The impact of CNS-directed treatment on quality of life in childhood cancer survivors

Abstract

Purpose Pediatric cancer survivors may have lower quality of life (QoL), but most research has assessed outcomes either in treatment or long-term survivorship. We focused on early survivorship (i.e., 3 and 5 years post-diagnosis), examining the impact of CNS-directed treatment on child QoL, as well as sex and age at diagnosis as potential moderators. Methods Families of children with cancer (ages 5-17) were recruited at diagnosis or relapse (N = 336). Survivors completed the PedsQL at 3 (n = 96) and 5 years (n = 108), along with mothers (101 and 105, respectively) and fathers (45 and 53, respectively). The impact of CNS treatment, sex, and age at diagnosis on child QoL was examined over both time since diagnosis and time since last treatment using mixed model analyses. Results Parent-report of the child's total QoL was in the normative range and stable between 3 and 5 years when examining time since diagnosis, while child reported QoL improved over time (p = 0.04). In terms of time since last treatment, mother and child both reported the child's QoL improved over time (p = 0.0002 and p = 0.0006, respectively). Based on parentreport, males with CNS-directed treatment had lower total QoL than females and males who did not receive CNS-directed treatment. Age at diagnosis did not moderate the impact of treatment type on total QoL. Conclusions Quality of life (QoL) in early survivorship may be low among males who received CNS-directed treatment. However, this was only evident on parent-report. Interventions to improve child QoL should focus on male survivors who received CNS-directed treatment, as well as females regardless of treatment type.

Cancer‐related stress in childhood cancer survivorship: Prevalence and associations with perceptions of health risks and quality of life

“…While this may have resulted from too narrowly defining neurotoxicity, an underrepresentation of brain tumor survivors in our sample, or a sex by neurotoxicity interaction, 12 clinical attention to QoL may be beneficial for families regardless of neurotoxic treatment history.…”

“…27 Among our sample, attrition at the 5-year follow-up was due to passive declines (i.e., unreachable), relocation, discontinued interest, and child death (n = 59). 12 Survivors (n = 100), mothers (n = 127), and fathers (n = 59) with data from the 5-year follow-up stress measure were included in analyses. Caregiverreported demographics are in Table 1, including a report of race and ethnicity in accordance with the U.S. Census.…”

“…Survivors who experience late effects and who have caregivers with more disease‐related worry report lower QoL. While mixed findings exist as to whether QoL among survivors returns to normative levels or if it remains below that of healthy controls, 10,11 there is consistent support that female survivors, individuals from underrepresented racial and ethnic groups, who receive neurotoxic treatment, and with brain tumors report lower QoL across survivorship 11,12 . In addition, stress broadly has been associated with lower QoL in pediatric cancer populations 13 .…”

“…While mixed findings exist as to whether QoL among survivors returns to normative levels or if it remains below that of healthy controls, 10,11 there is consistent support that female survivors, individuals from underrepresented racial and ethnic groups, who receive neurotoxic treatment, and with brain tumors report lower QoL across survivorship. 11,12 In addition, stress broadly has been associated with lower QoL in pediatric cancer populations. 13 For example, greater parenting stress in survivorship predicts heightened functional impairment in survivors (i.e., engagement in physical, social, and personal activities).…”

Long-term postoperative quality of life in childhood survivors with cerebellar mutism syndrome

“…The relationship between sex and QoL in pediatric patients with brain tumors remains controversial (Bell et al, 2018). Previous reports indicated that males had lower school-related QoL score (Bhat et al, 2005;Lipak et al, 2022;Ljungman et al, 2022). However, there were also reports that women had poorer QoL scores than men, or that no significant difference existed between males and females (Bull et al, 2014;Barrera et al, 2017;Quast et al, 2018).…”