Prediction Model Forecasts Quality of Life Among Childhood Cancer Survivors

A study published in JAMA Network Open last month found that a prediction model could accurately forecast health-related quality of life (HRQOL) among adult survivors of childhood cancer using sociodemographic, lifestyle, and health state factors.

Like many chronic conditions, childhood cancer creates a major healthcare burden in the US and globally each year. Data from the National Cancer Institute indicate that the five-year survival rate for childhood cancer has increased to more than 85 percent from 1975 to 2018, but the study authors noted that these survivors are prone to adverse outcomes related to their cancer and subsequent treatment, such as chronic health conditions and premature mortality.

The researchers further noted that previous research had investigated HRQOL among childhood cancer survivors, but a research gap exists in predicting declines in HRQOL or poor HRQOL for these individuals. These predictions are key to developing interventions to improve outcomes for childhood cancer survivors, they posited.

To build their prediction model, the researchers began by collecting data from 4,755 adults from the Childhood Cancer Survivor Study (CCSS) diagnosed between Jan. 5, 1970, and Dec. 31, 1986, with five or more years of survival. These participants completed three CCSS surveys related to quality of life from November 1992 to August 2003, February 2002 to May 2005, and January 2014 to November 2016.

HRQOL for this cohort was determined using the Medical Outcomes Study 36-Item Short Form Health Survey Physical and Mental Component Summary. The 36-Item Short Form Health Survey captures eight domains of HRQOL: physical functioning, role limitations resulting from physical health problems, bodily pain, general health perceptions, vitality, social functioning, role limitations resulting from emotional problems, and mental health.

From these data, researchers extracted predictive factors. The factors were separated into sociodemographic, lifestyle, and health state. Sociodemographic predictive factors included age at survey completion, sex, race and ethnicity, educational attainment, employment status, annual household income, marital status, living arrangement, insurance coverage, and primary care or oncology visits.

Lifestyle predictive factors included cigarette smoking, physical activity, and body weight per recommendations by the Centers for Disease Control & Prevention (CDC). Predictive factors for health state included chronic health conditions, emotional distress, and neurocognitive functional status.

Overall, the researchers found that between surveys one and two, 8.7 percent of participants had declining Physical Component Summary (PCS) scores and 8.4 percent had declining Mental Component Summary (MCS) scores. Risk factors associated with PCS score decline included female sex, family income less than $20 000 versus $80 000 or more, presence of chronic health conditions, and depression. Risk factors associated with MCS score decline included unemployment versus full-time employment, currently smoking cigarettes versus never smoking, depression, somatization, impaired task efficiency, and impaired organization.

The researchers stated that the strong association of chronic health conditions, emotional and neurocognitive impairment, and current smoking with declines in physical and mental HRQOL indicate that interventions targeting these risk factors are needed to improve outcomes for adult survivors of childhood cancer.  

This research builds on prior studies examining ways to improve care for cancer survivors.

In 2019, researchers found that mHealth apps for health and wellness can benefit cancer survivors, but those resources need to be personalized to the user.

Similarly, some research has shown that patient engagement and education are lacking in care plans for cancer survivors. However, two-way communication can help improve patient engagement in this area.