Patient-Reported Quality of Life in Adolescents and Young Adults with Cancer before, during, and after Radiation Therapy

Abstract

<h3>Purpose/Objective(s)</h3> Adolescents and young adults (AYAs, 15-39 yo) with cancer have unique vulnerabilities that affect quality-of-life (QOL) during treatment and in survivorship. Yet, few studies have assessed QOL in AYAs with cancer who received radiation therapy (RT). Therefore, we performed a cross-sectional study in AYAs with cancer who completed patient-reported outcomes (PROs) assessing QOL before, during, or after RT. <h3>Materials/Methods</h3> We identified 265 AYAs with cancer who were treated with RT and completed an AYA PRO survey from 2019-2022. The survey containing ten validated PRO instruments from the PROMIS inventory: Global Physical and Mental Health, Anxiety, Depression, Fatigue, Sleep Disturbance, Social Roles, Pain Interference, and Cognitive Function (score of 50 represents the mean from the reference U.S. general population; higher score represents more of the concept being measured). Patients were stratified into 3 cohorts based on the date of PRO completion: before RT, peri-RT (during RT or within 6 months of RT completion), or after RT (6+ months following RT completion). Mean (standard deviation [SD]) PRO scores were calculated. Patient characteristics were extracted from the medical record. Kruskal-Wallis analysis was used to compare scores between cohorts. ANOVA and t-test analyses were used to compare scores between co-variates. <h3>Results</h3> 87 (33%) patients completed PROs before RT, 84 (32%) peri-RT, and 94 (35%) after RT; median [IQR] age was 28 [21-33], 26 [20-32], and 22 [17-27], respectively. Cancer types varied; most had sarcoma (26%) or CNS cancer (23%). Compared to the before RT cohort, the peri-RT cohort had worse Global Physical and Mental Health PRO scores [SD] (48.7 [8.9] vs. 44.9 [9.8] (p=0.03) and 50.9 [8.6] vs. 46.2 [10.3] (p<0.01), respectively). These PRO scores were similar between the peri- and after RT cohorts (44.9 [9.8] vs. 45.5 [9.8] (p=0.68) and 46.2 [10.3] vs. 47.9 [9.6] (p=0.26), respectively). Compared to the before RT cohort, the peri- and after RT cohorts had better Anxiety PRO scores [SD] (55.2 [9] vs. 52.6 [10.4] and 51 [10], respectively, p=0.02). Remaining PRO scores were similar between cohorts (p>0.05). In the peri-RT cohort, patients with any acute RT toxicity had worse Pain Interference PRO scores [SD] vs. patients with none (50.8 [8.9] vs. 44.7 [5.7], p=0.03). In the after RT cohort, adolescents (15-18 yo) and young adults (26-39 yo) had worse Global Mental Health PRO scores [SD] vs. emerging adults (19-25 yo) (46.9 [9.1] and 47.9 [11.2], respectively, vs. 53.8 [9.2], p=0.04); patients with any late RT toxicity had worse Sleep Disturbance PRO scores [SD] vs. patients with none (58.4 [8] vs. 52.4 [9.2], p<0.001). <h3>Conclusion</h3> AYAs with cancer reported lower general physical and mental health QOL scores during RT, which persisted into survivorship. Developmental age, stage, and presence of RT toxicities may contribute to differing scores. Future longitudinal analyses are needed to improve QOL for AYAs receiving RT.