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Eiser C, Stride CB, Vora A, Goulden N, Mitchell C, Buck G, Adams M, Jenney MEM. Prospective evaluation of quality of life in children treated in UKALL 2003 for acute lymphoblastic leukaemia: A cohort study. Pediatr Blood Cancer 2017; 64. [PMID: 28475268 DOI: 10.1002/pbc.26615] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 03/19/2017] [Accepted: 03/27/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) from diagnosis until end of treatment for children with acute lymphoblastic leukaemia was investigated, examining effects of age, gender, risk-stratified treatment regimen, and therapy intensity (one vs. two 'delayed intensifications' [DIs]). METHOD In a multi-centre prospective study, parents reported their child's generic and disease-specific HRQoL and their own care-giving burden at five time points. From 1,428 eligible patients, 874 parents completed questionnaires at least once during treatment. RESULTS At each time point, generic HRQoL was significantly lower than equivalent norm scores for healthy children. HRQoL decreased significantly at the start of treatment, before recovering gradually (but remained below pre-treatment levels). Parents reported that older children worried more about side effects and their appearance, but showed less procedural anxiety than younger children. Concern for appearance was greater among girls than boys. Compared to Regimen B (i.e. additional doxorubicin during induction and additional cyclophosphamide and cytarabine during consolidation chemotherapy), patients receiving Regimen A had fewer problems with pain and nausea. There were no statistically significant differences in HRQoL by number of DI blocks received. INTERPRETATION HRQoL is compromised at all stages of treatment, and is partly dependent on age. The findings increase understanding of the impact of therapy on children's HRQoL and parental care-giving burden, and will contribute to the design of future trials.
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Affiliation(s)
- C Eiser
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - C B Stride
- Department of statistics, Management School, Conduit Road, University of Sheffield, Sheffield, United Kingdom
| | - A Vora
- Department of Paediatric Haematology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, United Kingdom
| | - N Goulden
- Department of paediatric haematology, Great Ormond Street Hospital, London, United Kingdom
| | - C Mitchell
- Department of Paediatric Haematology/Oncology, John Radcliffe Hospital, Oxford, United Kingdom
| | - G Buck
- Clinical Trial Service Unit, University of Oxford, Oxford, United Kingdom
| | - M Adams
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
| | - M E M Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
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Michel G, Gianinazzi ME, Eiser C, Bergstraesser E, Vetsch J, von der Weid N, Kuehni CE. Preferences for long-term follow-up care in childhood cancer survivors. Eur J Cancer Care (Engl) 2016; 25:1024-1033. [PMID: 27550385 DOI: 10.1111/ecc.12560] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2016] [Indexed: 11/28/2022]
Abstract
Follow-up care is important for childhood cancer survivors to facilitate early detection and treatment of late effects. We aimed to describe preferences for different organisational aspects and models of follow-up care among Swiss childhood cancer survivors, and characteristics associated with preferences for different models. We contacted 720 survivors aged 18+ years, diagnosed with cancer after 1990 (age 0-16 years), registered in the Swiss Childhood Cancer Registry (SCCR), and Swiss resident, who previously participated in a baseline survey. They received questionnaires to assess attendance and preferences for follow-up (rated on 4-point scales, 0-3). Clinical information was available from the SCCR. Survivors (n = 314: response rate 43.6%; 47.8% still attended follow-up) rated clinical reasons for follow-up higher than supportive reasons (p < .001). They rated checking for cancer recurrence (mean = 2.78, SD = 0.53) and knowing about risks for my children most important (mean = 2.22, SD = 0.83). They preferred to attend a children's hospital (mean = 1.94, SD = 1.11), adult hospital (mean = 1.86, SD = 0.98) or general practitioner (mean = 1.86, SD = 1.01) rather than a central specialised late effects clinic (mean = 1.25, SD = 1.06, p < .001), and be seen by paediatric (mean = 2.24, SD = 0.72) or medical oncologist (mean = 2.17, SD = 0.69). Survivors preferred decentralised clinic-based follow-up, rather than one central specialised late effects clinic. Survivors' preferences should be considered to ensure future attendance.
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Affiliation(s)
- G Michel
- Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland. .,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| | - M E Gianinazzi
- Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - C Eiser
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - E Bergstraesser
- Department of Paediatric Oncology, University Children's Hospital, Zurich, Switzerland
| | - J Vetsch
- Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - N von der Weid
- University Children's Hospital Beider Basel (UKBB), Basel, Switzerland
| | - C E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Price KJ, Knowles JA, Fox M, Wales JKH, Heller S, Eiser C, Freeman JV. Effectiveness of the Kids in Control of Food (KICk-OFF) structured education course for 11-16 year olds with Type 1 diabetes. Diabet Med 2016; 33:192-203. [PMID: 26248789 DOI: 10.1111/dme.12881] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 12/21/2022]
Abstract
AIM To assess the effect of a 5-day structured education course (Kids in Control of Food; KICk-OFF) on biomedical and psychological outcomes in young people with Type 1 diabetes. METHODS This was a cluster-randomized trial involving 31 UK paediatric centres. Participants were recruited prior to stratified centre randomization. Intervention centres delivered KICk-OFF courses, whereas control centres delivered usual care. Participants were 11-16 years of age and had Type 1 diabetes for at least one year. The KICk-OFF course was delivered by trained educators to eight participants per course. Glycaemic control and quality of life were measured at baseline, 6, 12 and 24 months. Secondary outcomes were hypoglycaemia, ketoacidosis, fear of hypoglycaemia and diabetes self-efficacy. RESULTS Three hundred and ninety-six participants provided baseline data (199 intervention and 197 control). At 6 and 12 months the intervention group showed significantly improved total generic quality of life scores compared with controls (baseline: 80 vs. 82; 6 months: 82 vs. 82; P = 0.04). Across the whole intervention group mean HbA1c levels were not significantly different from controls; baseline HbA1c mean (95% confidence interval), 78 mmol/mol (75-81) vs. 76 mmol/mol (74-79) [9.3% (9-9.6%) vs. 9.1% (8.9-9.4%); 24 months: 77 mmol/mol (74-79) vs. 78 mmol/mol (75-81) (9.2% (8.9-9.4%) vs. 9.3% (9-9.6%)], adjusted mean difference, -2.0 mmol/mol (6.5-2.5) [2.3% (-2.7% to 2.4%)], P = 0.38. CONCLUSIONS Attending a KICk-OFF course was associated with significantly improved total quality of life scores within 6 months. Glycaemic control, as measured by HbA1c , was no different at 24 months. (Clinical Trial Registry No: ISRCTN3704268).
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Affiliation(s)
- K J Price
- Sheffield Children's Hospital, Sheffield, UK
| | - J A Knowles
- Sheffield Children's Hospital, Sheffield, UK
| | - M Fox
- Sheffield Children's Hospital, Sheffield, UK
| | - J K H Wales
- Department of Child Health, University of Sheffield, Sheffield Children's Hospital, Sheffield, UK
| | - S Heller
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
| | - C Eiser
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - J V Freeman
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
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Ayling K, Brierley S, Johnson B, Heller S, Eiser C. How standard is standard care? Exploring control group outcomes in behaviour change interventions for young people with type 1 diabetes. Psychol Health 2014; 30:85-103. [PMID: 25118842 PMCID: PMC4270262 DOI: 10.1080/08870446.2014.953528] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Poor descriptions of standard care may compromise interpretation of results in randomised controlled trials (RCTs) of health interventions. We investigated quality of standard care in RCTs of behaviour change interventions for young people with type 1 diabetes and consider implications for evaluating trial outcomes. DESIGN We conducted systematic searches for articles published between 1999 and 2012. We extracted standard care descriptions and contacted trial authors to complete a checklist of standard care activities. The relationship between standard care quality and outcomes was examined via subgroup meta-analyses and meta-regression. MAIN OUTCOME MEASURES Standard care descriptions, standard care quality, and relationships between standard care quality with medical and psychological outcomes. RESULTS We identified 20 RCTs described across 26 articles. Published descriptions of standard care were limited to service-level features. Author responses indicated standard care provision extended beyond published accounts. Subgroup analyses suggested control groups receiving higher standard care quality showed larger improvements in both medical and psychological outcomes, although standard care quality did not predict outcomes significantly. CONCLUSION The quality of care delivered to control group participants can influence outcomes of RCTs. Inadequate reporting exacerbates this issue by masking variations between trials. We argue for increased clarity in reporting standard care in future trials.
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Affiliation(s)
- K Ayling
- a Division of Primary Care, School of Medicine , University of Nottingham , Nottingham , UK
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Rowland C, Danson SJ, Rowe R, Merrick H, Woll PJ, Hatton MQ, Wadsley J, Ellis S, Crabtree C, Horsman JM, Eiser C. Quality of life, support and smoking in advanced lung cancer patients: a qualitative study. BMJ Support Palliat Care 2014; 6:35-42. [DOI: 10.1136/bmjspcare-2013-000589] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 04/08/2014] [Indexed: 11/12/2022]
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Johnson B, Elliott J, Scott A, Heller S, Eiser C. Medical and psychological outcomes for young adults with Type 1 diabetes: no improvement despite recent advances in diabetes care. Diabet Med 2014; 31:227-31. [PMID: 23952498 DOI: 10.1111/dme.12305] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Abstract
AIM To assess medical and psychological outcomes among young people with Type 1 diabetes and to compare medical outcomes with a previous audit. METHODS An observational study in two diabetes clinics for young adults (aged 16-21 years) in Sheffield, UK. Young people (n = 96: 81.4% response rate) with Type 1 diabetes (diagnosed > 6 months) completed measures of depressive symptoms, anxiety and disordered eating and consented for their medical records to be consulted. RESULTS Mean HbA1c (86 ± 23 mmol/mol; 10.0 ± 2.1%); was comparable with that reported previously and considerably higher than recommended (< 58 mmol/mol or 7.5%). Screening rates were improved and non-attendance was lower than previously reported, but levels of non-proliferative retinopathy have increased. Microvascular complications are present in 46.9% of those diagnosed more than 7 years. Elevated levels of disordered eating were reported by 35.1%. Those scoring above cut-off levels for clinical anxiety (26.6%) and depression (10.9%) are comparable with other work with young people with Type 1 diabetes. CONCLUSIONS Despite technological advances and improvements to delivery of care, HbA1c remain above recommended levels in a significant proportion of young people, many of whom already have microvascular complications. We need to learn from European centres who achieve better results, improve transition from paediatric care, integrate mental health support with diabetes care provision and take into account young people's views about clinic.
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Affiliation(s)
- B Johnson
- Department of Psychology, University of Sheffield, Sheffield, UK; NIHR CLAHRC for South Yorkshire, Sheffield, UK
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Otero SC, Eiser C, Wright NP, Butler G. Implications of parent and child quality of life assessments for decisions about growth hormone treatment in eligible children. Child Care Health Dev 2013; 39:782-8. [PMID: 23294219 DOI: 10.1111/cch.12021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine differences between parents and children in ratings of child health-related quality of life (HRQL) prior to growth hormone treatment. METHOD HRQL measures were collected from 144 children and their caregivers. Inclusion criteria were aged between 10 and 16 years, diagnosed with Turner's syndrome, acquired or idiopathic growth hormone deficiency (AGHD or IGHD) and eligible to begin human GH treatment (GHT), or non-growth hormone deficient (GHD) short stature. RESULTS Parents rated children to have poorer physical and psychosocial HRQL than children rated themselves. Differences depended on the measure used. Parents rated children with IGHD and non-GHD short stature better than children rated themselves, but they rated children with AGHD or Turner's much worse than children rated themselves in terms of physical but not psychosocial functioning. CONCLUSIONS Decisions to prescribe GHT should include children's perspectives of HRQL whenever possible. Differences between parents and children are most likely in conditions that involve more complex medical needs (AGHD and Turner's). Generic and disease-specific HRQL measures may vary in sensitivity to HRQL differences between groups. More work is required to evaluate HRQL among younger children.
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Affiliation(s)
- S C Otero
- Child and Family Research Group, Department of Psychology, University of Sheffield, Sheffield, UK
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Eiser C, Johnson B, Brierley S, Ayling K, Young V, Bottrell K, Whitehead V, Elliott J, Scott A, Heller S. Using the Medical Research Council framework to develop a complex intervention to improve delivery of care for young people with type 1 diabetes. Diabet Med 2013; 30:e223-8. [PMID: 23510142 DOI: 10.1111/dme.12185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2013] [Indexed: 01/06/2023]
Abstract
AIMS We describe how we have used the development phase of the Medical Research Council (MRC) Guidelines to construct a complex intervention to improve physical and psychological health among young people (16-21 years) with Type 1 diabetes. METHODS We consulted previous reviews where available and conducted systematic searches of electronic databases to determine physical and mental health among the population, audited medical records, surveyed self-reported psychological health among our clinic population; and interviewed staff (n = 13), young people (n = 27) and parents (n = 18) about their views of current care. RESULTS Our audit (n = 96) confirmed a high HbA1c [86 mmol/mol (10.0%)] and one third (36.1%) reported significant eating problems. Young people did not attend 12% of their clinic appointments. Staff described difficulties communicating with young people who wanted staff to take account of their individual lifestyle when giving information. CONCLUSION Based on the findings of the systematic reviews and our audit, we concluded that there was sufficient evidence to justify development of a model of care specific to this age group. The components of the complex intervention include changes to standard care, an optional 5-day self-management course directed at young people and a separate family communication programme. The MRC Guidelines provided a valuable structure to guide development and evaluation of this intervention.
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Affiliation(s)
- C Eiser
- Department of Psychology, University of Sheffield, Sheffield, UK.
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Abstract
AIMS To determine: (1) prevalence of depression among young people with Type 1 diabetes compared with control groups or population norms; (2) implications of depression for HbA(1c) level; and (3) the relationship between history of depressive symptoms and future depressive symptoms. BACKGROUND Among adults with Type 1 diabetes depression is higher than the general population, and has been associated with adverse implications for self-care and HbA(1c) level. The last published review of depression among young people with Type 1 diabetes only included studies up to 1999. METHOD Systematic searches were conducted for articles published from January 1999 to December 2011 including young people (up to 25 years old) with Type 1 diabetes. RESULTS Twenty-three articles met the inclusion criteria. Of five studies that reported prevalence of depression compared with control groups, three found no differences. Of the three studies that investigated prevalence of depression making reference to population norms, all three showed higher rates of depressive symptoms. Fourteen of 15 studies found associations between more depressive symptoms and higher HbA(1c) level either cross-sectionally or longitudinally. Past depressive symptoms were associated with later depressive symptoms. CONCLUSIONS Current evidence is inconclusive about whether there is increased prevalence of depression among young adults with Type 1 diabetes, as established among adults, but those who are more depressed have higher HbA(1c) level. This review is limited by methodological problems and no identified work in the UK met the inclusion criteria. Given the adverse clinical outcomes, we conclude there is a case for routine mental health screening for young adults with Type 1 diabetes.
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Affiliation(s)
- B Johnson
- NIHR CLAHRC for South Yorkshire, Department of Psychology, University of Sheffield, Sheffield, UK.
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Abstract
AIMS We report a systematic review to determine (1) prevalence of eating problems compared with peers and (2) the association between eating problems and glycaemic control in young adults with Type 1 diabetes. METHOD We conducted a systematic literature search via electronic databases and meta-analysis. Cohen's d (the mean difference score between Type 1 diabetes and comparison groups) was calculated for 13 studies that met inclusion criteria. RESULTS Eating problems [both disordered eating behaviour (39.3 and 32.5%; d = 0.52, 95% CI 0.10-0.94) and eating disorders (7.0 and 2.8%; d = 0.46, 95% CI 0.10-0.81)] were more common in adolescents with Type 1 diabetes compared with peers and both were associated with poorer glycaemic control (d = 0.40, 95% CI 0.17-0.64). In restricted analyses involving measures adapted for diabetes, associations between eating problems and poorer glycaemic control remained (d = 0.54, 95% CI 0.32-0.76). Disordered eating behaviour (51.8 and 48.1%; d = 0.06, 95% CI -0.05 to 0.21) and eating disorders (6.4 and 3.0%; d = 0.43, 95% CI -0.06 to 0.91) were more common in adolescents with Type 1 diabetes compared with peers, but differences were non-significant. CONCLUSIONS Eating problems are common among this age group. Future work in populations with Type 1 diabetes should develop sensitive measures of eating problems and interventions, and establish predictors of eating problems. Screening in clinics is recommended.
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Affiliation(s)
- V Young
- Department of Psychology, NIHR CLAHRC for South Yorkshire, Medical School, University of Sheffield, Sheffield, UK.
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Pacey AA, Merrick H, Arden-Close E, Morris K, Barton LC, Crook AJ, Tomlinson MJ, Wright E, Rowe R, Eiser C. Monitoring fertility (semen analysis) by cancer survivors who banked sperm prior to cancer treatment. Hum Reprod 2012; 27:3132-9. [DOI: 10.1093/humrep/des300] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Sperm banking is routinely offered to men where there is a risk of infertility following cancer treatment but uptake is lower than expected. Since these men may turn to the internet for information, we used the search engine www.google.com to identify the material available about sperm banking and fertility preservation options. Sixty-six resources (NHS/Private Clinic, Charity, Press Releases, General and Forums/Blogs) fulfilled the criteria for inclusion and were examined for quality including readability, layout and content. The most frequently reported information related to: (1) effects of cancer treatment on fertility (77.3%); (2) reasons to bank sperm (69.7%); and (3) fertility recovery after treatment (57.6%). Information about maintaining contact with the sperm bank (18.2%) and disposal of banked samples (10.6%) was less often included. The quality of information available on the Internet about sperm banking was variable. The readability of all resources was assessed as 'fairly difficult', i.e. reading skills required were too complex for the average member of the public to understand. Furthermore, visual presentation of material (e.g. lay out) did not facilitate easy reading. More attention should be given to information about longer-term issues, such as fertility recovery and the use or disposal of banked sperm.
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Affiliation(s)
- H Merrick
- Department of Psychology, University of Sheffield, Sheffield, UK
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Brierley S, Eiser C, Johnson B, Young V, Heller S. Working with young adults with Type 1 diabetes: views of a multidisciplinary care team and implications for service delivery. Diabet Med 2012; 29:677-81. [PMID: 22375561 DOI: 10.1111/j.1464-5491.2012.03601.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Young adults with Type 1 diabetes experience difficulties achieving glucose targets. Clinic attendance can be poor, although health and self-care tend to be better among those who attend regularly. Our aims were to describe staff views about challenges working with this age-group (16-21 years). METHODS Semistructured interviews were conducted with 14 staff from Sheffield Teaching Hospitals diabetes care team. Interviews were audio-recorded, transcribed and analysed using thematic analysis. RESULTS Three main themes emerged. Unique challenges working with young adults included staff emotional burden, the low priority given to self-care by young adults and the complexity of the diabetes regimen. Working in a multidisciplinary team was complicated by differences in consultation styles, poor team cohesion and communication. An ideal service should include psychological support for the professional team, identification of key workers, and development of individualized care plans. CONCLUSIONS Staff differed in their views about how to achieve optimal management for young adults, but emphasized the need for greater patient-centred care and a range of interventions appropriate for individual levels of need. They also wanted to increase their own skills and confidence working with this age-group. While these results reflect the views of staff working in only one diabetes centre, they are likely to reflect the views of professionals delivering care to individuals of this age; replication is needed to determine their generalizability.
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Affiliation(s)
- S Brierley
- Department of Psychology Department of Human Metabolism, University of Sheffield, Sheffield NIHR CLAHRC for South Yorkshire, UK.
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Rowland C, Eiser C, Rowe R, Danson S. 136 Implications of smoking for quality of life and medical decision making in lung cancer patients. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Follow-up is recommended for survivors of childhood cancer. Decisions about care tend to be made in terms of physical health, but psychological late effects including post-traumatic stress disorder (PTSD) and symptoms (PTSS) are prevalent. We report prevalence of PTSD/PTSS in a UK cohort, self-care and implications for organisation of follow-up. Eligible survivors (n= 218) under regular follow-up were invited to complete measures of PTSD, late effects and self-efficacy. Information about late effects was also taken from medical notes. A total of 118 survivors responded (54.1%) and 108 (49.5%) completed questionnaires. Prevalence of clinical PTSD (13.9%) was comparable with US findings. Female subjects and those who reported more late effects reported more PTSD. In regression analyses, number of survivor-reported late effects (but not number-recorded in medical notes) and PTSS predicted self-efficacy. Significant numbers of survivors report PTSS but this is unrelated to diagnosis or treatment. Female subjects and those who reported more physical late effects also reported more PTSS. Decisions to discharge survivors from routine care must consider psychological well-being as well as physical late effects. We recommend routine psychological screening for all survivors of childhood cancer and suggest this can be acceptable to survivors and feasible in clinic.
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Affiliation(s)
- N Taylor
- Department of Psychology, University of Sheffield, Western Bank, Sheffield, UK
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Eiser C, Arden-Close E, Morris K, Pacey AA. The legacy of sperm banking: how fertility monitoring and disposal of sperm are linked with views of cancer treatment. Hum Reprod 2011; 26:2791-8. [DOI: 10.1093/humrep/der243] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Purpose. We conducted a systematic search of published literature,
to assess (i) quality of life (QoL) for survivors of a bone tumour compared with the normal
population; (ii) QoL implications following amputation, successful or failed limb salvage;
(iii) adaptation of young children to amputation compared with older children or
adolescents. Methods. Electronic databases were searched including Medline,
PsycLIT and Cinahl covering the years 1982– 1998. Results. We identified 11 studies. Regardless of treatment, physical
functioning was poor compared with population norms or healthy siblings.There was less
consistent evidence regarding emotional functioning. Seven studies compared functioning
in amputees and limb salvage patients.Two reported advantages in physical function for the
limb salvage group, one for the amputees and the rest no differences. Evidence about social
functioning or marriage is inconclusive, but there are suggestions that amputees report more
job discrimination. Discussion. The literature is inconclusive, largely because of
methodological problems. These include small and non-representative samples, and lack of
sensitive and appropriate measures. Specific gaps in the literature include very little
work concerned with psychological outcomes for children, or for those experiencing failed
limb salvage. More attention needs to be given to gender differences in emotional response
to traumatic surgery.The implications of the results for helping families balance the merits of
different treatments are discussed.
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Affiliation(s)
- C Eiser
- CRC Child and Family Research Group School of Psychology University of Exeter Exeter EX4 4QG UK
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Eiser C, Cool P, Grimer RJ, Carter SR, Cotter IM, Ellis AJ, Kopel S. Quality of life in children following treatment for a malignant primary bone tumour around the knee. Sarcoma 2011; 1:39-45. [PMID: 18521199 PMCID: PMC2373584 DOI: 10.1080/13577149778461] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose. We report on the quality of life following treatment for a malignant primary
bone tumour around the knee in skeletally immature children. Patients. Patients (n = 41; mean age = 18 years; range 8–28) had all
experienced chemotherapy in a neo-adjuvant setting, surgical excision of the tumour and endoprosthetic replacement. Methods. Interviews were conducted separately with the child and mother and focused
on mobility, body image and the impact of treatment on schooling, employment and plans for the future. Results. Mobility in the group was variable. Only 12% reported that they could run with
any confidence. The proportion who were able to swim (49%) or ride a bike (46%) was higher.
All had experienced major disruption in schooling (mean absence following diagnosis = 12 months).
Eight had repeated a school year and 41% patients reported that their schoolwork was affected.
As a result of their experience, eight (six females and two males) chose health-related employment.
Concerns for the future were highest among males and those with manual jobs. Three patients were receiving
psychiatric support, in relation to extreme concern about the risk of recurrence. All expressed satisfaction with treatment,
and older patients believed that the prosthesis gave a better quality of life than amputation. Discussion. Our data suggest that outcome following limb-salvage surgery is variable. Education is disrupted. Even so, only two left school with no qualifications. Employment is most restricted among males with few qualifications who may benefit from sensitive vocational counselling.
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Affiliation(s)
- C Eiser
- CRC Child and Family Research Group Department of Psychology University of Exeter Devon Exeter EX4 4QG UK
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Abstract
Purpose. We investigated self-reported quality of life (QoL), body image and daily competence of patients as a consequence of
limb salvage surgery (LSS), primary or secondary amputation, and the views of patients following secondary amputation. Patients. Patients (n=37) had all been treated for osteosarcoma or Ewing's sarcoma in the lower limb. Methods. QoL was measured by questionnaire. A separate interview to determine satisfaction with decision-making was
conducted with those treated for secondary amputation. Results. For the total group, QoL was below that expected from population norms. There were no differences in QoL between
those undergoing LSS surgery compared with amputation. However, LSS reported better daily competence and were less likely
to use a walking aid. For the total group, body image and daily competence were associated with better QoL. Discussion. All these patients are at risk of compromised QoL following surgery. Our data are in line with previous work
suggesting outcomes may be better for LSS compared with amputation. Following secondary amputation, most patients (80%)
did not regret initial LSS treatment, but felt that the time gained allowed them to come to terms with subsequent surgery.
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Affiliation(s)
- C Eiser
- Department of Psychology University of Sheffield Sheffield S10 2TP UK
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Clarke SA, Skinner R, Guest J, Darbyshire P, Cooper J, Vora A, Urquhart T, Jenney M, Powell J, Eiser C. Clinical outcomes and health-related quality of life (HRQOL) following haemopoietic stem cell transplantation (HSCT) for paediatric leukaemia. Child Care Health Dev 2011; 37:571-80. [PMID: 21143268 DOI: 10.1111/j.1365-2214.2010.01182.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Haemopoietic stem cell transplantation (HSCT) is a life-saving but intensive procedure associated with potentially severe adverse late effects. We aimed to determine morbidity and health-related quality of life (HRQOL) in a sample of survivors aged 8-18 years at least 1 year post HSCT for paediatric acute leukaemia, compared with a non-transplanted group of survivors matched for age, gender, initial disease and time since treatment. METHODS Families (N = 54; HSCT n= 29) recruited from four UK centres completed measures of child behaviour and school attendance, HRQOL and finances. Mothers completed measures of their own well-being. Clinical outcome data were extracted from medical records. RESULTS Children in the HSCT group had significantly more late effects and had received more tests for vision, bone, dental and skin health, and thyroid, lung, and gonadal function than the non-transplanted group. HRQOL scores for the HSCT group were significantly lower in all domains compared with the non-transplanted group and population norms, but were not significantly related to clinical indices. Mothers in the HSCT group had significantly poorer mental well-being than population norms. CONCLUSION Significant morbidity and compromised HRQOL was found in survivors of HSCT. The burden of caring for a child after HSCT has a continuing toll on mothers' well-being.The importance of counselling families about possible long-term consequences is emphasized.
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Affiliation(s)
- S-A Clarke
- Department of Psychology, University of Sheffield, Sheffield, UK.
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Arden-Close E, Absolom K, Greenfield DM, Hancock BW, Coleman RE, Eiser C. Gender differences in self-reported late effects, quality of life and satisfaction with clinic in survivors of lymphoma. Psychooncology 2010; 20:1202-10. [DOI: 10.1002/pon.1835] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 12/21/2022]
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Michel G, Taylor N, Absolom K, Eiser C. Benefit finding in survivors of childhood cancer and their parents: further empirical support for the Benefit Finding Scale for Children. Child Care Health Dev 2010; 36:123-9. [PMID: 19961498 DOI: 10.1111/j.1365-2214.2009.01034.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diagnosis of a life-threatening condition has been linked to post-traumatic stress. However, only recently has it been acknowledged that positive outcomes including post-traumatic growth or benefit finding may also occur. The aim of our study was to extend previous work describing benefit finding among survivors of childhood cancer, by determining the contribution of demographic and medical variables and associations between child benefit finding and parent post-traumatic growth. METHODS Survivors of any child cancer (leukaemia, central nervous system or solid tumour; age 12-15 years; completed treatment >2 years) were recruited from routine follow-up clinics and asked to complete questionnaires [Benefit Finding Scale for Children (BFSC), quality of life (QOL), post-traumatic stress (PTS), illness perception and optimism]. Parents completed parallel measures to describe their own post-traumatic growth (PTG), QOL, PTS and illness perception. RESULTS Forty-eight survivors and parents completed questionnaires (response rate: 81%). The BFSC showed good internal reliability (alpha = 0.91). Diagnosis of leukaemia, greater optimism and reports that the illness still affects their life today were associated with higher scores on the BFSC among survivors themselves. For parents, perceptions of how much the illness still affects them emotionally was associated with PTG. There was no association between children's benefit finding and parents' PTG. CONCLUSIONS The BFSC is a useful and reliable instrument to assess positive outcomes after cancer in children. The extent to which survivors are optimistic and perceive on-going effects of the illness on their daily lives is significantly associated with the ability to find benefit after end of treatment.
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Affiliation(s)
- G Michel
- Department of Psychology, University of Sheffield, Western Bank, Sheffield.
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Clarke SA, Skinner R, Guest J, Darbyshire P, Cooper J, Shah F, Roberts I, Eiser C. Health-related quality of life and financial impact of caring for a child with Thalassaemia Major in the UK. Child Care Health Dev 2010; 36:118-22. [PMID: 19961496 DOI: 10.1111/j.1365-2214.2009.01043.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thalassaemia Major (TM) is a serious condition characterized by life-long dependence on blood transfusions and chelation therapy. Our aim was to determine health-related quality of life (HRQOL) in children with TM living in the UK, and the impact of caring for a child receiving National Health Service treatment on family finances. METHODS This was a cross-sectional assessment of HRQOL in children (n= 22) with TM aged 8-18 years. Children were recruited from three UK Paediatric Haematology and Bone Marrow Transplant centres. Mothers completed measures of their child's HRQOL [PedsQL 4.0 (Measurement Model for the Pediatric Quality of Life Inventory, James W. Varni PhD, PedMetrics, Quantifying the Qualitative SM, Copyright 1998-2009)] and behaviour (Strengths and Difficulties questionnaire), and the impact of caring for the child on family finances. RESULTS Child behaviour was within the normal range but child HRQOL was significantly lower than population norms. Family financial concerns associated with TM were associated with poorer child HRQOL (P= 0.020). CONCLUSIONS Thalassaemia Major poses a considerable challenge to child HRQOL, well documented in areas of the world where TM is prevalent. Despite the availability of National Health Service care and financial benefits our study suggests a similar burden in the UK.
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Affiliation(s)
- S A Clarke
- Department of Psychology, University of Sheffield, Sheffield S102TP, UK.
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Absolom K, Eiser C, Michel G, Walters SJ, Hancock BW, Coleman RE, Snowden JA, Greenfield DM. Follow-up care for cancer survivors: views of the younger adult. Br J Cancer 2009; 101:561-7. [PMID: 19638979 PMCID: PMC2736810 DOI: 10.1038/sj.bjc.6605213] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Since the launch of the National Cancer Survivorship Initiative, there has been a surge of interest surrounding the value and organisation of long-term follow-up care after cancer treatment. We report the views of 309 adult cancer survivors (aged 18–45 years) on provision of follow-up and preferences for care. Methods: A total of 207 survivors completed questionnaires before and after routine consultant-led follow-up appointments and 102 were recruited by post. Measures of health status (including late effects, perceived vulnerability to late effects and quality of life), reasons for attending follow-up (clinical and supportive), issues to be discussed at follow-up and preferences for different models of care were assessed. Results: In all, 59% of the survivors reported experiencing one or more cancer-related health problems. Survivors rated clinical reasons for attending follow-up more highly than supportive reasons (P<0.001), although nutritional advice and counselling were considered useful (60 and 47%, respectively). Those still receiving scheduled follow-up appointments did not discuss the range of issues intended with ‘late effects’ and ‘fertility’, which were particularly under-discussed. Hospital rather than GP follow-up was more highly rated. Conclusion: Survivors value the clinical reassurance currently provided by consultant-led care. However, supportive needs are not systematically addressed. Multi-disciplinary services are recommended to meet supportive needs in addition to clinical care.
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Affiliation(s)
- K Absolom
- Department of Psychology, University of Sheffield, Sheffield S10 2SJ, UK
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Michel G, Greenfield D, Absolom K, Ross R, Davies H, Eiser C. Follow-up care after childhood cancer: Survivors’ expectations and preferences for care. Eur J Cancer 2009; 45:1616-23. [DOI: 10.1016/j.ejca.2009.02.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 02/13/2009] [Accepted: 02/26/2009] [Indexed: 11/25/2022]
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Haupt R, Spinetta J, Ban I, Barr R, Beck J, Byrne J, Calaminus G, Coenen E, Chesler M, D’Angio G, Eiser C, Feldges A, Gibson F, Lackner H, Masera G, Massimo L, Magyarosy E, Otten J, Reaman G, Valsecchi M, Veerman A, Penn A, Thorvildsen A, von den Bos C, Jankovic M. Langzeitüberlebende einer Krebserkrankung im Kindesalter: Heilung und Betreuung. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-008-1864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Waller H, Eiser C, Knowles J, Rogers N, Wharmby S, Heller S, Hall C, Greenhalgh S, Tinklin T, Metcalfe C, Millard E, Parkin V, Denial M, Price K. Pilot study of a novel educational programme for 11-16 year olds with type 1 diabetes mellitus: the KICk-OFF course. Arch Dis Child 2008; 93:927-31. [PMID: 18676435 DOI: 10.1136/adc.2007.132126] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS To pilot an educational programme (KICk-OFF) for children and adolescents with type 1 diabetes mellitus (DM). Evaluation included (i) independent assessment of curriculum quality, (ii) acceptability to families and (iii) possible impact on standardised outcome measures (HbA1c, body mass index (BMI), diary reports of hypoglycaemia, quality of life (QoL)). METHODS 48 children aged 11-16 years (mean age 13.60 (SD 1.36) years) were recruited from three UK centres. Six 5-day outpatient courses on carbohydrate counting and insulin dose adjustment were held. Semi-structured interviews were conducted with children and parents before and after the course. Glycaemic control (HbA1c), BMI and frequency of hypoglycaemia were assessed before the course and at 3 and 6 months after intervention. QoL was assessed before the course and at 2 weeks, 3 and 6 months. RESULTS Educational evaluation indicated the course format was appropriate and consistent. Parent and child interviews suggested that pre-course expectations were largely met. There were no changes in HbA1c, BMI or episodes of hypoglycaemia, but children and parents reported improved QoL (p<0.05). CONCLUSIONS KICk-OFF was well-received by children and parents and was associated with improved QoL. In this small pilot study, glycaemic control did not change but findings justify conducting a future randomised controlled trial involving a revised curriculum, a larger study population including a control group and longer follow-up.
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Affiliation(s)
- H Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
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Frobisher C, Winter DL, Lancashire ER, Reulen RC, Taylor AJ, Eiser C, Stevens MCG, Hawkins MM. Extent of Smoking and Age at Initiation of Smoking Among Adult Survivors of Childhood Cancer in Britain. J Natl Cancer Inst 2008; 100:1068-81. [DOI: 10.1093/jnci/djn210] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eiser C. Commentary on Evidence-based assessment of health-related quality of life and functional impairment in pediatric psychology. J Pediatr Psychol 2008. [DOI: 10.1093/jpepsy/jsn072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hutchings HA, Upton P, Cheung WY, Maddocks A, Eiser C, Williams JG, Russell IT, Jackson S, Jenney MEM. Adaptation of the Manchester-Minneapolis Quality of Life instrument for use in the UK population. Arch Dis Child 2007; 92:855-60. [PMID: 17522166 PMCID: PMC2083244 DOI: 10.1136/adc.2006.098947] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The availability of health-related quality of life (HRQL) measures that are reliable, valid, brief and comprehensible and appropriate for use with UK children is limited. We report the validation of a HRQL measure suitable for UK use in healthy children, children with chronic disease conditions and socially disadvantaged children. PATIENTS A total of 1238 children took part in the study, including healthy children as controls (n = 824) and five exemplar groups: children diagnosed with asthma (n = 87), diabetes (n = 103) or inflammatory bowel disease (IBD; n = 69), children in remission from cancer (n = 68) and children in public care (n = 87). METHODS In phase I, the Manchester-Minneapolis Quality of Life instrument (MMQL) Child Form was translated into UK English. In phases II and III, the questionnaire was shortened and validated. RESULTS MMQL was anglicised and shortened to five components comprising 29 items. Good internal reliability was found with alpha reaching at least 0.69 for all subscales. Construct validity was established through moderate correlations with comparable PedsQL subscales (Pearson's r ranged from 0.38 to 0.58, p<0.01). Discriminant validity was also demonstrated in children with asthma and IBD, children in remission from cancer and children in public care, all of whom reported significantly lower HRQL than healthy children. Children with diabetes showed similar HRQL to their healthy peers. Good reproducibility and moderate responsiveness were demonstrated for the new measure. CONCLUSIONS The anglicised and shortened MMQL was shown to be valid and reliable and could be a valuable new tool for the assessment of HRQL in children.
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Affiliation(s)
- H A Hutchings
- School of Medicine, University of Wales, Swansea, UK.
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Abstract
BACKGROUND Current therapies for childhood cancer have resulted in improved survival rates. However, this has been achieved at considerable price to families, with financial costs including additional expenditure and loss of earnings having been described. The impact of these extra costs for UK families and the extent to which help from charities and government benefits is able to alleviate this is unknown. METHODS Questionnaires concerning income, expenditure, employment and financial support were completed by 145 parents, recruited from three United Kingdom Children's Cancer Study Group treatment centres. RESULTS Parents' responses highlighted increased expenditure related mainly to travel to treatment centres. The majority of families (55%) had spent between pound 50-100 in the past week over and above pre-illness expenditure, with a further 18% spending more than pound 100. Many parents (mainly mothers) had either given up or reduced outside employment in order to care for their child and this was associated with further financial problems for 42.7% of families. Despite help from charities and government benefits for the majority of families, extra costs were associated with money worries for 68.3% of families. CONCLUSIONS Although families are offered timely information about their entitlement to benefits, financial problems are incurred by families of a child with cancer partly because legislation prevents benefits being claimed for the first 3 months of a child's illness - the time when expenses are still at their highest. Furthermore, because benefits are backdated only to the point at which the claim was made, families do not recoup all their costs. Waiving of the 84-day wait period for children undergoing chemotherapy and radiotherapy, and the introduction of weekly bridging payments while a Disability Living Allowance claim is being assessed, would ameliorate this problem and so improve the treatment experience for families.
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Affiliation(s)
- C Eiser
- Department of Psychology, The University of Sheffield, Western Bank, Sheffield, UK
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Abstract
BACKGROUND Treatment of childhood cancer occurs over a 2- to 3-year period, with initial intense phases of chemotherapy followed by less severe treatment periods. From first diagnosis, families are encouraged by healthcare professionals (following government guidelines) to try to maintain a normal life. The aim of this paper is to contribute to our understanding of how 'normal' family life is compromised from the perspective of the families themselves during this period of extreme stress and concern for the health and well-being of their child. METHODS This study was longitudinal and involved a cross section of 32 mothers of children recently diagnosed with acute lymphoblastic leukaemia (ALL) currently participating in the Medical Research Council ALL-97 randomized control trial. Mothers were interviewed at three time points (3-4 months post diagnosis, 15 and 27 months) using a semi-structured format with open-ended questions. A qualitative methodology was employed to analyse interview data using Thematic analysis. RESULTS Mothers reported understanding the importance of achieving normal life, but described how this was difficult to realize. At first interview, mothers were optimistic that they could achieve the 'normal life' as advised by healthcare workers. At 12 and 24 months, although all mothers reported that life was not back to normal, there were differences in how they perceived this lack of normality. Whereas some families experienced frustration and disappointment, others had adjusted and managed to accept the new order. CONCLUSIONS Families felt encouraged on diagnosis to be told that despite the severity of the disease and treatment regime, a normal life was possible and should be pursued. Our findings indicate that over time, more concrete information is needed to guide parents through the treatment process in order to help them achieve this.
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Affiliation(s)
- E A Earle
- Child and Family Research Group, Department of Psychology, The University of Sheffield, Sheffield, UK
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Abstract
BACKGROUND The development of instruments to measure child self-reported quality of life (QOL) is dependent on whether children can understand the concepts behind items. Researchers need more information on how children are interpreting and answering items. This paper aims to investigate the strategies school-aged children use to answer QOL items. METHODS A generic 30-item QOL measure (the TedQL) was administered to 266 healthy children (5-6, 7-9 years old). Children were asked to 'think aloud' while answering a selection of 10 TedQL items (n = 4 ability, n = 4 social, n = 2 mood items), and their responses were recorded verbatim. RESULTS The strategies children reported using when answering items were coded into five categories: (1) social comparisons; (2) stable character references; (3) concrete examples; (4) other reasons; or (5) no reason given. Concrete examples were used most frequently by children. Strategy type was dependent on age, with 7-9-year-olds reporting social comparisons and concrete examples more frequently than 5-6-year-olds. Five-to-six-year-olds gave no reasons for their response choices more frequently than 7-9-year-olds. Strategy type also differed by item type, with social comparisons used more frequently for ability items, and stable character references for social items. However, concrete examples were used consistently highly across ability and social items. CONCLUSIONS Children aged 5-9 years most commonly report using concrete examples of specific instances when answering QOL items. However, strategy use varies as a function of age and types of items. Our results highlight the importance of keeping in mind children's developmental age when interpreting responses from child QOL instruments.
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Affiliation(s)
- J Cremeens
- Division of Behavioural Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
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Sheppard L, Eiser C, Davies HA, Carney S, Clarke SA, Urquhart T, Ryder MJ, Stoner A, Wright NP, Butler G. The Effects of Growth Hormone Treatment on Health-Related Quality of Life in Children. Horm Res Paediatr 2006; 65:243-9. [PMID: 16582566 DOI: 10.1159/000092455] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Accepted: 12/08/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The effects of growth hormone deficiency (GHD) on linear growth in children are well documented, but there is less convincing evidence regarding the impact on health-related quality of life (QOL). We examined QOL in children aged 8-16 years with acquired GHD following treatment for malignancy (AGHD) or idiopathic GHD (IGHD) on commencing growth hormone treatment (GHT) over 6 months. We adopted a longitudinal design involving consecutive patients and their families attending clinic over an 18-month period. Mothers and children were invited to complete questionnaires before GHT (T1) and 6 months later (T2). METHODS Mothers of 22 children (AGHD n = 14; IGHD n = 8) completed standardized measures of child QOL and behaviour. Children completed parallel measures of QOL, short-term memory tasks and fitness either in clinic or at the family home. RESULTS For children with AGHD, QOL was significantly below population norms at T1 and improved over time. For children diagnosed with IGHD, QOL at T1 was below, but comparable with population norms. QOL improved over time, though not significantly. CONCLUSION GHT is potentially valuable for improving QOL in children, especially in cases of AGHD. We conclude that benefits of GHT for QOL need to be evaluated independent of different diagnostic groups.
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Affiliation(s)
- L Sheppard
- CR-UK Child and Family Health Group, Department of Psychology, University of Sheffield, Sheffield, UK.
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Greenfield DM, Wright J, Brown JE, Hancock BW, Davies HA, O'toole L, Eiser C, Coleman RE, Ross RJ. High incidence of late effects found in Hodgkin's lymphoma survivors, following recall for breast cancer screening. Br J Cancer 2006; 94:469-72. [PMID: 16465193 PMCID: PMC2361189 DOI: 10.1038/sj.bjc.6602974] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Assessment of late effects in a cohort of female Hodgkin's lymphoma patients treated with mantle radiotherapy, identified from the DoH breast cancer screening recall showed high mortality and frequent undiagnosed abnormalities in tissues affected by radiotherapy. With increasing age, this patient group may suffer premature cardiac and respiratory morbidity.
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Affiliation(s)
- D M Greenfield
- Academic Unit of Clinical Oncology, Cancer Research Centre, University of Sheffield, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK
| | - J Wright
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| | - J E Brown
- Academic Unit of Clinical Oncology, Cancer Research Centre, University of Sheffield, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK
| | - B W Hancock
- Academic Unit of Clinical Oncology, Cancer Research Centre, University of Sheffield, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK
- Academic Unit of Clinical Oncology, Cancer Research Centre, University of Sheffield, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK. E-mail:
| | - H A Davies
- Sheffield Children's Hospital Trust, Western Bank, Sheffield S10 2TH, UK
| | - L O'toole
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| | - C Eiser
- Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - R E Coleman
- Academic Unit of Clinical Oncology, Cancer Research Centre, University of Sheffield, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK
| | - R J Ross
- Division of Clinical Sciences (North), University of Sheffield, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
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Abstract
BACKGROUND Children surviving a brain tumour face major difficulties including learning problems, lengthy school absences and psychosocial problems, all of which can impact on school functioning. Our aims were to provide information for parents and teachers about the skills and resources of this group. Specifically, we aimed to: describe the special educational needs of these children; document the impact of diagnosis and treatment on school attendance; compare parent and teacher assessments of social, emotional and behavioural difficulties. METHODS Forty families agreed to participate (response rate = 58.82%). The children (19 males and 21 females) were aged from 6 to 16 years and had completed treatment at least 2 years previously (range = 2 years-12 years 5 months). Questionnaires (Strengths and Difficulties and school experience) were completed by mothers and teachers. RESULTS Survivors were experiencing a wide range of physical, learning and interpersonal difficulties, according to parent and teacher reports. Almost half the children (n = 19) had ongoing neurological problems that were significant enough to require special help at school. Literacy and numeracy were the most common learning difficulties. Parents also rated brain tumour survivors as having more behavioural and emotional problems than would be expected from population norms. For example, survivors were rated as having more Total Difficulties (t = 6.86, P < 0.001), Emotional Symptoms (t = 8.82, P < 0.001), Hyperactivity (t = 2.25, P = 0.03), Peer Relationship Problems (t = 7.58, P < 0.001) and poorer Pro-social Behaviour (t = -3.34, P = 0.002) than would be expected from population norms. These problems were also seen to be having a significant impact on the child's functioning (t = 3.95, P < 0.001). Teachers rated these problems as less serious than parents. CONCLUSION These children experience significant problems in school some time after diagnosis and when they are considered medically cured. Closer school-hospital liaison is essential to maximize integration and achievement in these children.
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Affiliation(s)
- P Upton
- CR-UK Child and Family Research Unit, University of Sheffield, Western Bank, Sheffield S10 2TP, UK.
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Abstract
BACKGROUND Relationships between child quality of life (QOL), maternal well-being and parenting were explored in a questionnaire study. METHOD Mothers of 126 full-term (FT) and 91 pre-term (PT) infants during the child's second year of life completed measures of their own and the child's quality of life and behavioural difficulties. We developed a measure of parenting style derived from Regulatory Focus Theory (RFT), to distinguish greater reported use of promotion as opposed to prevention strategies (emphasising gains rather than losses, and encouraging pursuit of goals rather than prevention of harm). RESULTS The two groups of mothers showed no differences on the parenting measure, but those in the PT compared with the FT group described their infant as having lower QOL and more behavioural and mood problems, and rated their own well-being as less satisfactory. Greater use of promotion was associated with reports of fewer difficulties (better QOL) for the child and better mothers' well-being. Differences in mothers' well-being as a function of group (FT vs. PT) and promotion were strongly mediated by mothers' perceptions of their child's difficulties. At the same time, associations with child difficulties were partly mediated by mothers' well-being, suggesting that maternal distress may have partly contributed to higher perceptions of such difficulties. Among PT infants, the degree of prematurity predicted child difficulties, but was not consistently related to mothers' well-being. DISCUSSION Mothers of PT infants report more physical health and behavioural difficulties than mothers of FT infants, but specific parenting styles can contribute to child difficulties and QOL in both infants and their mothers. CONCLUSION We conclude that RFT has potential for understanding the conflicts experienced by parents caring for vulnerable children.
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Affiliation(s)
- C Eiser
- Department of Psychology, University of Sheffield, UK.
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Abstract
OBJECTIVES Survival rates for childhood cancer have improved substantially partly as a result of national and international randomized clinical trials (RCT). However, the decision for families is complex and emotional. Our aim was to describe the views of mothers of children newly diagnosed with ALL regarding consent to randomized controlled trials. DESIGN Qualitative interview to explore mothers knowledge, and reasons for involving their child in RCTs. Interviews took place in mothers' homes. PARTICIPANTS Fifty mothers of children with newly diagnosed ALL (age 4-16 years; mean = 7.4) recruited through research nurses at outpatient appointments. RESULTS All but three families had consented for their child to be treated in the RCT, although there was wide variation in their understanding of the aims, costs and benefits. Most mothers reported the aim of the trial to compare 'old' and 'new' treatments. CONCLUSION Despite detailed verbal and written information, mothers were poorly informed about the purpose of the trial, and possibility of side effects. Individual preferences for either standard or new treatment were routinely reported. The data raise questions about the extent to which families give truly informed consent to recruitment of their child to an RCT.
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Affiliation(s)
- C Eiser
- Cancer Research UK Professor of Child Health Psychology, Child and Family Research Group, Department of Psychology, University of Sheffield, Western Bank, UK.
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42
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Eiser C, Vance YH, Glaser A, Galvin H, Horne B, Picton S, Stoner A, Butler G. Growth Hormone Treatment and Quality of Life among Survivors of Childhood Cancer. Horm Res Paediatr 2005; 63:300-4. [PMID: 16020938 DOI: 10.1159/000087066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Accepted: 05/13/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We report the health-related quality of life (QOL) of survivors of childhood cancer (acute lymphoblastic leukaemia, ALL, or central nervous system, CNS, tumour), and whether or not they had growth hormone deficiency (GHD) requiring growth hormone treatment (GHT). METHOD We assessed 77 survivors of childhood ALL (n = 51) or CNS tumours (n = 26), aged between 8-18 years, and free from disease for > or = 4 years. Survivors and their mothers independently rated survivors' QOL, and mothers completed semi-structured interviews to determine their views of the benefits and disadvantages of GHT. RESULTS Survivors, especially those treated for a CNS tumour, reported poorer QOL compared with UK population norms. Although survivors of ALL reported better QOL than survivors of CNS tumours, there were no differences depending on whether or not they were prescribed GHT. However, mothers reported that those prescribed GHT had worse QOL than those not. All but 2 survivors were responsible for their own injections. A minority of mothers were disappointed with the child's rate of growth, and reported that children experienced pain with injections. CONCLUSION We conclude that QOL in survivors of childhood cancer is compromised compared with the normal population, especially following CNS tumours. Longitudinal studies are vital to determine whether GHT can contribute to improved QOL for cancer survivors, especially those who experience more intensive initial therapy regimes.
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Affiliation(s)
- C Eiser
- Cancer Research UK Child and Family Research Group, University of Sheffield, Sheffield, UK.
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Abstract
OBJECTIVES To validate PedsQL for children in public care and develop an 'in-care' module. DESIGN AND SETTING Questionnaire development and validation. Questionnaires were completed in placement. A total of 69 children in public care (aged 8-18 years) and their carers were recruited through routine paediatric assessments, and 662 children not in public care were recruited from local schools. MEASURES Self- and proxy-report versions of PedsQL generic module and the 'in-care' module. RESULTS Cronbach's alpha for the generic module ranged from 0.66 to 0.88 and from 0.74 to 0.90 for self- and proxy-report respectively. Lower scores were reported for children in care compared with peers living at home for proxy- and self-report. Proxy- and self-report correlation ranged from 0.43 to 0.60 (P < 0.001). Cronbach's alpha for the in-care module was 0.87 and 0.91 for self- and proxy-report respectively. Proxy- and self-report scores showed significant correlation with generic module scores. The highest correlations were seen with sub-scales measuring Psychosocial Functioning (e.g. Emotional Functioning: Pearson's r = 0.67 and 0.59, P < 0.001 for self- and proxy-report respectively). Proxy- and self-report correlation was 0.45 (P < 0.001). CONCLUSIONS We found PedsQL generic module and the newly developed 'in-care' module to have excellent internal reliability for self- and proxy-report. Validity was established for both measures and significant correlation found between child and proxy ratings. Although further testing of the measures is recommended, both have potential value in assessing the success of placements and could provide a reliable and valid tool for individual patient analysis in clinical practice and for research with this group.
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Affiliation(s)
- P Upton
- Department of Psychology, University of Sheffield, Sheffield, UK
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Waller H, Eiser C, Heller S, Knowles J, Price K. Adolescents' and their parents' views on the acceptability and design of a new diabetes education programme: a focus group analysis. Child Care Health Dev 2005; 31:283-9. [PMID: 15840148 DOI: 10.1111/j.1365-2214.2005.00507.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The present study was conducted as part of an ongoing project to develop an innovative educational intervention for young people with type 1 diabetes. We aimed to seek the views of children and adolescents with type 1 diabetes and their parents regarding (i) the acceptability of the new programme and (ii) practical aspects regarding course design and delivery. METHODS Twenty-four children and 29 parents attended one of eight separate focus groups. Semi-structured interview schedules were developed around two main areas of discussion: views on the education programme; and views on the design and delivery of current and future education. Discussions were tape-recorded and transcribed, before undergoing systematic qualitative analysis. RESULTS Participants agreed that the proposed intervention was feasible, and were enthusiastic that it could improve quality of life and 'normality'. Potential problems included self-management during school-time and parental anxiety. In terms of course design/delivery, participants emphasized the need to maximize enjoyment on the course (e.g. integrating fun and practical sessions, holding parts of the course outside of the clinic setting), and encourage effective learning and adherence to the regimen (e.g. including separate parent education, and using IT-based reference material). CONCLUSIONS The qualitative methodology proved an effective way of eliciting child and parent views and informing the development of the proposed intervention. These findings can now be incorporated into the development of the education programme.
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Affiliation(s)
- H Waller
- Department of Psychology, University of Sheffield, Sheffield, UK.
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Eiser C, Greco V, Vance Y, Horne B, Glaser A. Perceived discrepancies and their resolution: quality of life in survivors of childhood cancer. Psychol Health 2004. [DOI: 10.1080/08870440310001594501] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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46
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Abstract
I would like to begin by putting forward the idea that there is much to be gained from a more generic as opposed to a medical model in working with chronically sick children. I would like to consider the potential advantages of this generic approach, and then go on to consider more specifically what can be learned, firstly, from the specific example of childhood cancer and, secondly, from chronic illness more generally. Whether we work with children with cancer, cystic fibrosis or any other chronic condition, we have to be impressed by the child's capacity to 'survive against the odds'. While early work described the problems or deficits shown by sick children, it is now clear that there is huge variability in outcomes. Many children show extraordinary resilience and coping. We are increasingly concerned about quality of life (QOL) as well as quantity of survival. In expanding on the thesis that much can be learned from other diseases, I am going to use QOL as an example.
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Affiliation(s)
- C Eiser
- Cancer Research UK Child and Family Research Group, University of Sheffield, Sheffield, UK
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47
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Abstract
AIMS To determine differences in ratings of quality of life (QOL) depending on respondent (mother or child) and implications for the validity of measures of QOL, and interpretation of scores. METHOD Forty-five survivors of acute lymphoblastic leukaemia (ALL) and 23 survivors of central nervous system (CNS) tumours and their mothers completed a generic measure of QOL: the Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0; Varni et al., 2001). RESULTS Although correlations between mother and survivor ratings were largely moderate to good, further analyses showed that mothers reported QOL to be worse than survivors. Both mothers and survivors rated physical health worse than psychological health, and survivors of a CNS tumour had poorer QOL than survivors of ALL. Although survivors of ALL reported reasonably good physical health, their psychosocial health was more adversely affected. CONCLUSIONS Implications for further use of the PedsQL 4.0 in the clinical or research context are discussed. Incidental findings highlight some limitations of the PedsQL 4.0 for work with this population.
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Affiliation(s)
- C Eiser
- Cancer Research UK Child, University of Sheffield, Sheffield, UK.
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Abstract
Urologists are well aware of the importance of the quality of life (QoL) in determining the success of their treatments. The public are increasingly aware of this aspect of medicine. The advent of fetal ultrasonography has made knowledge of QoL in long-term survivors of congenital anomalies essential in counselling about pregnancy termination. It is becoming mandatory that clinical trials involving adults include an assessment of QoL. For children, measuring QoL has been restricted to life-threatening conditions such as cancer or transplantation medicine. Measuring QoL is difficult in children and adolescents, and this is reflected in the few suitable instruments available. The development of sexuality contributes a further difficulty as many anxieties typical of those with genital anomalies may be common to all teenagers. Several instruments rely on the opinions of a proxy (parent or carer) but self-assessment by the child is preferable where possible. The need for child self-assessment is supported by finding little concordance between child and proxy assessments. While measuring QoL is challenging, we provide a substantial case for greater consideration of QoL in paediatric urology.
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Affiliation(s)
- E W Gerharz
- Department of Urology, Julius Maximilians University Medical School, Würzburg, Germany.
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Tillmann V, Darlington ASE, Eiser C, Bishop NJ, Davies HA. Male sex and low physical activity are associated with reduced spine bone mineral density in survivors of childhood acute lymphoblastic leukemia. J Bone Miner Res 2002; 17:1073-80. [PMID: 12054163 DOI: 10.1359/jbmr.2002.17.6.1073] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Survivors of acute lymphoblastic leukemia (ALL) are at risk of osteoporosis and obesity. We studied bone mineral density (BMD), percent of fat mass (%FM), and activity levels in survivors of ALL treated without radiotherapy. Lumbar and total areal BMD (g/cm2) and %FM were measured in 28 survivors (aged 5.7-14.7 years) of childhood ALL by dual-energy X-ray absorptiometry (DXA) scan (GE Lunar, Prodigy) an average of 5 years after completion of chemotherapy (UK Medical Research Council randomized trial protocol XI [UKALL XI]). One boy fractured his arm during treatment. Apparent volumetric lumbar BMD (BMD(vol); g/cm3) was calculated and %FM was adjusted for sex and age (%FM(adj)). Physical activity was measured by accelerometer and questionnaire. The results were compared with 28 sex- and age-matched healthy controls. Total body and lumbar areal BMD (g/cm2) were not different between the ALL group and the control group. However, mean lumbar BMD(vol) in survivors of ALL was significantly lower than in controls (0.303 +/- 0.036 g/cm3 vs. 0.323 +/- 0.03 g/cm3; p < 0.01), which mostly was caused by the difference in boys (0.287 +/- 0.032 g/cm3 vs. 0.312 +/- 0.027 g/cm3; p < 0.05). Weekly activity score by questionnaire was significantly lower in the ALL group than in the control group (geometric mean 50 vs. geometric mean 74; p < 0.05). Male gender, low activity levels and an intravenous (iv) high dose of methotrexate were associated with low lumbar BMD(vol). Patients who received an iv high dose of methotrexate (n = 18) had significantly higher %FM(adj) than those with intrathecal methotrexate only (n = 10; 141 +/- 70% vs. 98 +/- 37%;p < 0.05). In conclusion, male survivors of childhood ALL have reduced lumbar BMD(vol), whereas no such difference was seen in girls. Overall, survivors of ALL were physically less active than their healthy controls and lower activity correlated with lower lumbar BMD(vol) and higher %FM(adj).
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Affiliation(s)
- V Tillmann
- Department of Child Health, Sheffield Children's Hospital, Western Bank, United Kingdom
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Abstract
BACKGROUND The importance of psychosocial variables in asthma is increasingly recognised, although attempts to relate these to asthma outcomes often produce only weak relationships. This study aimed to identify whether such relationships might be obscured by the effects of recent asthma experience on psychological status. METHODS An adult community sample of 37 patients who had suffered a recent attack of asthma and 37 with stable asthma were given measures of panic fear and control confidence. The relationship with subsequent emergency service use was examined using two way ANOVA and correlational analyses. Covariate influences (psychiatric morbidity, age, sex, treatment level, asthma duration, social status) were considered. RESULTS Control confidence predicted emergency service use in different ways for recent attack and stable asthma patients. This interaction was highly significant (F(1,69) = 10.32, p<0.005) with high confidence relating to an increased risk of an attack in the recent attack group and low confidence relating to increased risk for the stable asthma group. There was also an interaction between panic fear and attack context (F(1,69) = 11.05, p<0.005) with low panic fear resulting in more attacks for recent attack cases. CONCLUSIONS Attack context (having a recent attack) is an important mediator of psychological status. Strong cognitive/affective responses to attacks may motivate improved self-care and this represents a window of opportunity for self-care interventions. Weak cognitive/affective responses to attacks may reflect denial and require different intervention approaches. For those with recently stable asthma the relationships are qualitatively and quantitatively different, and the implications for intervention are also discussed.
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Affiliation(s)
- C J Greaves
- School of Psychology, University of Exeter, Exeter EX4 4QG, UK.
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