Sociodemographic and Medical Determinants of Quality of Life in Long-Term Childhood Acute Lymphoblastic Leukemia Survivors Enrolled in EORTC CLG Studies

Abstract

Background: due to increasing survival rates in childhood acute lymphoblastic leukemia (ALL), the number of survivors has been expanding. A significant proportion of these survivors can experience long-term emotional and psychosocial problems. However, the exact risk factors remain inconclusive. We investigated potential risk factors for decreased daily life quality and life challenges in long-term childhood ALL survivors enrolled between 1971 and 1998 in EORTC studies. Methods: self-report questionnaires were collected from 186 survivors (109 females; mean age at diagnosis 5.62 years, range 0.2–14.7; median time since diagnosis of 20.5 years (12.9–41.6)), including the Short-Form Health Survey (SF-12) and Impact of Cancer-Childhood Survivors (IOC-CS). Multivariable linear regression models were used to assess the impact of gender, age at diagnosis, relapse/second neoplasm, National Cancer Institute (NCI) risk group and cranial radiotherapy on 2 subscales of the SF-12 (physical and mental health) and five subscales of the IOC-CS (life challenges, body and health, personal growth, thinking and memory problems and socializing). Results: mental component scores of SF-12 were not significantly associated with any risk factor. Physical component scores were lower in relapsed, irradiated and NCI high-risk patients. Regarding IOC-CS negative impact subscales, life challenges was more negatively impacted by cancer in female, younger (i.e., <6 years) and relapsed patients. Regarding the positive impact scales, personal growth was more positively impacted in relapsed patients, whereas body and health, and socializing, were less positively impacted in these patients, compared to non-relapsed patients. Socializing was more positively impacted in older patients (>6 years). Conclusions: this study demonstrates that long-term outcomes can be both adverse and positive, depending on the patient’s demographic and clinical characteristics. Younger, female, and relapsed patients might encounter more life challenges years after their disease, while physical challenges could occur more often in relapsed and high-risk patients. Finally, the positive effect on socializing in the older patients sheds new light on the importance of peer interactions for this subgroup. Specific individual challenges thus need specialized support for specific subgroups.

Quality of life of adolescent and adult survivors of childhood cancer in Europe—A systematic review

“…Survivors' age at diagnosis was not correlated with QoL in most studies 19,23,24,30,31,35,36,41,42,46,49,53 . In four studies, however, older age at diagnosis was associated with lower QoL 22,29,44,52 .…”

“…In a third study, survivors aged 18‐25 were at higher risk of impaired PCS than survivors aged 46‐55 22 . Female survivors reported worse QoL in seven studies 19,22,24,28,30,42,52 and better QoL in two 31,45 ; gender was not associated with QoL in other studies 23,29,32,36,41,46,47,53 . Higher educational achievement 22,28,32,44,51,52 and being employed 32,47,52,53 were generally correlated with better QoL and PF.…”

“…In a different study, survivors of haematological cancers treated with HSCT reported poorer physical functioning than survivors of other cancers 19 . Treatment intensity, 30,46,53 time since diagnosis, 19,23,31,32,44,46,53 tumour stage 53 and relapse status 23,24,31,44,46 did not affect QoL in most studies, but some found that intensive treatment was related to worse mental scores, 42,44 that longer time since diagnosis resulted in greater VT and MH 45 and that a higher tumour stage was associated with poorer QoL 41,42,51 . Conflicting results were found with regard to relapse status.…”

Associations between cancer‐related distress and fatigue in childhood cancer survivors: A longitudinal study

“…Another possible explanation is that younger, female patients might experience more life challenges (i.e. sexuality, intimate relationships, job opportunities, household) years after their disease 39 . Furthermore, they also reported higher levels of fatigue.…”

Psychological Well-Being, Cognitive Functioning, and Quality of Life in 205 Adolescent and Young Adult Childhood Cancer Survivors Compared to Healthy Peers

“…An interesting fact, that emerged from studies on quality of life, was linked to age at the time of diagnosis: those who were older at the time of diagnosis later reported more depressive symptoms and higher levels of stress ( Kazak et al, 2010 ; Zebrack et al, 2012 ), while younger (< 6 years old), female, and relapsed patients might encounter more life challenges after their disease ( Sleurs et al, 2022 ).…”