Large Improvements in Health-Related Quality of Life and Physical Fitness during Multidisciplinary Inpatient Rehabilitation for Pediatric Cancer Survivors

Abstract

Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric cancer survivors. The aim of this study was to present data from a multidisciplinary inpatient rehabilitation treatment. Children took part in a four-week multidisciplinary family-oriented inpatient rehabilitation. A total of 236 children (>5–21 years) and 478 parents routinely completed electronic patient-reported outcomes (ePROs), performance-based assessments, and clinician-rated assessments before (T1) and at the end (T2) of rehabilitation. HRQOL was assessed with the PedsQL generic core and PedsQL cancer module. Data were analyzed using repeated measures analysis of variance (ANOVA). Statistically significant improvements with medium to large effect sizes were observed for most HRQOL scales (η2 = 0.09–0.31), as well as performance-based and clinician-rated assessments for physical activity and functional status (η2 > 0.28). Agreement between children’s PROs and parents’ proxy ratings was lower before (rICC = 0.72) than after (rICC = 0.86) rehabilitation. While the concordance between children and parents’ assessment of changes during rehab was low to moderate (r = 0.19–0.59), the use of the performance score led to substantially increased scores (r = 0.29–0.68). The results of this naturalistic observational study thus highlight the benefits of multidisciplinary pediatric inpatient rehabilitation for childhood cancer survivors. The use of the performance score is recommended in this field.

Disagreement between mothers' and fathers' rating of health-related quality of life in children with cancer

“…Children consistently reported fewer impairments than their parents, particularly one month following cancer therapy. This seems to be the main reason for disagreement between patients and parents and is in accordance with other studies showing that caregivers have the tendency to overestimate their children’s HRQOL impairments [ 20 , 23 , 37 – 39 ]. The PedsQL Generic for general HRQOL showed mainly moderate and good agreement shortly after diagnosis and agreement remained only on the physical domain with ongoing therapy.…”

Mentalizing and epistemic trust as critical success factors in psychosomatic rehabilitation: results of a single center longitudinal observational study

“…Since we found a substantial variation in mentalizing at baseline, the performance score (T2D) was used in the SEM model. The T2D is a simple method to correct for baseline differences (46), which allows to use baseline corrected variables in SEM models and has been shown to facilitate interpretability in various fields of rehabilitation research (42,43,47,48). Moreover, we investigated additional factors that may be associated with the improvement of mentalizing in psychosomatic rehabilitation.…”

Incidence and prevalence of musculoskeletal health conditions in survivors of childhood and adolescent cancers: A report from the Swiss childhood cancer survivor study

“…The goal of rehabilitation is to improve physical functioning, 39 as well as prevention of secondary complications that can occur in persons with MSHC, for example, back pain, low‐trauma fractures, or gait abnormalities 14,15 . Several studies have highlighted the importance of rehabilitation in mitigating the impact of the cancer treatment and improving physical functioning of survivors 16,40,41 . Even though guidelines recommend an assessment of children and adolescents with cancer by a rehabilitation professional, 42 evidence suggests that rehabilitation services are currently underutilised in this population 43–46 .…”

“…14 , 15 Several studies have highlighted the importance of rehabilitation in mitigating the impact of the cancer treatment and improving physical functioning of survivors. 16 , 40 , 41 Even though guidelines recommend an assessment of children and adolescents with cancer by a rehabilitation professional, 42 evidence suggests that rehabilitation services are currently underutilised in this population. 43 , 44 , 45 , 46 Therefore, it is important to assess MSHCs in survivors during follow‐up care, as follow‐up care providers can initiate referral to rehabilitation services if indicated.…”