Impact of short stature on health-related quality of life in long-term survivors of acute lymphoblastic leukemia in childhood and adolescence

Laura Collins,Uma Athale,Amy Cranston,Ronald Barr

doi:10.1186/s41687-018-0084-z

Abstract

PurposeSome survivors of acute lymphoblastic leukemia (ALL) in childhood and adolescence exhibit short stature, especially if their treatment included cranial irradiation. The impact of this outcome on health-related quality of life (HRQL) is uncertain and so formed the basis for the investigation reported here.MethodsThis study examined the association between self-reported HRQL and measured height in a cohort (n = 75) of survivors of ALL more than 10 years from diagnosis. HRQL was expressed as utility scores generated from a multi-attribute preference-based measure, the Health Utilities Index (HUI) which includes the complementary systems HUI2 and HUI3. For single attributes the range is from 1.00 (no limitations) to 0.00 (lowest level of function). For overall HRQL the range is 1.00 (perfect health) to 0.00 (equivalent to being dead). A negative score is associated with states of health worse than being dead.ResultsThere were no statistically significant differences in overall HRQL between subjects <25th (n = 16, 21%), 15th (n = 11, 15%) and 10th (n = 10, 13%) centiles. A greater amount of emotional morbidity, focused on anger and depression, was manifest in those <25th and 15th centiles, with clinically important differences of 0.07 (p = 0.03) and 0.077 (p = 0.016) respectively, but not in the shortest group who were < 10th centile.ConclusionsStudies in large cohorts of young adults in the general population has reported an inconsistent relationship between height and HRQL. Results from the current study suggest that no such relationship exists in long-term survivors of ALL in childhood and adolescence.

Highlights

Among the late sequelae of the treatment of acute lymphoblastic leukemia (ALL) in children are diminished final height and overweight/obesity [1]
In 2007 colleagues in Brazil [2] identified a considerable literature on short stature in such populations while presenting their own results which revealed that the adverse effect on final height began during treatment and was especially evident in those who had undergone
(2018) 2:59 height Z score less than − 1.96. In those who received no cranial radiotherapy (CRT) the prevalence was 3.8% while in those who had had CRT but not total body irradiation (TBI) 10.1% were of short stature

Summary

Introduction

Among the late sequelae of the treatment of acute lymphoblastic leukemia (ALL) in children are diminished final height (short stature) and overweight/obesity [1]. Collins et al Journal of Patient-Reported Outcomes (2018) 2:59 height Z score less than − 1.96. In those who received no CRT the prevalence was 3.8% while in those who had had CRT but not TBI 10.1% were of short stature. Despite this abundance of information on diminished final height in survivors of ALL there are very limited data on the broader impact of this outcome, the association of short stature with psychological morbidity in children at large has been well recognised for at least 25 years [5]. This study examined the influence of growth hormone and the relationship of HRQL to stature was not presented

Methods

Results

Conclusion