Psychosocial Impairment and Lower Quality of Life among Childhood Cancer Survivors in Egypt, Single Institution Experince.

Survival itself has, until recently, been the marker of successful cancer therapy, but now more attention is being focused on the long-term effects of cancer therapy and the quality of life (QOL)of the survivors.

OBJECTIVE: To assess health related quality of life and behavior and emotional problems among childhood cancer survivors at Ain Shams Pediatric Oncology Clinic, Cairo, Egypt.

DESIGN: This study was conducted on 30 childhood cancer survivors attending the cancer survivors’ clinic at Ain Sham Children’s University Hospital in the period of October 2004–April 2005. The PedsQL™ 4.0 Generic Core Scales (physical, emotional, social and, school functioning) translated into Arabic language has been utilized. Parallel child self-report and parent proxy-report questionnaire formats have been used. Items were reverse-scored and linearly transformed to a 0–100 scale, so that higher scores indicate better QOL. Assessment of behavioral and emotional disturbance was performed using The Child Behavior Checklist (CBCL)

Results: Age range 6–16 years with a mean age of 10.7±2.9 years, 18 (60%) were males and 12(40%) were females. Seventeen patients (56.6%) were acute leukemia survivors and 10(43.4%) lymphomas and solid tumors. There was statistically significant (p<0.001) decrease in the overall generic PedsQL in cancer survivors (mean 67±11.6) compared to normal children (mean 83.9±12.5) with school functioning area being the most affected (score 47.5±13). ALL survivors had significantly lower mean QOL (62.5±11.8) compared to other cancer survivors (72.8±8.8) (p<0.05). Gender (females) and CNS-directed therapy were risk factors for poorer QOL. Strong agreement between parents and their children QOL rating was seen in most of the QOL domains {overall QOL (p=0.001) physical well being (p=0.04), emotional feelings (p=0.0004), and social interaction (p=0.003) with the strongest correlation in the school domain (p=0.000004)}. Fifty three percent of the survivors showed clinical range of social incompetence with survivors who were diagnosed before the age of 3 were less socially competent than those who were diagnosed after this age (p<0.05), 63% expressed Internalizing behavioral problems and while 23% had Externalizing problems.

CONCLUSION: This results demonstrate Chidhood cancer survivors are at significant risk of poor psychosocial functioning and QOL.