Trajectory of HRQOL scores in pediatric patients receiving proton therapy: results from the Pediatric Proton Consortium Registry (PPCR)

Abstract

Health-related quality of life (QOL) outcomes are an important metric in understanding the perceived health and emotional well-being of pediatric proton radiotherapy (RT) patients. Here we compare reported QOL outcomes at two time points during radiotherapy to determine the effect RT has on the holistic health of a patient. Pediatric patients (<22 years) treated with RT across multiple institutions were prospectively enrolled on an optional QOL study through the PPCR. Child and proxy answers to the PedsQL v.4.0 are evaluated to generate a total core score (QOL score) ranging from 0-100 (best). QOL scores captured during the first (early) and last (late) week of RT were evaluated. Paired t-tests and Wilcoxon sign-ranked tests were used to assess differences in early and late-RT QOL score within groups, independent t-tests and the Kruskal-Wallis test were used to assess differences between groups. One hundred twenty patients (n=69 (57.5%) CNS, n= 51 (42.5%) non-CNS) enrolled between 9/2015 and 1/2018 comprised the study cohort. Among non-CNS patients, 22 (43.1%) had a head/neck primary tumor. Median age was 10.5 years (<1 to 21.8). Median RT total dose was 54 Gy (21.0-76.0). Mean RT QOL score did not change significantly during RT (early: 74.6; late: 74.8, p=0.87). Children with CNS tumors noted a 3-point increase in QOL scores during RT (p=0.03), whereas QOL among children with non-CNS tumors did not significantly change (p=0.13). Non-CNS primary tumor site had no significant effect on change in QOL score (p=0.31). Patients with KPS=100 at the beginning of RT showed a non-significant decline of 5.0-points, but started higher than patients with a KPS of <100 who remained stable during RT. QOL scores did not differ by anesthesia use for RT (p=0.85), age (p=0.09), or by exposure to concurrent chemotherapy (p=0.34). During RT, children with CNS tumors reported an increase in the QOL score which differed from patients with non-CNS primaries who reported a non-significant decrease in scores. Anesthesia use, age, and concurrent chemotherapy did not significantly effect QOL scores. The PedsQL can be used to monitor the QOL of patients receiving proton radiotherapy. Future efforts to determine if QOL monitoring can lead to improvements in patient’s care and thus treatment experience are warranted.Tabled 1Abstract TU_41_3730; Table 1N(%)Early-RT Score Mean (sd)Late-RT Score Mean (sd)P within groupsP between groups PTumor TypeCNS69 (57.5)76.3 (16.1)79.3 (13.8)0.030.003Non-CNS51 (42.5)72.3 (16.4)68.7 (17.9)0.13AnesthesiaYes47(39.2)72.7 (14.8)72.6 (17.1)0.860.85No70 (58.3)76.0(17.1)76.3 (16.2)0.78Age (years)<10.56175.2 (14.8)73.5 (16.1)0.350.09>10.55974.0 (17.9)76.1 (16.9)0.11ChemotherapyYes79 (65.8)72.2 (16.9)71.3 (17.4)0.960.35No38 (31.7)80.7 (13.1)82.0 (12.0)0.51KPS1003080.8 (15.3)75.8 (15.4)0.070.02<1005870.9 (15.7)72.7 (15.7)0.24 Open table in a new tab