Speechley Kathy N, Barrera Maru, Shaw Amanda K, Morrison Howard I, Maunsell Elizabeth
Departments of Pediatrics and Epidemiology and Biostatistics, University of Western Ontario and Children's Health Research Institute, London, ON, Canada.
J Clin Oncol. 2006 Jun 1;24(16):2536-43. doi: 10.1200/JCO.2005.03.9628.
The main objective was to compare parent-reported health-related quality of life (HRQL) of child and adolescent survivors of childhood cancer to that of controls who had no history of cancer.
We assessed HRQL of 800 child and adolescent survivors younger than 16 years and 923 randomly selected, age- and sex-matched controls from the general population in a national multicenter retrospective cohort study using the Child Health Questionnaire parent report. Participation was 69% among survivors and 57% among controls.
Survivors had means that were consistently lower than controls on the HRQL physical summary (PH; 49.9 v 55.3; P <.005), psychosocial summary (PS; 49.4 v 52.6; P < .005), and all but one of the eight subscale scores. Clinically important survivor-control differences in means on PH were found for survivors of CNS tumors, bone tumors, lymphoma, leukemia, soft tissue sarcoma and Wilms' tumor (differences: -8.7, -7.0, -6.3, -5.4, -4.4, -3.8/100, respectively); on PS, survivors of CNS tumors were most compromised (-6.1/100). Survivor-control differences in both PH and PS were also large for survivors treated with radiation only (-5.8 and -11.9/100, respectively), or radiation combined with surgery (-6.6 and -5.9/100, respectively), or radiation combined with both surgery and chemotherapy (-7.8 and -5.1/100, respectively). Cranial radiation was associated with the most compromised HRQL.
According to parents, HRQL for survivors was somewhat poorer, overall, than for controls. Survivors of CNS tumors, lymphoma, and leukemia and those patients treated with cranial radiation were reported to have poorest HRQL. These findings support development of guidelines for levels of follow-up care for particular groups of survivors.
主要目标是比较儿童癌症幸存者的父母报告的健康相关生活质量（HRQL）与无癌症病史的对照组的情况。
在一项全国多中心回顾性队列研究中，我们使用儿童健康问卷父母报告评估了800名16岁以下的儿童和青少年幸存者以及923名从普通人群中随机选取的年龄和性别匹配的对照组的HRQL。幸存者的参与率为69%，对照组为57%。
在HRQL身体总结（PH；49.9对55.3；P<.005）、心理社会总结（PS；49.4对52.6；P<.005）以及八个子量表分数中除一个之外的所有分数上，幸存者的均值始终低于对照组。在PH均值上，发现中枢神经系统肿瘤、骨肿瘤、淋巴瘤、白血病、软组织肉瘤和肾母细胞瘤的幸存者与对照组存在具有临床意义的差异（差异分别为：-8.7、-7.0、-6.3、-5.4、-4.4、-3.8/100）；在PS上，中枢神经系统肿瘤的幸存者受损最严重（-6.1/100）。仅接受放疗的幸存者（分别为-5.8和-11.9/100）、接受放疗联合手术的幸存者（分别为-6.6和-5.9/100）或接受放疗联合手术及化疗的幸存者（分别为-7.8和-5.1/100）在PH和PS方面的幸存者与对照组差异也很大。颅脑放疗与最严重受损的HRQL相关。
根据父母的报告，总体而言，幸存者群的HRQL比对照组略差。据报告，中枢神经系统肿瘤、淋巴瘤和白血病的幸存者以及接受颅脑放疗的患者HRQL最差。这些发现支持为特定幸存者群体制定后续护理水平指南。
