Health-related quality of life in long-term survivors of relapsed childhood acute lymphoblastic leukemia

Stefan Essig, Nicolas X von der Weid, Marie-Pierre F Strippoli, Cornelia E Rebholz, Gisela Michel, Corina S Rueegg, Felix K Niggli, Claudia E Kuehni, Swiss Pediatric Oncology Group (SPOG), R Ammann, R Angst, M Beck Popovic, P Brazzola, J Greiner, H Hengartner, T Kuehne, K Leibundgut, F Niggli, L Nobile Buetti, A H Ozsahin, J Rischewski, M Grotzer, N von der Weid, Stefan Essig, Nicolas X von der Weid, Marie-Pierre F Strippoli, Cornelia E Rebholz, Gisela Michel, Corina S Rueegg, Felix K Niggli, Claudia E Kuehni, Swiss Pediatric Oncology Group (SPOG), R Ammann, R Angst, M Beck Popovic, P Brazzola, J Greiner, H Hengartner, T Kuehne, K Leibundgut, F Niggli, L Nobile Buetti, A H Ozsahin, J Rischewski, M Grotzer, N von der Weid

Abstract

Background: Relapses occur in about 20% of children with acute lymphoblastic leukemia (ALL). Approximately one-third of these children can be cured. Their risk for late effects is high because of intensified treatment, but their health-related quality of life (HRQOL) was largely unmeasured. Our aim was to compare HRQOL of ALL survivors with the general population, and of relapsed with non-relapsed ALL survivors.

Methodology/principal findings: As part of the Swiss Childhood Cancer Survivor Study (SCCSS) we sent a questionnaire to all ALL survivors in Switzerland who had been diagnosed between 1976-2003 at age <16 years, survived ≥5 years, and were currently aged ≥16 years. HRQOL was assessed with the Short Form-36 (SF-36), which measures four aspects of physical health and four aspects of mental health. A score of 50 corresponded to the mean of a healthy reference population. We analyzed data from 457 ALL survivors (response: 79%). Sixty-one survivors had suffered a relapse. Compared to the general population, ALL survivors reported similar or higher HRQOL scores on all scales. Survivors with a relapse scored lower in general health perceptions (51.6) compared to those without (55.8;p=0.005), but after adjusting for self-reported late effects, this difference disappeared.

Conclusion/significance: Compared to population norms, ALL survivors reported good HRQOL, even after a relapse. However, relapsed ALL survivors reported poorer general health than non-relapsed. Therefore, we encourage specialists to screen for poor general health in survivors after a relapse and, when appropriate, specifically seek and treat underlying late effects. This will help to improve patients' HRQOL.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Participant status of acute lymphoblastic…
Figure 1. Participant status of acute lymphoblastic leukemia survivors in the Swiss Childhood Cancer Survivor Study.
As of May 19, 2011. *of those traced and sent questionnaire. ALL: acute lymphoblastic leukemia; SF-36: Short Form-36.
Figure 2. Short Form-36 scales, in all…
Figure 2. Short Form-36 scales, in all survivors and by relapse status, adjusted results.
Full model, adjusted for gender, current age, time since diagnosis, having a partner, education, chemo−/radiotherapy, bone marrow transplantation, duration of therapy, and self-reported late effects; German population norm used. SF-36: Short Form-36.

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