Examining health-related quality of life in pediatric cancer patients with febrile neutropenia: Factors predicting poor recovery in children and their parents

Anna Crothers; Gabrielle M Haeusler; Monica A Slavin; Franz E Babl; Francoise Mechinaud; Robert Phillips; Heather Tapp; Bhavna Padhye; David Zeigler; Julia Clark; Thomas Walwyn; Leanne Super; Frank Alvaro; Karin Thursky; Richard De Abreu Lourenco

doi:10.1016/j.eclinm.2021.101095

Examining health-related quality of life in pediatric cancer patients with febrile neutropenia: Factors predicting poor recovery in children and their parents

EClinicalMedicine. 2021 Aug 20:40:101095. doi: 10.1016/j.eclinm.2021.101095. eCollection 2021 Oct.

Authors

Anna Crothers¹, Gabrielle M Haeusler^{2

3

4

5

6

7}, Monica A Slavin^{2

3

8

9}, Franz E Babl^{6

7

10}, Francoise Mechinaud¹¹, Robert Phillips^{12

13}, Heather Tapp¹⁴, Bhavna Padhye¹⁵, David Zeigler¹⁶, Julia Clark¹⁷, Thomas Walwyn¹⁸, Leanne Super¹⁹, Frank Alvaro²⁰, Karin Thursky^{2

3

8

21

9}, Richard De Abreu Lourenco¹

Affiliations

¹ Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia.
² Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
³ NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
⁴ The Paediatric Integrated Cancer Service, Parkville, Australia.
⁵ Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Australia.
⁶ Murdoch Children's Research Institute, Parkville, Australia.
⁷ Department of Paediatrics, University of Melbourne, Parkville, Australia.
⁸ Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
⁹ Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
¹⁰ Department of Emergency Medicine, Royal Children's Hospital, Parkville, Australia.
¹¹ Unité d'hématologie immunologie pédiatrique, Hopital Robert Debré, APHP Nord Université de Paris, France.
¹² Centre for Reviews and Dissemination, University of York, York, UK.
¹³ Leeds Children's Hospital, Leeds General Infirmary, Leeds, UK.
¹⁴ Department of Oncology, Women's and Children's Hospital, Adelaide, Australia.
¹⁵ Cancer Centre for Children, Westmead Children's Hospital, Sydney, Australia.
¹⁶ Kid's Cancer Centre, Sydney Children's Hospital, Sydney, Australia.
¹⁷ Infection Management Service, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
¹⁸ Department of Oncology, Perth Children's Hospital, Perth, Australia.
¹⁹ Children's Cancer Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia.
²⁰ Children's Cancer Department, John Hunter Children's Hospital, University of Newcastle, Newcastle, Australia.
²¹ NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.

Abstract

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.

Funding: National Health and Medical Research Council Grant (APP1104527).

Keywords: Cancer; Child; Febrile neutropenia; Fever; Health-related quality of life; Parent, pediatric cancer; Pediatric oncology.

Grants and funding

G0800472/MRC_/Medical Research Council/United Kingdom