Young Childhood Cancer Survivors Research Articles

Unique influences of pain frequency and pain-related worry on health-related quality of life in survivors of childhood cancer

Pain is common during childhood cancer treatment, can persist into survivorship, and is under-managed in young survivors of childhood cancer (SCCs). Pain may influence health-related quality of life in SCCs simply via its frequency, and/or by triggering worries about cancer recurrence. The purpose of this study was to explore proximal associations between pain frequency, pain-related worry, and health-related quality of life in SCCs. In this study, 111 SCCs (52% female, Mage: 17.67 years, range 8-25 years) were recruited from a Canadian Children's Hospital and completed self-report measures of pain frequency, pain-related worry, and health-related quality of life. Descriptive statistics, bivariate correlations, chi-square analyses and a hierarchical linear regression were performed. Pain was frequently experienced in SCCs (70% reported pain in previous month) and was commonly worried about as a sign of cancer recurrence (39% of sample endorsed some degree of worry). Those who endorsed worrying about pain were 95% more likely to endorse experiencing that symptom over the previous month, X2(1, N = 110) = 21.13, p

Acceptability and feasibility of a parent-targeted dietary intervention in young survivors of childhood cancer: "Reboot".

Assess the acceptability and feasibility of delivering Reboot, a telephone dietary intervention to parents of pediatric cancer survivors. The research question asks whether tailored dietary support is acceptable and feasible to deliver to parents of young cancer survivors who have recently completed cancer treatment? Pre-post study. Nineteen parents of pediatric cancer survivors (aged 2-13years) in remission, who had received cancer treatment at a tertiary children's hospital, less than 5years prior to the intervention. Participants received four weekly 45-min telephone sessions led by a psychologist or dietitian and one postintervention booster session 6weeks later. Sessions addressed strategies to increase children's vegetable and fruit intake. Of the 19 parents who started the intervention, 14 completed all sessions within 8weeks and 12 completed the booster session within 10weeks. The mean session duration was 47min. All participants reported that Reboot increased their confidence and knowledge about promoting healthy eating habits to their child. Reboot is an acceptable intervention in young cancer survivors aimed at increasing vegetable and fruit intake after cancer treatment. The results from the Reboot pilot provides preliminary evidence that a targeted intervention to improve the diets of childhood cancer survivors may be feasible with future modification.

Impact of the parent-child relationship on psychological and social resilience in pediatric cancer patients.

The primary objective of this research was to examine patterns of parent-child relationship functioning among pediatric cancer survivors and their caregivers across a variety of relationship indicators (ie, Involvement, Attachment, Communication, Parenting Confidence, and Relational Frustration), and evaluate how these factors relate to psychosocial outcomes in survivors. Young survivors aged 10 to 18 and their caregivers (N = 165) completed measures related to posttraumatic stress and general distress. Caregivers also completed assessments of parent-child relationship functioning, and survivors completed assessments of social functioning. Latent profile analysis was performed to identify patterns of relationship functioning. Medical, demographic, and parent functioning variables were examined as predictors, and youth's psychological and social functioning were examined as outcomes. A three-class solution was the best fit to the data. The struggling parent-child relationship profile (15%) evidenced below average levels of parent-child relationship functioning across several domains. The normative parent-child relationship (60%), was characterized by average levels of parent-child relationship functioning across all domains. Finally, the high-involved parent-child relationship profile (25%) demonstrated above average levels of parent-child relationship functioning in involved activities, communication, and attachment and normative levels of functioning across all other domains. Medical and parent functioning factors predicted profile membership. In turn, profile membership was associated with survivor psychological and social outcomes. Findings document the importance of extending existing research to examine patterns of parent-child relationship functioning, which may serve as a clinically relevant target to improve psychological and social outcomes in young survivors of childhood cancer.

Perceptions of changes in clinical, informational, and supportive relationships after end of treatment among parents of young childhood cancer survivors.

Parents of childhood cancer patients experience changes in relationships with their health-care team as the child transitions from treatment to long-term survivorship (LTS). These changes may affect parent receptivity of survivorship-health-related programs, yet little is known about the experience of changing clinical relationships for parents as treatment ends and children transition into LTS. In-depth, semistructured interviews were conducted with 20 English-speaking parents of childhood cancer survivors less than 13years old who were greater than 1-year posttreatment. Audiotaped, transcribed interview content was analyzed using emergent themes grouped and refined in a process of multistaged constant comparison. There was a consensus among parents regarding the emotional stressors of the period immediately after the end of treatment. Regardless of positive or negative recollection of treatment, parents commonly viewed their health-care team with affection and this period as one of stability and security. Transitioning off treatment was viewed as a severe disruption of the security of weekly, treatment-related contact with nurses, nurse practitioners, physician's assistants, and physicians. LTS was generally viewed as presenting lower levels, but new types of stress as new, psychosocial late effects were seen to emerge. Clinical needs shifted to prevention and late-effect management. Parents of young childhood cancer survivors experience a similar emotional trajectory from treatment to transitioning off treatment and into LTS. This period is seen by parents as uniquely distressing because it represents a disruption of the hard-won safety represented by regular clinical relationships.

Statistical Methods in the Evaluation of Cardio-Respiratory Parameters in Young Childhood Cancer Survivors and Healthy Peers

Abstract This study concerns the problem of late complications of antineo-plastic therapy. Reduced parameters of the cardiorespiratory system in childhood may have a tremendous impact on health. In order to assess the selected parameters, to evaluate physical endurance, and compare the results with those obtained for healthy children, a test was carried out on a treadmill, until 80% of maximum pulse rate was reached. To compare the differences between the treatment group and the control group, three approaches were used. The first one was the classical statistical inference, the second consisted in forming a multidimensional normal model and also involved modelling of the correlation between variables. The unstructured type of the working correlation matrix was chosen to obtain the results and correct standard errors. In the last approach, logistic regression was used to model the relationship between binary outcome and covariates, and to differentiate between the groups of patients on the basis of their cardiovascular parameters.

Perceived Benefits and Challenges of Psychosocial Service Uses for Adolescents and Young Survivors of Childhood Cancer

Perceived Benefits and Challenges of Psychosocial Service Uses for Adolescents and Young Survivors of Childhood Cancer

Design and Rationale for a Parent-Led Intervention to Increase Fruit and Vegetable Intake in Young Childhood Cancer Survivors (Reboot): Protocol for a Pilot Study.

BackgroundPoor dietary habits are common among childhood cancer survivors, despite increasing their risk of cardio metabolic complications after cancer treatment. Here, we describe the design and rationale for a pilot telephone-based, parent-led intervention aimed at increasing fruit and vegetable intake in young cancer survivors (Reboot).ObjectiveThis pilot study aims to assess the feasibility and acceptability of delivering evidence-based telephone support to parents of childhood cancer survivors. A secondary aim includes assessing the effect of Reboot on improving childhood cancer survivors’ dietary quality by increasing child fruit and vegetable intake and variety and its contribution to overall nutrient intake.MethodsWe aim to recruit parents of 15 young cancer survivors aged 2 to 12 years who have completed cancer treatment less than five years ago. The intervention comprises of 4 weekly 45-minute telephone sessions led by a health professional and one booster session 6 weeks later. Sessions address the effects of cancer treatment on children’s diets, recommended fruit and vegetable intake for children, and evidence-based strategies to promote the consumption of fruit and vegetables as well as to manage fussy eating.ResultsReboot is based on an existing, evidence-based parent nutrition intervention and modified for childhood cancer survivors following extensive collaboration with experts in the field. Primary outcomes of feasibility and acceptability will be measured by the number of participants who complete all five sessions, average session length (minutes), length between sessions (days) and parent Likert ratings of the usefulness and impact of the intervention collected after the booster session. Of the 15 participants we aim to recruit, 3 have completed the intervention, 1 declined to participate, 11 are actively completing the intervention and 2 participants are providing written consent. The remaining 3 participants will be recruited via telephone follow-up calls. The intervention is due to be completed by July 2018.ConclusionsReboot aims to support healthy dietary behaviors in childhood cancer survivors who are at increased risk of developing serious cardiometabolic complications after their cancer treatment. Results will inform the development and implementation of future evidence-based dietary interventions delivered to childhood cancer survivors, particularly those living in rural and remote areas.Registered Report IdentifierRR1-10.2196/9252

Body composition, dietary intake and physical activity of young survivors of childhood cancer

To describe the body composition, dietary intake and physical activity and of paediatric, adolescent and young adult childhood cancer survivors (CCS) and examine the factors that impact body composition after treatment. This prospective cross-sectional study involved 74 subjects who were at least three years post treatment. Measurements included anthropometry, whole body potassium counting, air displacement plethysmography, and three day physical activity and diet diaries. The CCS had significantly reduced body cell mass index Z-scores compared to controls (p=0.0001), with 59% considered undernourished. The CCS had a significantly higher percent fat (p=0.002) than the controls, with 27% classified as obese. The intake of 60% of CCS met estimated energy requirements, but the CCS consumed high amount of energy from fat and low amount of energy from carbohydrates. A high percentage of CCS did not meet their dietary requirements for calcium (61%), magnesium (46%), folate (38%) and iodine (38%). The CCS group had a light active lifestyle with 64% spending more than 2h daily on screen time. Receiving a bone marrow transplant (r=-0.27; p=0.02) and physical activity level (r=0.49; p=0.0001) were significantly correlated with body cell mass index. This study demonstrates that increased fat mass and decreased body cell mass is a concern for CCS and that CCS have poor health behaviours including light active lifestyles, excessive screentime, high fat intake, and poor intake of essential nutrients. This study has highlighted that CCS are at risk of both obesity and undernutrition and that increasing body cell mass as well as decreasing fat mass should be a focus of energy balance interventions in survivorship. There is a need for parents and children undergoing treatment for cancer to be educated about diet quality and importance of daily physical activity to ensure healthy habits are established and maintained into survivorship.

BP.04.02] TUMOR NECROSIS FACTOR-RELATED APOPTOSIS-INDUCING LIGAND (TRAIL) IS ASSOCIATED WITH INFLAMMATION IN YOUNG ADULT SURVIVORS OF CHILDHOOD CANCER

Objective: Cancer survivors previously treated with cardiotoxic therapies (anthracycline, chest and neck radiotherapy) are at risk for early atherosclerosis secondary to inflammation and endothelial dysfunction. The aim of the study was to assess markers of inflammation and subclinical atherosclerosis in young adult survivors of childhood cancer. Design and method: We evaluated cardiovascular risk factors and assessed biochemical markers of inflammation and intima-media thickness (IMT) in 50 five-year survivors of childhood cancer (CCS) and in 29 healthy controls. Results: Cancer survivors (age 23.6 ± 2.8 years, 10.4 ± 4.1 years since the end of treatment, 94% with hematologic malignancies) had higher total cholesterol level (4.7 ± 1 versus 4.3 ± 0.6 mmol/l; p = 0.03) and LDL cholesterol (2.6 ± 0.9 versus 2.2 ± 0.6 mmol/l; p = 0.03) but were comparable with controls for other traditional cardiovascular risk factors. IMT was similar in both groups (0.43 ± 0.05 mm in CCS and 0.41 ± 0.05 mm in controls; p = 0.13). Inflammatory markers: hsCRP and fibrinogen were increased in CCS compared to controls (0.79 [0.33–2.42] versus 0.30 [0.17–0.57] mg/l; p = 0.006 and 2.8 [2.5–3.3] versus 2.2 [1.9–2.4] g/l; p < 0.001, respectively). Serum TRAIL levels were lower in CCS than in controls (97.6 ± 38.7 versus 127.8 ± 37.6 pg/ml; p = 0.001) and correlated negatively with PTX3 (r = −0.64; p < 0.001). IMT was not associated with inflammatory markers in CCS. Conclusions: Young childhood cancer survivors 10 years after treatment had increased cholesterol level and inflammatory markers but no signs of subclinical atherosclerosis. Low serum TRAIL levels were significantly associated with higher PTX3. It may suggest possible role of TRAIL in the control of chronic inflammatory activation and reflect a dysregulation of apoptosis in patients previously treated for cancer. (The study was supported by the Research Grant No. DEC-2012/7/N/NZ5/0080.)

Online social network use among parents of young childhood cancer survivors.

82 Background: Online social networks (OSNs) have emerged in the past decade as potentially powerful tools for health information sharing and health behavior change. According to a recent study by the Pew Research Center, 75% of all parents are active on OSNs. Given the high level of need for childhood cancer survivorship health education and preventive health behavior change, OSNs represent key resources for parents to engage with experts and peers over survivorship health. Methods: A cross-sectional survey of 114 parents of young and adolescent ( &lt; 13 years) childhood cancer survivors was used to examine parent OSN use in specific platforms. Recruitment was conducted through online social support groups of two childhood cancer non-profits that focus on parent support. The novel online survey investigated OSN frequency of use, history of making new friends in OSNs, and whether OSNs were “good for sharing and receiving reliable and high quality information on diet, physical activity, and other healthy behaviors.” Results: Parents reported high levels of OSN use with 80% reporting daily use. Facebook was the most commonly used OSN by a wide margin. Seventy-eight percent of parents reported using it every day. The next most used OSN was Instagram (15%). Parents reported making new friends on Facebook (86%), followed by Instagram (22%) and Twitter (10%). Among parents who have used the respective OSNs, several were endorsed as being “good” or “extremely good” for sharing survivorship-related preventive health information. Facebook was endorsed by 76% of its users, Twitter and Pinterest by 59%, Google+ by 52%, and Instagram by 40%. None of the demographic variables collected predicted parent OSN use or perception. There was a strong association between parents using OSNs daily and their reporting having made new friends on OSNs (p &lt; .000). Conclusions: Parents of young childhood cancer survivors recruited from online support groups report high levels of OSN use and making new friends through OSNs, and find OSNs potentially good sources for sharing and receiving survivorship-related health information. OSNs in general, and Facebook in particular, represent promising avenues for childhood cancer survivorship health information dissemination.

The Estimation of Intima-Media Thickness and Cardiovascular Risk Factors in Young Survivors of Childhood Cancer.

Cancer treatment in childhood is thought to accelerate the development of atherosclerosis, leading to significant cardiovascular complications and, ultimately, increasing cardiovascular mortality in childhood cancer survivors, which explains the need to assess vascular status in this group. The purpose of this paper was to assess early atherosclerotic lesions based on the analysis of intima-media thickness (IMT) of the common carotid artery, as well as to analyze cardiovascular risk factors in young childhood cancer survivors. The analysis of 158 patients aged 6 to29 years, with a history of previous cancer treatment for different childhood malignancies, revealed a statistically significant difference in IMT between them and 66 age-matched healthy controls. The observed higher IMT scores in childhood cancer survivors may be indicative of premature atherosclerosis. The actual scores were 0.056±0.007 versus 0.052±0.003 (P=0.0001) as a mean score for both carotid arteries in the study group and controls, respectively. We did not observe significant differences in IMT between cancer survivors treated with chemotherapy only versus those treated with chemotherapy and radiotherapy. Similar to the general population, childhood cancer survivors are affected by different cardiovascular risk factors. These factors may enhance the direct cardiotoxicity of cancer treatment, leading to symptomatic incidents in further life, which emphasizes the need of early prevention and/or treatment in this subpopulation.

Carotid intima-media thickness in young survivors of childhood cancer.

Radiotherapy (RT) and some chemotherapy regimens are known risk factors predisposing to the development of premature arterial disease. Vascular ultrasound measurement of carotid intima-media thickness (IMT) is a non-invasive technique, useful to detect early subclinical symptoms of atherosclerosis that can appear in the paediatric population. We analysed the influence of chemotherapy and moderate doses of head or neck irradiation in childhood cancer survivors on the possibility of premature carotid artery disease. Ultrasound measurements of the intima-media thickness (IMT) inthe common carotid artery (CCA), bulb and internal carotid artery (ICA) were performed in 74 young cancer survivors and in 48 age- and sex-matched controls. In the whole study group, we observed higher IMT in all positions as compared with the control, except for comparable thickness in the CCA (bilaterally). We failed to find any differences in IMT between irradiated and non-irradiated females. In irradiated males, all IMT measurements on the right side were higher than in non-irradiated patients. There was no effect of body mass index, blood pressure, serum cholesterol, triglycerides, fibrinogen and thyroid hormones on IMT. In the irradiated group, a positive correlation was observed between IMT in the right bulb and the post-radiation time. Anticancer treatment during childhood, especially including irradiation to the mediastinum, head or neck, affects the IMT, particularly in males. This suggests a possible role of irradiation in the premature development of carotid artery disease.

Effect of Low-Magnitude, High-Frequency Mechanical Stimulation on BMD Among Young Childhood Cancer Survivors

Bone accrual during youth is critical to establish sufficient strength for lifelong skeletal health. Children with cancer may develop low bone mineral density (BMD) any time before or after diagnosis. To evaluate the ability of low-magnitude, high-frequency mechanical stimulation to enhance BMD among childhood cancer survivors. Double-blind randomized clinical trial conducted at St Jude Children's Research Hospital from June 1, 2010, to January 22, 2013, using cancer survivors, ages 7 to 17 years, who were previously treated at St Jude Children's Research Hospital, were in remission, and at least 5 years from diagnosis, with whole-body or lumbar spine BMD z scores of -1.0 or lower. Participants were randomized (stratified by sex and Tanner stage) to either a placebo device or low-magnitude, high-frequency mechanical stimulation device, which was used at home. Placebo or low-magnitude, high-frequency mechanical stimulation (0.3 g; 32-37 Hz) for 2 sessions lasting 10 minutes each, 7 days per week for 1 year. All participants were prescribed daily cholecalciferol (vitamin D) and calcium. Changes in areal and volumetric BMD and bone biomarkers were compared by analysis of variance, adjusted for strata. Of the 65 participants, 32 were randomized to the intervention group (mean [SD] age was 13.6 [3.7] years, 18 [56.2%] were male, and 27 [84.4%] were white), and 33 were randomized to the placebo group (mean [SD] age was 13.6 [2.9] years, 17 [51.5%] were male, and 26 [78.8%] were white). Forty-eight participants completed the trial, 22 in the intervention group and 26 in the placebo group with median adherence of 70.1% for intervention and 63.7% for placebo groups. With intention-to-treat analysis, mean (SD) whole-body BMD z score by dual x-ray absorptiometry improved by 0.25 (0.78) in the intervention (n = 22), but decreased by -0.19 (0.79) in the placebo group (n = 26, P = .05). Circulating osteocalcin at 12 months correlated with change in total body BMD (r = 0.35, P = .02). Tibial trabecular bone among participants completing 70% or more of the prescribed sessions increased by a mean of 11.2% (95% CI, 5.2 to 17.2%) compared with those completing less than 70% who decreased by a mean of -1.3% (95% CI, -7.3 to 4.7%; P = .02). Change in circulating receptor activator of nuclear factor κ-B ligand was higher in the intervention than in the placebo group (0.06 [0.16] vs -0.04 [0.17] pmol/L) (P = .04). Pediatric cancer survivors with low BMD may benefit from low-magnitude, high-frequency mechanical stimulation as a novel and safe intervention to optimize peak bone mass during youth, alone or in conjunction with other therapies. clinicaltrials.gov Identifier: NCT01010230.

Long-term positive and negative psychosocial outcomes in young childhood cancer survivors, type 1 diabetics and their healthy peers

This study examined posttraumatic growth (PTG) in young childhood cancer survivors (CCS) and type 1 diabetics (DM), with physically healthy peers as the control group (CG). Anxiety and depression as negative mental outcomes in the three groups, as well as fear of progression in DM and CCS were examined. A total of 107 participants with ages ranging from 18 to 35 years were examined: CCS (n=33), type 1 diabetics (n=39) and peers without a history of chronic disease (n=35). PTG and negative psychosocial outcomes were assessed with self-report questionnaires. There was a significant difference between the groups regarding PTG. On a subscale level DM reported higher appreciation of life (p=0.024), higher personal strength (p=0.010), and more new possibilities (p=0.010) compared to CG. CCS experienced higher spiritual changes than DM (p=0.050). DM reported higher levels of anxiety compared to CCS (p=0.026) and CG (p=0.049). Depression was higher in DM compared to CG (p=0.003). Fear of progression was higher in DM compared to CCS (p<0.001). These findings show that psychological growth was experienced by young CCS and participants with DM. Furthermore, these findings highlight that adolescents with a significant health diagnosis in childhood or youth can undergo a similar or even more positive psychosocial development as peers without a history of chronic disease. However, young type 1 diabetics seem to be a more vulnerable group in terms of anxiety, depression and fear of progression.

Online Focus Group Discussion is a Valid and Feasible Mode When Investigating Sensitive Topics Among Young Persons With a Cancer Experience.

BackgroundClinical research often lacks participants of young age. Adding to the small amount of scientific studies that focus on the population entering adulthood, there are also difficulties to recruit them. To overcome this, there is a need to develop and scientifically evaluate modes for data collection that are suitable for adolescents and young adults. With this in mind we performed 39 online focus group discussions among young survivors of childhood cancer to explore thoughts and experiences around dating, being intimate with someone, and having children.ObjectiveThe aim of the study was to evaluate online focus group discussions as a mode for data collection on sensitive issues among young persons with a cancer experience.MethodsOne hundred thirty-three young persons (16-25 years) previously diagnosed with cancer, participated in 39 synchronous online focus group discussions (response rate 134/369, 36%). The mode of administration was evaluated by analyzing participant characteristics and interactions during discussions, as well as group members’ evaluations of the discussions.ResultsPersons diagnosed with central nervous tumors (n=30, 27%) participated to a lower extent than those with other cancer types (n=103, 39%; χ 2= 4.89, P=.03). The participants described various health impairments that correspond to what would be expected among cancer survivors including neuropsychiatric conditions and writing disabilities. Even though participants were interested in others’ experiences, sexual issues needed more probing by the moderators than did fertility-related issues. Group evaluations revealed that participants appreciated communicating on the suggested topics and thought that it was easier to discuss sex when it was possible to be anonymous toward other group members.ConclusionsOnline focus group discussions, with anonymous participation, are suggested to be a feasible and valid mode for collecting sensitive data among young persons with a cancer experience.

Follow-up care of young childhood cancer survivors: attendance and parental involvement.

Despite recommendations, only a proportion of long-term childhood cancer survivors attend follow-up care. We aimed to (1) describe the follow-up attendance of young survivors aged 11-17years; (2) describe the parental involvement in follow-up, and (3) investigate predictors of follow-up attendance and parental involvement. As part of the Swiss Childhood Cancer Survivor Study, a follow-up questionnaire was sent to parents of childhood cancer survivors aged 11-17years. We assessed follow-up attendance of the child, parents' involvement in follow-up, illness perception (Brief IPQ), and sociodemographic data. Clinical data was available from the Swiss Childhood Cancer Registry. Of 309 eligible parents, 189 responded (67%; mean time since diagnosis 11.3years, range 6.8-17.2) and 75% (n=141) reported that their child still attended follow-up. Of these, 83% (n=117) reported ≥1 visit per year and 17% (n=23) reported <1 visit every year. Most survivors saw pediatric oncologists (n=111; 79% of 141), followed by endocrinologists (n=24, 17%) and general practitioners (n=22, 16%). Most parents (92%) reported being involved in follow-up (n=130). In multivariable and Cox regression analyses, longer time since diagnosis (p=0.025) and lower perceived treatment control (assessed by IPQ4: how much parents thought follow-up can help with late effects; p=0.009) were associated with non-attendance. Parents' overall information needs was significantly associated with parental involvement in the multivariable model (p = 0.041). Educating survivors and their parents on the importance and effectiveness of follow-up care might increase attendance in the longer term.

Follow-up care of young childhood cancer survivors: attendance and parental involvement

Follow-up care of young childhood cancer survivors: attendance and parental involvement

Posttraumatic Stress Disorder and Illness Perception in Young Survivors of Childhood Cancer

ObjetivoEste estudo teve como objetivo avaliar a presença de Transtorno de Estresse Pós-Traumático (TEPT) e a sua relação com a perceção da doença numa amostra de 65 jovens sobreviventes de cancro infantil, com uma média de idades de 19 anos (DP= 2,70) e que tinham terminado o tratamento, em média, há sete anos.MétodoForam aplicados instrumentos para obtenção de dados sociodemográficos e clínicos, de sintomas de TEPT – “Posttraumatic Stress Disorder Checklist – Civilian” (PCL-C) e de perceção da doença – “Revised Illness Perception Questionnaire for Healthy People” (IPQ-RH).ResultadosA presença de sintomas de TEPT variade 9,2% a 18,5% na amostra, e a perceção da doença esteve correlacionada com os sintomas deste transtorno. As subescalas Representação Emocional e Coerência da Doença (IPQ-RH), foram preditoras dos sintomas de Reexperiência (β = 0,0370; p &lt; 0,01; β = 0,261; p&lt;0,05, respetivamente). A subescala Representação Emocional (IPQ-RH) também foi preditora de sintomas de Esquiva (β = 0,330; p &lt; 0,001).ConclusãoConcluiu-se que a perceção da doença deve ser investigada para prevenir os sintomas de TEPT em sobreviventes de câncer infantil.

Health-related quality of life in young survivors of childhood cancer.

Childhood cancer and its treatment may affect health-related quality of life (HRQoL) in childhood cancer survivors, but population-based studies in young survivors are scarce. We aimed to: (1) compare HRQoL between young survivors and population norms and (2) find factors that influence parent-reported HRQoL in survivors. As part of the Swiss Childhood Cancer Survivor Study, a questionnaire was mailed to parents of survivors aged 8-16 years, registered in the Swiss Childhood Cancer Registry, ≥5 years after diagnosis. We used the KIDSCREEN-27 instrument to compare self- and parent-reported HRQoL between survivors (N = 425) and standardized norms in the five dimensions of physical well-being, psychological well-being, autonomy, peers and school environment (mean = 50, SD = 10). We then used multivariable linear regressions to test the influence of socio-demographic and cancer-related factors on HRQoL. Self-reported physical well-being was comparable to norms. Other HRQoL dimensions were higher than norms, with the highest mean = 52.2 (p < 0.001) for school environment. Parent-reported HRQoL in survivors was comparable to population norms; only physical well-being was lower (mean = 47.1, p < 0.001), and school environment was higher (mean = 51.1, p = 0.035). Parent-reported HRQoL was lower for survivors of CNS tumors (physical well-being: β = -5.27, p = 0.007; psychological well-being: β = -4.39, p = 0.044; peers β = -5.17, p = 0.028), survivors of neuroblastoma (psychological well-being β = -5.20, p = 0.047), and survivors who had had a relapse (physical well-being β = -5.41, p = 0.005). Assessing HRQoL during follow-up care, with a focus on physical well-being, specific diagnoses (e.g., CNS tumor) and late complications (e.g., relapse) might help to early identify problems and offer support to survivors with reduced HRQoL.

Health-related quality of life in young survivors of childhood cancer

Health-related quality of life in young survivors of childhood cancer