve between treatment onset (T1) and 6 months later (T2) for all children, especially those in the AGHD group. This was based on previous work suggesting compromised QOL in children after treatment for malignancy [5, 14]. In addition, we expected that children experiencing most height improvement would report greater improvements in QOL.…”