期刊
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
卷 52, 期 2, 页码 243-253出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jpainsymman.2016.04.002
关键词
Quality of life; pediatric cancer; palliative care; end of life; patient-reported outcomes; symptom distress
资金
- NIH/NCI [1K07 CA096746-01, L40 CA170049]
- Charles H. Hood Foundation Child Health Research Award
- American Cancer Society
- NIH/NCATS [KL2 TR000421]
Context. Modifiable factors of health-related quality of life (HRQOL) are poorly described among children with advanced cancer. Symptom distress may be an important factor for intervention. Objectives. We aimed to describe patient-reported HRQOL and its relationship to symptom distress. Methods. Prospective, longitudinal data from the multicenter Pediatric Quality of Life and Symptoms Technology study included primarily patient-reported symptom distress and HRQOL, measured at most weekly with the Memorial Symptoms Assessment Scale and Pediatric Quality of Life inventory, respectively. Associations were evaluated using linear mixed-effects models adjusting for sex, age, cancer type, intervention arm, treatment intensity, and time since disease progression. Results. Of 104 enrolled patients, 49% were female, 89% were white, and median age was 12.6 years. Nine hundred and twenty surveys were completed over nine months of follow-up (84% by patients). The median total Pediatric Quality of Life score was 74 (interquartile range 63-87) and was ``poor/ fair'' (e.g., <70) 38% of the time. ``Poor/ fair'' categories were highest in physical (53%) and school (48%) compared to emotional (24%) and social (16%) subscores. Thirteen of 24 symptoms were independently associated with reductions in overall or domain-specific HRQOL. Patients commonly reported distress from two or more symptoms, corresponding to larger HRQOL score reductions. Neither cancer type, time since progression, treatment intensity, sex, nor age was associated with HRQOL scores in multivariable models. Among 25 children completing surveys during the last 12 weeks of life, 11 distressing symptoms were associated with reductions in HRQOL. Conclusion. Symptom distress is strongly associated with HRQOL. Future research should determine whether alleviating distressing symptoms improves HRQOL in children with advanced cancer. (C) 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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