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

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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 parent-report, 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.

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Data availability

The manuscript does not have a data repository.

Code availability

SPSS version 26 was utilized to run statistical analysis, along with PROC MIXED procedure in SAS; version 9.3.

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Acknowledgements

We would like to thank the families who participated and our funding source, the National Cancer Institute and intramural funding from the Abigail Wexner Research Institute at Nationwide Children’s Hospital.

Funding

We would like to thank our funding source, the National Cancer Institute and intramural funding from the Abigail Wexner Research Institute at Nationwide Children’s Hospital.

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Authors and Affiliations

  1. Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Keagan G. Lipak, Joseph R. Rausch, Rachel S. Fisher, Olivia E. Clark, Ansley E. Kenney, Alexandra C. Himelhoch, Leena Nahata, Kathryn Vannatta & Cynthia A. Gerhardt

  2. Department of Pediatrics, The Ohio State University, Columbus, OH, USA

    Joseph R. Rausch, Randal S. Olshefski, Leena Nahata, Kathryn Vannatta & Cynthia A. Gerhardt

  3. Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA

    Kemar V. Prussien & Bruce E. Compas

  4. Division of Hematology/Oncology/BMT, Nationwide Children’s Hospital, Columbus, OH, USA

    Randal S. Olshefski

  5. Department of Psychology, The Ohio State University, Columbus, OH, USA

    Kathryn Vannatta & Cynthia A. Gerhardt

  6. Division of Endocrinology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Leena Nahata

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by KGL, JRR, RSF, KVP, OEC, AEK, ACH and CAG. The first draft of the manuscript was written by KGL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cynthia A. Gerhardt.

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The authors declare that there is no conflict of interest.

Ethical approval

The questionnaires and methodology for this study was approved by the Institutional Review Board committee at Nationwide Children’s Hospital.

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Parents and children provided written informed consent and assent (ages 10–17) prior to completing paper and pencil surveys at their convenience.

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Patients signed informed consent regarding publishing their data.

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Portions of this work were presented at the Pediatric Academic Societies Annual Meeting, Baltimore, Maryland, April 27th, 2019. https://www.xcdsystem.com/pas/program/2019.

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Lipak, K.G., Rausch, J.R., Fisher, R.S. et al. The impact of CNS-directed treatment on quality of life in childhood cancer survivors. Qual Life Res 31, 817–829 (2022). https://doi.org/10.1007/s11136-021-02984-1

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