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- Title
Multilevel Characteristics of Cumulative Symptom Burden in Young Survivors of Childhood Cancer.
- Authors
Horan, Madeline R.; Srivastava, Deo Kumar; Choi, Jaesung; Krull, Kevin R.; Armstrong, Gregory T.; Ness, Kirsten K.; Hudson, Melissa M.; Baker, Justin N.; Huang, I-Chan
- Abstract
Key Points: Question: What are the prevalence and factors associated with symptom burden in young (aged 8-18 years) childhood cancer survivors? Findings: In this cohort study of 302 young childhood cancer survivors, 38% of the survivors experienced moderate or high global cumulative symptom burden. Self-reported caregiver anxiety and neighborhood-level/census-track–based deprivation were associated with greater survivor-reported global symptom burden, while meaning and purpose was a protective factor. Meaning: The findings of this study suggest that symptoms are prevalent years after young childhood cancer survivors' initial cancer diagnosis, and interventions to reduce caregiver anxiety and neighborhood adversity and improve resilience may alleviate symptom burden. Importance: Symptom burden and its characteristics among survivors of pediatric cancers aged 8 to 18 years remain understudied. Objective: To examine the prevalence of symptom burden among young childhood cancer survivors and identify associations with sociodemographic, clinical, and psychological resilience skills, and health-related quality of life (HRQOL). Design, Setting, and Participants: A cross-sectional analysis using data collected from November 1, 2017, to January 31, 2019, in a survivorship clinic at a US-based comprehensive cancer center was conducted. Participants included 302 dyads of children aged 8 to 18 years who survived at least 5 years beyond diagnosis and their primary caregivers. Data analysis was performed from March 13, 2023, to February 29, 2024. Exposures: Diagnosis, caregiver-reported family conflict, self-reported caregiver anxiety, neighborhood-level social vulnerability, and survivor-reported meaning and purpose. Main Outcomes and Measures: Novel symptom-level burden, integrating the attributes of severity and daily activity interference using the pediatric version of the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events, global cumulative symptom burden, and HRQOL using the EuroQol-5D. Multinomial logistic regression identified characteristics associated with symptom burden; linear regression assessed symptom burden and HRQOL associations. Results: Among 302 survivors (mean [SD] age, 14.2 [2.9] years, mean [SD] time since diagnosis, 10.9 [2.9] years; 153 [50.7%] male), 186 (62.0%) had low, 77 (25.7%) moderate, and 37 (12.3%) high global cumulative symptom burden. Greater caregiver anxiety was associated with moderate (risk ratio [RR], 1.56; 95% CI, 1.09-2.24) global symptom burden. Greater neighborhood deprivation was associated with moderate global symptom burden (RR, 4.86; 95% CI, 1.29-18.26). Survivors with greater meaning/purpose were less likely to have moderate (RR, 0.42; 95% CI, 0.29-0.61) and high (RR, 0.27; 95% CI, 0.16-0.46) global symptom burden. The burden of individual symptoms displayed similar patterns. Low (Cohen d, −0.60; 95% CI, −0.87 to −0.32) and moderate/high (d, −0.98; 95% CI, −1.53 to −0.43) general pain, moderate/high numbness (d, −0.99; 95% CI, −1.69 to −0.29), and moderate/high worry (d, −0.55; 95% CI, −0.99 to −0.11) were associated with lower HRQOL. Conclusions and Relevance: In this cross-sectional study of young childhood cancer survivors, symptom burden was prevalent. Caregiver anxiety and disparity-related neighborhood factors were associated with greater symptom burden, whereas meaning and purpose was a protective factor. Greater specific symptom burden contributed to poorer HRQOL. The findings suggest that interventions targeting resilience and neighborhood adversity may alleviate symptom burden and improve HRQOL. This cross-sectional study examines the factors associated with symptom burden and health-related quality of life in 5-year survivors of childhood cancer.
- Subjects
UNITED States; PSYCHOLOGICAL resilience; CROSS-sectional method; CANCER treatment; LIFE; TUMORS in children; RESEARCH funding; FAMILY conflict; QUESTIONNAIRES; LOGISTIC regression analysis; MULTIPLE regression analysis; SYMPTOM burden; DECISION making; DESCRIPTIVE statistics; ANXIETY; QUALITY of life; CANCER patient psychology; SOCIODEMOGRAPHIC factors; CONFIDENCE intervals; PSYCHOLOGY of caregivers; DATA analysis software; SPECIALTY hospitals; NEIGHBORHOOD characteristics; SYMPTOMS; ADOLESCENCE; CHILDREN
- Publication
JAMA Network Open, 2024, Vol 7, Issue 1, pe2410145
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.10145