Purpose: To identify associations between specific therapy-related events such as length of hospitalization and neuropathic pain with health-related quality of life (HRQOL) outcomes for children with acute lymphoblastic leukemia and lymphoblastic lymphoma.
Hypothesis: In children (ages 2 – 30 years) with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma, poor health-related quality of life (HRQOL) scores as measured by the PedsQL modules during low-intensity “maintenance” therapy are significantly associated with increased care measures during the initial phases of therapy, including prolonged hospitalization and use of narcotics or neuropathic pain medications.
Specific Aims:
1.To evaluate the relationship between extended hospitalization time (as defined by total days or weeks admitted, or by number of unanticipated admissions) during intensive phases of therapy, and HRQOL scores during maintenance therapy in children ages 2 years and older with ALL or lymphoblastic lymphoma.
2. To evaluate the relationship between increased supportive care for pain by use of patient-controlled analgesia (PCA), long acting oral narcotics, or the use of neuropathic pain medications during therapy, and HRQOL scores during maintenance therapy in children ages 2 years and older with ALL or lymphoblastic lymphoma.
Methods: A cross-sectional single institution pilot study was performed for children with ALL or lymphoblastic lymphoma who had reached maintenance therapy or had recently completed treatment. HRQOL scores were obtained using the PedsQL 4.0 Generic Core Scales and PedsQL 3.0 Cancer Module, and retrospective chart review was performed for each patient.
Results: 57 subjects were available for analysis. Multiple regression analysis found that longer total time of hospitalization correlated with poorer overall PedsQL 4.0 summary scores (p = 0.002). Age, time since the start of maintenance therapy, and the number of unscheduled hospitalizations were independently prognostic for physical scores. The use of neuropathic pain medications was strongly associated with poorer social functioning scores (OR 4.58, p = 0.03), the number of weeks hospitalized also negatively influenced social scores (OR 0.90, p = 0.04).
Conclusions: Specific therapy-related events can predict changes in HRQOL outcomes for children and adolescents with ALL and lymphoblastic lymphoma. Future research should include prospective evaluations of HRQOL outcomes throughout therapy and determine what interventions may improve HRQOL outcomes.