Pediatric Patient-Reported Quality of Life Before and after Radiotherapy: A Prospective Registry Study.

Abstract

PURPOSE/OBJECTIVE(S)\nModern radiotherapy (RT) technologies strive to effectively treat pediatric cancers while minimizing impact on quality of life (QoL). We hypothesized that with contemporary RT and supportive cares, most children maintain QoL during RT, but certain patient or treatment factors may be associated with clinically meaningful changes in QoL and require increased attention.\n\n\nMATERIALS/METHODS\nWe utilized a prospective QoL registry and reviewed clinical data for pediatric patients treated with RT from 2015- 2019 at two institutions. PedsQL™ Pediatric Quality of Life Inventory surveys were completed by patients or parents at the start (pre-RT) and completion of RT (post-RT). QoL scores were compared to a healthy child score of 83 +/-14.8. Changes in QoL from pre-RT to post-RT and differences in QoL between groups were compared to a minimal clinically important difference (MCID) of 4.4.\n\n\nRESULTS\nOf 177 pediatric patients treated during the study period, 141 (80%) completed QoL surveys at any time point, and 79 (44%) completed both pre-RT and post-RT surveys. Sensitivity analyses showed patients who didn t complete post-RT surveys were not more likely to have post-RT physician-assessed grade 2+ toxicity. Of the 79 who completed both surveys, 19 (24%) were treated with craniospinal irradiation (CSI), 18 (23%) were treated with non-CSI CNS radiation, and 42 (53%) were treated for extracranial disease. Seventy-four patients (94%) received protons. Pre-RT, 53% of patients had total QoL scores within the healthy child range (healthy QoL), compared to 59% post-RT. From pre-RT to post-RT, only 7 patients (8%) had QoL scores drop from healthy to unhealthy QoL, while 12 (15%) improved from unhealthy to healthy, 35 (44%) remained healthy, and 25 (32%) remained unhealthy. For patients who received CSI, 58% had healthy QoL pre-RT, compared to 63% post-RT. Patients receiving chemotherapy prior to RT were more likely to have unhealthy QoL pre-RT (P < 0.001), and those receiving concurrent chemotherapy were more likely to have unhealthy QoL post-RT (P\u202f=\u202f0.002). For the entire cohort, there was no significant change in QoL from pre-RT to post-RT (median change +1.6, IQR -5.9-+11.9, P\u202f=\u202f0.880 for MCID). Thirty-four patients (43%) met the MCID for improvement in QoL during treatment, while 22 (28%) met the MCID for decline in QoL. No patient or treatment factors, including race, ethnicity, disease stage, insurance status, prior surgery, total radiation dose or fractions, or daily anesthesia were associated with worsening of QoL from pre-RT to post-RT.\n\n\nCONCLUSION\nWith modern RT techniques and supportive care, there was no statistically or clinically significant decline in pediatric QoL during RT, with almost 60% of patients falling within the healthy child range at the end of RT. Chemotherapy prior to and during RT appears to impact QoL, and these patients should be counseled and monitored carefully.