Rajagopal Revathi, Raman Nur'Aini, Ong Lai Choo, Foo Jen Chun, Fong Choong Yi
Division of Hematology-Oncology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
Pediatr Hematol Oncol. 2023 Feb;40(1):26-39. doi: 10.1080/08880018.2022.2069895. Epub 2022 May 24.
Pediatric central nervous system tumor survivors (CNSTS) experience late effects that may affect their health-related quality of life (HRQOL). The study aims: i) compare HRQOL among Malaysian CNSTS with acute lymphoblastic leukemia survivors (ALLS) and healthy children, and ii) explore factors associated with low HRQOL. We performed a comparative cross-sectional HRQOL study of 46 CNSTS aged 5-18 years and 90 ALLS (age and gender-matched) who completed treatment for >1 year, and a published cohort of healthy children. Pediatric Quality of Life Inventory (PedsQL) was used for all groups and PedsQL Cancer Module for CNSTS and ALLS. Multiple regression analysis was used to determine factors associated with low HRQOL. Mean PedsQL total scale score, physical health score and psychosocial health score of CNSTS were 69.0 (SD 20.3), 68.7 (SD 27.9) and 69.2 (SD 19.2) respectively. These scores were significantly lower in all domains particularly in teenagers compared with healthy children and ALLS. The median PedsQL Cancer Module score of CNSTS was significantly lower than ALLS in total scale, cognitive problems and communication. Physical impairment was associated with lower PedsQL scores in all 3 domains; special education placement was associated with lower PedsQL total scale and physical health scores and clinically significant internalizing behavioral difficulties score was associated with lower PedsQL psychosocial health scores. CNSTS reported lower PedsQL scores in all domains than ALLS and healthy children. Clinicians need to be vigilant of HRQOL needs among CNSTS, especially those with risk factors of special education needs, physical impairment, and internalizing behavioral difficulties.
小儿中枢神经系统肿瘤幸存者（CNSTS）会经历可能影响其健康相关生活质量（HRQOL）的晚期效应。本研究旨在：i）比较马来西亚CNSTS与急性淋巴细胞白血病幸存者（ALLS）及健康儿童的HRQOL，ii）探究与低HRQOL相关的因素。我们对46名年龄在5至18岁且完成治疗超过1年的CNSTS、90名年龄和性别匹配的ALLS以及一组已发表的健康儿童队列进行了比较性横断面HRQOL研究。所有组均使用儿童生活质量量表（PedsQL），CNSTS和ALLS使用PedsQL癌症模块。采用多元回归分析来确定与低HRQOL相关的因素。CNSTS的PedsQL总量表得分、身体健康得分和心理社会健康得分的均值分别为69.0（标准差20.3）、68.7（标准差27.9）和69.2（标准差19.2）。与健康儿童和ALLS相比，这些得分在所有领域均显著较低，尤其是在青少年中。CNSTS的PedsQL癌症模块得分中位数在总量表、认知问题和沟通方面显著低于ALLS。身体损伤与所有3个领域的PedsQL得分较低相关；特殊教育安置与PedsQL总量表和身体健康得分较低相关，且具有临床意义的内化行为困难得分与PedsQL心理社会健康得分较低相关。CNSTS在所有领域的PedsQL得分均低于ALLS和健康儿童。临床医生需要警惕CNSTS的HRQOL需求，尤其是那些有特殊教育需求、身体损伤和内化行为困难等危险因素的患者。
