HealthPartners Institute for Education and Research, Minneapolis, MN, USA; University of Minnesota Medical School, Minneapolis, MN, USA.
Psychooncology. 2014 Jun;23(6):692-9. doi: 10.1002/pon.3470. Epub 2014 Feb 4.
Neurocognitive late effects after childhood acute lymphoblastic leukemia (ALL) are well-documented, but their impact on quality of life (QOL) is not well understood. In this multi-site study, we examined the relative influence of neurocognitive functioning, steroid randomization (prednisone vs. dexamethasone), and demographic characteristics on QOL in first-remission survivors of childhood ALL.
Participants included 263 ALL survivors (ages 7-17 years at the time of evaluation; mean age at diagnosis 3.9 years) who were treated on similar legacy Children's Cancer Group chemotherapy protocols and did not receive cranial radiation. Children completed detailed neuropsychological performance tests. The Pediatric QOL Inventory was completed by children and their parents. Participants were a mean of 9 years from diagnosis at the time of assessment (with a range of 4 to 13 years).
Children and their parents reported lower mean child psychosocial QOL than healthy population norms (p < 0.05), but were not in the impaired range. Physical QOL was similar to population norms. Though neurocognitive difficulties were predominantly mild for the sample as a whole, neurocognitive deficits, specifically problems in verbal cognitive abilities and visual-motor integration skills, were significantly associated with poor physical (p < 0.01) and Psychosocial QOL (p < 0.01). QOL was not associated with previous steroid randomization.
ALL survivors with neurocognitive deficits are at risk for poor QOL, with broad implications for their physical, social, and school functioning.
儿童急性淋巴细胞白血病（ALL）后神经认知的晚期效应已有充分的记录，但它们对生活质量（QOL）的影响尚未得到很好的理解。在这项多中心研究中，我们研究了神经认知功能、类固醇随机化（泼尼松与地塞米松）以及人口统计学特征对儿童 ALL 初缓解幸存者 QOL 的相对影响。
参与者包括 263 名 ALL 幸存者（评估时年龄为 7-17 岁；诊断时平均年龄为 3.9 岁），他们接受了类似的儿童癌症组化疗方案治疗，未接受颅部放疗。儿童完成了详细的神经心理表现测试。儿科生活质量问卷由儿童及其父母完成。参与者在评估时平均距离诊断 9 年（范围为 4 至 13 年）。
儿童及其父母报告的儿童心理社会生活质量平均值低于健康人群的正常值（p<0.05），但未处于受损范围。身体生活质量与人群正常值相似。尽管整个样本的神经认知困难主要为轻度，但神经认知缺陷，特别是在言语认知能力和视觉运动整合技能方面的问题，与较差的身体（p<0.01）和心理社会生活质量（p<0.01）显著相关。生活质量与先前的类固醇随机化无关。
有神经认知缺陷的 ALL 幸存者存在生活质量差的风险，对其身体、社交和学校功能都有广泛的影响。
