柳叶刀 中性粒细胞减少症的儿童癌症患者的健康相关生活质量

       

背景:


发热性中性粒细胞减少症(FN)对癌症儿童及其家庭的健康相关生活质量(HRQoL)的影响还知之甚少。研究者试图描述儿童和家长在FN发作期间和之后的HRQL过程。


方法:


有关HRQL的数据是在多点澳大利亚癌症儿童感染性并发症预测研究(PICNICC)中收集的。参与者是在2016年11月至2018年1月期间登记的。分别于发病后0~3天、7天和30天用儿童健康实用量表(CHU9D)和生活质量评定量表(AQoL-8D)评定儿童(N=167个FN事件)和父母(N=218个FN事件)的HRQL。使用基于群体的轨迹建模(GBTM)来描述HRQL的过程。


结果:


对于儿童,确定了三个不同的组:在30天的随访过程中持续较低的HRQOL(慢性:78/167;47%),在FN发病后至30天的随访中持续提高HRQOL(恢复:36/167;22%),以及在所有三个时间点持续较高的HRQOL(弹性:53/167;32%)。根据这些定义,父母被分为两个不同的组:慢性(N=107/218,49%)和韧性(N=111/218,51%)。孩子是男性、患有实体癌、存在经济压力以及父母和孩子之间的关系困难是父母和孩子成为慢性群体成员的重要预测因素。被归类为高危FN的儿童明显更有可能属于恢复组。女性、患有血癌、没有经济或人际关系困难都预示着父母和孩子都属于弹性群体。

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图1  儿童0的HRQL的预测值(虚线)和实际值(实线)。FN发作后1天、7天和30天

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图1  儿童0的HRQL的预测值(虚线)和实际值(实线)。FN发作后1天、7天和30天

结论:


大约一半的儿童和父母的HRQOL得分长期较低,在FN事件解决后,这一得分并没有改善。孩子的性别、癌症类型、经济和关系压力的存在都预示着父母和孩子的长期群体成员关系。这些家庭可能会从抗癌治疗期间增加的经济和心理社会支持中受益。


原文摘要:


Background


The impact febrile neutropenia (FN) has on the health-related quality of life (HRQoL) of children with cancer and their families is poorly understood. We sought to characterize the course of child and parent HRQoL during and following FN episodes.


Method


Data on HRQoL were collected in the multisite Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study. Participants were enrolled between November 2016 to January 2018. The Child Health Utility (CHU9D) was used to assess HRQoL in children (N = 167 FN events) and the Assessment of Quality of Life (AQoL-8D) was used to assess HRQoL parents (N = 218 FN events) at three time points: 0–3 days, 7-days and 30-days following the onset of FN. Group-based trajectory modeling (GBTM) was used to characterize the course of HRQoL.


Findings


For children, three distinct groups were identified: persistently low HRQoL over the 30-day course of follow-up (chronic: N = 78/167; 47%), increasing HRQoL after the onset of FN to 30 days follow-up (recovering: N = 36/167; 22%), and persistently high HRQoL at all three timepoints (resilient: N = 53/167; 32%). Applying these definitions, parents were classified into two distinct groups: chronic (N = 107/218, 49%) and resilient (N = 111/218, 51%). The child being male, having solid cancer, the presence of financial stress, and relationship difficulties between the parent and child were significant predictors of chronic group membership for both parents and children. Children classified as high-risk FN were significantly more likely to belong to the recovery group. Being female, having blood cancers and the absence of financial or relationship difficulties were predictive of both parents and children being in the resilient group.


Interpretation


Approximately half the children and parents had chronically low HRQoL scores, which did not improve following resolution of the FN episode. The child's sex, cancer type, and presence of financial and relationship stress were predictive of chronic group membership for both parents and children. These families may benefit from increased financial and psychosocial support during anti-cancer treatment.


参考文献:


H. Parry, R. Bruton, G. Tut, M. Ali, C. Stephens, D. Greenwood, et al., Immunogenicity of single vaccination with BNT162b2 or ChAdOx1 nCoV-19 at 5–6 weeks post vaccine in participants aged 80 years or older: an exploratory analysis. The Lancet Healthy Longevity2021). doi:10.1016/S2666-7568(21)00169-0.





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