Examining health-related quality of life in pediatric cancer patients with febrile neutropenia: Factors predicting poor recovery in children and their parents

Abstract

Background The impact febrile neutropenia (FN) has on the health-related quality of life (HRQoL) of children with cancer and their families is poorly understood. We sought to characterize the course of child and parent HRQoL during and following FN episodes. Method Data on HRQoL were collected in the multisite Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study. Participants were enrolled between November 2016 to January 2018. The Child Health Utility (CHU9D) was used to assess HRQoL in children ( N = 167 FN events) and the Assessment of Quality of Life (AQoL-8D) was used to assess HRQoL parents ( N = 218 FN events) at three time points: 0–3 days, 7-days and 30-days following the onset of FN. Group-based trajectory modeling (GBTM) was used to characterize the course of HRQoL. Findings For children, three distinct groups were identified: persistently low HRQoL over the 30-day course of follow-up (chronic: N = 78/167; 47%), increasing HRQoL after the onset of FN to 30 days follow-up (recovering: N = 36/167; 22%), and persistently high HRQoL at all three timepoints (resilient: N = 53/167; 32%). Applying these definitions, parents were classified into two distinct groups: chronic ( N = 107/218, 49%) and resilient ( N = 111/218, 51%). The child being male, having solid cancer, the presence of financial stress, and relationship difficulties between the parent and child were significant predictors of chronic group membership for both parents and children. Children classified as high-risk FN were significantly more likely to belong to the recovery group. Being female, having blood cancers and the absence of financial or relationship difficulties were predictive of both parents and children being in the resilient group. Interpretation Approximately half the children and parents had chronically low HRQoL scores, which did not improve following resolution of the FN episode. The child's sex, cancer type, and presence of financial and relationship stress were predictive of chronic group membership for both parents and children. These families may benefit from increased financial and psychosocial support during anti-cancer treatment. Funding National Health and Medical Research Council Grant (APP1104527).

Febrile illness in high-risk children: a prospective, international observational study

“…We do not have sufficient evidence to effectively alter current practice [ 35 , 39 , 40 ]. Immunocompromised children remain frequently hospitalised for intravenous antibiotic treatment, which has a negative impact on patient and family quality of life [ 17 ].…”

“…This approach has led to a significant reduction in mortality and morbidity [ 15 ], but consequently antibiotic overuse, increased risk of antimicrobial resistance, and prolonged hospitalisation. Fever accounts for 60.2% of emergency department (ED) attendance in paediatric cancer [ 16 ] and is a significant burden for caregivers [ 17 ] and healthcare systems. Commonly used biomarkers such as C-reactive protein (CRP) and procalcitonin aid the diagnostic process, but are often not sensitive enough to rule out bacterial infection [ 18 , 19 ].…”

Health utility of children with acute lymphoblastic leukemia in China

“…Unexpectedly, disease severity was found not associated with health utility regardless of adjustment for other influencing factors. Unlike other types of childhood cancer ( 10 , 33 ), disease severity of pALL was not so much about symptoms or clinical presentation, but rather determined by molecular measurements in order to guide treatment. Nevertheless, patients with intermediate or high-risk ALL received more intensive chemotherapy than those with low risk mainly during induction and consolidation phases, hence they were more likely to have adverse events and consequently lower health utility.…”

An analysis of the resource use and costs of febrile neutropenia events in pediatric cancer patients in Australia

“…These events are typically managed in-hospital using intravenous antibiotics, with the duration depending on blood culture results, fever resolution, a rising neutrophil count, and underlying cancer treatment status. 1 Available data indicate unplanned admissions due to FN represent a high burden in terms of their impact on patient and caregiver quality of life 2 and an increased use of healthcare resources. 3 Patients experiencing an FN event, including in the pediatric setting, are heterogeneous and have different risk factors impacting prognosis and outcomes.…”