Supportive Care in Cancer

, Volume 18, Issue 12, pp 1581–1587 | Cite as

Health-related quality of life and cognitive outcomes among child and adolescent survivors of leukemia

  • Shyh-Shin Chiou
  • Ren-Chin Jang
  • Yu-Mei Liao
  • Pinchen Yang
Original Article



Long-term survival of childhood leukemia has become a reality with treatment advancement; hence, the need to assess the survivors’ health-related quality of life (HRQL) is essential. Although a growing number of Western studies have documented the considerable impact of diagnosis and treatment on HRQL in pediatric leukemia survivors, little finding has been reported in non-Western developing countries.


We used a previously validated 14-dimensional questionnaire, Child Health Questionnaire 50-item Parent Form (CHQ-PF 50), to examine the perceived HRQL of 32 child/adolescent survivors, currently aged 13.17 ± 2.49 years, who had experienced first complete continuous remission from leukemia for at least 3 years. The HRQL status was compared with that obtained from community subjects (N = 154) and survivors’ nonadult siblings (N = 30). Intelligence quotients (IQ) and computerized neuropsychological assessments were performed for subjects.


The HRQL of leukemia survivors was noted to be worse than that of community children and nonadult siblings as reflected by significantly lower scores in both the physical summary and the psychosocial summary score of CHQ-PF 50. 15.6% of the survivors had impaired intelligence (estimated IQ below 70). 27.8% of the adolescents were impaired in the cognitive domains as assessed by neuropsychological tests.


In this Taiwanese single institution experience, pediatric leukemia survivors carried a morbidity burden into their teen years as reflected by worse HRQL than controls. These findings may guide the support required by this population.


Cancer survivor Health-related quality of life Pediatric leukemia Adolescent 


  1. 1.
    Brenner H, Kaatsch P, Burkhardt-Hammer T, Harms DO, Schrappe M, Michaelis J (2001) Long-term survival of children with leukemia achieved by the end of the second millennium. Cancer 92:1977–1983CrossRefPubMedGoogle Scholar
  2. 2.
    Silverman LB, Gelber RD, Dalton VK, Asselin BL, Barr RD, Clavell LA, Hurwitz CA, Moghrabi A, Samson Y, Schorin MA, Arkin S, Declerck L, Cohen HJ, Sallan SE (2001) Improved outcome for children with acute lymphoblastic leukemia: results of Dana-Farber Consortium Protocol 91–01. Blood 97:1211–1218CrossRefPubMedGoogle Scholar
  3. 3.
    Geenen MM, Cardous-Ubbink MC, Kremer LC, van den Bos C, van der Pal HJ, Heinen RC, Jaspers MW, Koning CC, Oldenburger F, Langeveld NE, Hart AA, Bakker PJ, Caron HN, van Leeuwen FE (2007) Medical assessment of adverse health outcomes in long-term survivors of childhood cancer. JAMA 297:2705–2715CrossRefPubMedGoogle Scholar
  4. 4.
    Mody R, Li S, Dover DC, Sallan S, Leisenring W, Oeffinger KC, Yasui Y, Robison LL, Neglia JP (2008) Twenty-five year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. Blood 111:5515–5523CrossRefPubMedGoogle Scholar
  5. 5.
    Oeffinger KC, Eshelman DA, Tomlinson GE, Buchanan GR, Foster BM (2000) Grading of late effects in young adult survivors of childhood cancer followed in an ambulatory adult setting. Cancer 88:1687–1695CrossRefPubMedGoogle Scholar
  6. 6.
    Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, Friedman DL, Marina N, Hobbie W, Kadan-Lottick NS, Schwartz CL, Leisenring W, Robison LL (2006) Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 355:1572–1582CrossRefPubMedGoogle Scholar
  7. 7.
    Pui CH, Cheng C, Leung W, Rai SN, Rivera GK, Sandlund JT, Ribeiro RC, Relling MV, Kun LE, Evans WE, Hudson MM (2003) Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia. N Engl J Med 349:640–649CrossRefPubMedGoogle Scholar
  8. 8.
    Stevens MC, Mahler H, Parkes S (1998) The health status of adult survivors of cancer in childhood. Eur J Cancer 34:694–698CrossRefPubMedGoogle Scholar
  9. 9.
    Apajasalo M, Sintonen H, Siimes MA, Hovi L, Holmberg C, Boyd H, Makela A, Rautonen J (1996) Health-related quality of life of adults surviving malignancies in childhood. Eur J Cancer 32A:1354–1358CrossRefPubMedGoogle Scholar
  10. 10.
    Langeveld NE, Stam H, Grootenhuis MA, Last BF (2002) Quality of life in young adult survivors of childhood cancer. Support Care Cancer 10:579–600CrossRefPubMedGoogle Scholar
  11. 11.
    Maunsell E, Pogany L, Barrera M, Shaw AK, Speechley KN (2006) Quality of life among long-term adolescent and adult survivors of childhood cancer. J Clin Oncol 24:2527–2535CrossRefPubMedGoogle Scholar
  12. 12.
    Pemberger S, Jagsch R, Frey E, Felder-Puig R, Gadner H, Kryspin-Exner I, Topf R (2005) Quality of life in long-term childhood cancer survivors and the relation of late effects and subjective well-being. Support Care Cancer 13:49–56CrossRefPubMedGoogle Scholar
  13. 13.
    Shankar S, Robison L, Jenney ME, Rockwood TH, Wu E, Feusner J, Friedman D, Kane RL, Bhatia S (2005) Health-related quality of life in young survivors of childhood cancer using the Minneapolis-Manchester Quality of Life-Youth Form. Pediatrics 115:435–442CrossRefPubMedGoogle Scholar
  14. 14.
    Patrick DL, Chiang YP (2000) Measurement of health outcomes in treatment effectiveness evaluations: conceptual and methodological challenges. Med Care 38:II14–II25PubMedGoogle Scholar
  15. 15.
    Eiser C, Morse R (2001) A review of measures of quality of life for children with chronic illness. Arch Dis Child 84:205–211CrossRefPubMedGoogle Scholar
  16. 16.
    Liu HC, Chen SH, Chang KH, Chiang LC, Liu CY, Chang HL, Tsai LL, Liang DC (2002) Overall and event-free survivals for acute lymphoblastic leukemia in children at a single institution in Taiwan. Pediatr Hematol Oncol 19:19–29CrossRefPubMedGoogle Scholar
  17. 17.
    Liang DC, Hung IJ, Yang CP, Lin KH, Chen JS, Hsiao TC, Chang TT, Pui CH, Lee CH, Lin KS (1999) Unexpected mortality from the use of E. coli L-asparaginase during remission induction therapy for childhood acute lymphoblastic leukemia: a report from the Taiwan Pediatric Oncology Group. Leukemia 13:155–160CrossRefPubMedGoogle Scholar
  18. 18.
    Lin WY, Liu HC, Yeh TC, Wang LY, Liang DC (2008) Triple intrathecal therapy without cranial irradiation for central nervous system preventive therapy in childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 50:523–527CrossRefPubMedGoogle Scholar
  19. 19.
    Landgraf JM, Abetz L, Ware JE (1999) The CHQ User’s manual. HealthAct, Boston, MAGoogle Scholar
  20. 20.
    Waters E, Salmon L, Wake M (2000) The parent-form Child Health Questionnaire in Australia: comparison of reliability, validity, structure, and norms. J Pediatr Psychol 25:381–391CrossRefPubMedGoogle Scholar
  21. 21.
    Wechsler D (1991) Manual for the Wechsler intelligence scale for children, 3rd. Psychological Corp, New YorkGoogle Scholar
  22. 22.
    Sattler J (1992) Assessment of children, revised and updated version. JM Sattler Publisher, Inc, San DiegoGoogle Scholar
  23. 23.
    Wechsler D (1997) Wechsler adult intelligence scale III. Psychological Corporation, San Antonio, TexGoogle Scholar
  24. 24.
    Dwolatzky T, Whitehead V, Doniger GM, Simon ES, Schweiger A, Jaffe D, Chertkow H (2003) Validity of a novel computerized cognitive battery for mild cognitive impairment. BMC Geriatr 3:4CrossRefPubMedGoogle Scholar
  25. 25.
    Lydick E, Epstein RS (1993) Interpretation of quality of life changes. Qual Life Res 2:221–226CrossRefPubMedGoogle Scholar
  26. 26.
    Cohen J (1977) Statistical power analysis for behavioral science (Revised Edition). Academic, New YorkGoogle Scholar
  27. 27.
    Dolgin MJ, Somer E, Buchvald E, Zaizov R (1999) Quality of life in adult survivors of childhood cancer. Soc Work Health Care 28:31–43CrossRefPubMedGoogle Scholar
  28. 28.
    Grant J, Cranston A, Horsman J, Furlong W, Barr N, Findlay S, Barr R (2006) Health status and health-related quality of life in adolescent survivors of cancer in childhood. J Adolesc Health 38:504–510CrossRefPubMedGoogle Scholar
  29. 29.
    Speechley KN, Barrera M, Shaw AK, Morrison HI, Maunsell E (2006) Health-related quality of life among child and adolescent survivors of childhood cancer. J Clin Oncol 24:2536–2543CrossRefPubMedGoogle Scholar
  30. 30.
    Anderson V, Smibert E, Ekert H, Godber T (1994) Intellectual, educational, and behavioural sequelae after cranial irradiation and chemotherapy. Arch Dis Child 70:476–483CrossRefPubMedGoogle Scholar
  31. 31.
    Cousens P, Waters B, Said J, Stevens M (1988) Cognitive effects of cranial irradiation in leukaemia: a survey and meta-analysis. J Child Psychol Psychiatry 29:839–852CrossRefPubMedGoogle Scholar
  32. 32.
    Langer T, Martus P, Ottensmeier H, Hertzberg H, Beck JD, Meier W (2002) CNS late-effects after ALL therapy in childhood. Part III: neuropsychological performance in long-term survivors of childhood ALL: impairments of concentration, attention, and memory. Med Pediatr Oncol 38:320–328CrossRefPubMedGoogle Scholar
  33. 33.
    Said JA, Waters BG, Cousens P, Stevens MM (1989) Neuropsychological sequelae of central nervous system prophylaxis in survivors of childhood acute lymphoblastic leukemia. J Consult Clin Psychol 57:251–256CrossRefGoogle Scholar
  34. 34.
    Buizer AI, de Sonneville LM, van den Heuvel-Eibrink MM, Veerman AJ (2005) Chemotherapy and attentional dysfunction in survivors of childhood acute lymphoblastic leukemia: effect of treatment intensity. Pediatr Blood Cancer 45:281–290CrossRefPubMedGoogle Scholar
  35. 35.
    von der Weid N, Mosimann I, Hirt A, Wacker P, Nenadov Beck M, Imbach P, Caflisch U, Niggli F, Feldges A, Wagner HP (2003) Intellectual outcome in children and adolescents with acute lymphoblastic leukaemia treated with chemotherapy alone: age- and sex-related differences. Eur J Cancer 39:359–365CrossRefPubMedGoogle Scholar
  36. 36.
    Achenbach TM, McConaughy SH, Howell CT (1987) Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull 101:213–232CrossRefPubMedGoogle Scholar
  37. 37.
    Levi RB, Drotar D (1999) Health-related quality of life in childhood cancer: discrepancy in parent-child reports. Int J Cancer Suppl 12:58–64CrossRefPubMedGoogle Scholar
  38. 38.
    Eiser C (1997) Children’s quality of life measures. Arch Dis Child 77:350–354CrossRefPubMedGoogle Scholar
  39. 39.
    Theunissen NC, Vogels TG, Koopman HM, Verrips GH, Zwinderman KA, Verloove-Vanhorick SP, Wit JM (1998) The proxy problem: child report versus parent report in health-related quality of life research. Qual Life Res 7:387–397CrossRefPubMedGoogle Scholar
  40. 40.
    Sawyer M, Antoniou G, Toogood I, Rice M (1999) A comparison of parent and adolescent reports describing the health-related quality of life of adolescents treated for cancer. Int J Cancer Suppl 12:39–45CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Shyh-Shin Chiou
    • 1
  • Ren-Chin Jang
    • 1
  • Yu-Mei Liao
    • 1
  • Pinchen Yang
    • 2
    • 3
  1. 1.Department of Pediatrics, College of MedicineKaohsiung Medical University and Kaohsiung Medical University HospitalKaohsiungTaiwan
  2. 2.Department of Psychiatry, College of MedicineKaohsiung Medical University and Kaohsiung Medical University HospitalKaohsiungTaiwan
  3. 3.Department of PsychiatryKaohsiung Medical University HospitalKaohsiungTaiwan

Personalised recommendations