Association Between Prevalence of Symptoms and Impaired Health-Related Quality of Life in Adult Survivors of Childhood Cancer
In a study reported in the Journal of Clinical Oncology, I-Chan Huang, PhD, of University of Florida at Gainesville, and colleagues investigated the association between prevalence of symptoms and health-related quality of life in adult survivors of childhood cancer enrolled in the St. Jude Lifetime Cohort study. They found a high prevalence of symptoms, which were associated with impaired health-related quality of life.
Study Details
The study included patients with childhood malignancy treated at St. Jude Children's Research Hospital, survival ≥ 10 years from diagnosis, and current age ≥ 18 years. Symptoms were self-reported using a comprehensive health questionnaire and categorized into 12 classes: cardiac; pulmonary; motor/movement; pain in head; pain in back/neck; pain involving sites other than head, neck, and back; sensation abnormalities; disfigurement; learning/memory; anxiety; depression; and somatization. Health-related quality of life was measured by the physical component summary (PCS) and mental component summary (MCS) and six domain scores of the Medical Outcomes Study 36-Item Short-Form Health Survey (physical functioning, role limitations resulting from physical health problems, general health perceptions, vitality, social functioning, and role limitations resulting from emotional problems).
Among 1,667 survivors (response rate = 65%), mean age was 34 years, 51.5% were women, 84% were white, and mean time from diagnosis was 25.5 years. Cancer diagnosis included central nervous system tumors (8%), leukemia (47%), lymphoma (18.5%), and solid tumors (26.5%). Treatments included chemotherapy (88%), radiotherapy (66%), and amputation (4%).
Symptom Classes
Pain involving sites other than head, neck, and back (59%); disfigurement (56%); pain in back/neck (48.5%); pain in head (36%); and sensation abnormalities (34%) were the most frequently reported symptom classes. Most patients were affected by multiple symptom classes, with 17% reporting two symptom classes, 17.5% reporting three, 12% reporting four, and 11% reporting five.
Overall, each symptom class was significantly associated with impaired PCS and MCS (P < .05), except pulmonary symptoms with MCS. Participants with higher education levels had better PCS and MCS. Chemotherapy and radiotherapy were significantly associated with impaired PCS but not MCS (P < .05).
Association With Impaired Health-Related Quality of Life
Greater symptom prevalence was associated with poorer health-related quality of life. In multivariable analysis, symptom classes explained up to 60% of the variance in PCS and 56% of the variance in MCS, whereas demographic and clinical variables explained up to 15% and 10% of variance, respectively.
The prevalences of cardiac symptoms; motor/movement problems; pain involving sites other than head, neck, and back; sensation abnormalities; disfigurement; depression; and somatization were significantly associated with impairment in the majority of health-related quality-of-life domains. Pain involving sites other than head, neck, and back; sensation abnormalities; disfigurement; learning/memory problems; and somatization were associated with impairment in all six health-related quality-of-life domains (all P < .05).
Cardiac symptoms and motor/movement problems were associated with impaired physical aspects of health-related quality of life (physical functioning, role limitations resulting from physical health problems, and general health perceptions, all P < .05). Anxiety and depression were associated with impaired mental aspects of health-related quality of life (vitality, social functioning, and role-emotional, all P < .05).
Longer time since diagnosis was associated with higher cumulative prevalence in all symptom classes. For all symptoms, the prevalence increased significantly from year 10 to 30, with the increase slowing thereafter.
The investigators concluded: “[A] large proportion of survivors … suffer from a variety of symptoms that adversely impact [health-related quality of life]. Measuring symptoms alone without measuring [health-related quality of life] or vice versa may result in failure to understand the full impact of cancer and its treatment. Appropriate interventions that target specific symptoms may improve survivors’ [health-related quality of life].”
The study was supported by National Cancer Institute and National Institute of Child Health and Human Development grants and by the American Lebanese Syrian Associated Charities.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
