de Vries Machteld A G, van Litsenburg Raphaële R L, Huisman Jaap, Grootenhuis Martha A, Versluys A Birgitta, Kaspers Gert Jan L, Gemke Reinoud J B J
Department of Paediatrics and Division of Oncology-Haematology, VU University Medical Centre, Amsterdam, The Netherlands.
Health Qual Life Outcomes. 2008 Nov 26;6:103. doi: 10.1186/1477-7525-6-103.
Glucocorticoids are important in the treatment of childhood acute lymphoblastic leukaemia (ALL). However, cyclic administration of high dose glucocorticoids may cause rapid and substantial changes in quality of life (QoL). The maintenance phase of the Dutch ALL-9 protocol consisted of alternating two weeks on and five weeks off dexamethasone (6 mg/m(2)/day). The present study was performed to assess the effect of dexamethasone on QoL during treatment for ALL according to this protocol.
In a multicentre prospective cohort study, QoL was assessed halfway (T1) and at the end of the two-year treatment (T2). A generic (Child Health Questionnaire) and disease specific (PedsQL cancer version) QoL questionnaire were used to assess QoL in two periods: on and off dexamethasone, respectively.
41 children (56% males) were evaluated, mean age at diagnosis was 5.6 years. The CHQ physical and psychosocial summary scores were significantly lower than population norms. At T1 and T2, overall QoL showed no significant change. However, regarding specific domains (pain, cognitive functioning, emotion/behaviour and physical functioning) QoL decreased over time. QoL was significantly more impaired during periods on dexamethasone.
Dexamethasone was associated with decreased QoL. At the end of treatment, reported QoL during dexamethasone deteriorated even more on certain scales (pain, cognitive functioning, emotion/behaviour and physical functioning). Knowledge of the specific aspects of QoL is essential to improve counselling and coping in paediatric oncology. Adverse effects of specific drugs on QoL should be taken into account when designing treatment protocols.
糖皮质激素在儿童急性淋巴细胞白血病（ALL）的治疗中起着重要作用。然而，高剂量糖皮质激素的周期性给药可能会导致生活质量（QoL）迅速且大幅变化。荷兰ALL - 9方案的维持阶段包括地塞米松（6 mg/m²/天）交替使用两周和停药五周。本研究旨在根据该方案评估地塞米松在ALL治疗期间对生活质量的影响。
在一项多中心前瞻性队列研究中，在治疗的两年期中途（T1）和结束时（T2）评估生活质量。使用一份通用的（儿童健康问卷）和一份疾病特异性的（儿童生活质量量表癌症版）生活质量问卷，分别在服用地塞米松期间和停药期间这两个时间段评估生活质量。
对41名儿童（56%为男性）进行了评估，诊断时的平均年龄为5.6岁。儿童健康问卷的身体和心理社会总结分数显著低于总体标准。在T1和T2时，总体生活质量没有显著变化。然而，就特定领域（疼痛、认知功能、情绪/行为和身体功能）而言，生活质量随时间下降。在服用地塞米松期间，生活质量受损更显著。
地塞米松与生活质量下降有关。在治疗结束时，服用地塞米松期间报告的生活质量在某些量表（疼痛、认知功能、情绪/行为和身体功能）上恶化得更严重。了解生活质量的具体方面对于改善儿科肿瘤学中的咨询和应对至关重要。在设计治疗方案时应考虑特定药物对生活质量的不良影响。
