Longitudinal Assessment of Health-related Quality of Life in Childhood Acute Lymphoblastic Leukemia During Active Treatment in Indonesia

Children with acute lymphoblastic leukemia (ALL) are at risk for poor health-related quality of life (HRQOL) due to the treatment and disease itself. This study presents a serial measurement of the HRQOL of children with ALL during cancer treatment and investigates the impact of demographic, socioeconomic, and medical patient characteristics on their HRQOL. A prospective HRQOL longitudinal study of children with ALL was conducted at an academic hospital between 2016 and 2020. HRQOL was measured using PedsQL 4.0 and PedsQL 3.0 at 3 treatment phases: induction, consolidation, and maintenance. The HRQOL of children 2 to 18 years of age was assessed using a proxy report, and children 5 to 18 years also reported themselves using patient self-report. The comparison scores between subsequent treatment phases of those interviewed in each time measurement were measured using a repeated measures ANOVA test and a post hoc analysis with the Bonferroni test. One hundred thirteen children 5 to 18 years of age and 221 parents participated. The mean age at diagnosis was 6.6±4.0 years. Children had standard-risk ALL (51%) and were boys (56%). The total score of HRQOL and most subscales significantly improved during treatment. Physical health, school functioning, procedural anxiety, and communication were most affected in early treatment. Although all scores improved over time, school functioning and communication remained lower than other subscales. The age classification impacted the improvement of most HRQOL subscales. In conclusion, the HRQOL improved during treatment. Interventions to maintain physical health and reduce procedural anxiety in early treatment are required. Improving health care providers' communication skills and facilitating hospital schooling will ameliorate HRQOL.