Health-related Quality of Life in children and adolescents treated for acute lymphoblastic leukaemia (ALL), compared with healthy peers: a longitudinal study of early survivorship.

Abstract

Purpose: Survival for childhood Acute Lymphoblastic Leukaemia (ALL) has surpassed 90%, making quality of survival an important endpoint in treatment outcomes. This study examined health-related quality of life (HRQoL) trajectories in early survivorship for patients post-ALL treatment compared with a matched group of healthy peers, and explored the association of individual factors (age, sex) and treatment intensity with HRQoL outcomes.

Methods: Eighty-three paediatric patients aged 4-16 years who recently completed treatment for ALL were recruited to the study, alongside 53 age- and sex-matched healthy children. All participants completed the self-report Pediatric Quality of Life Inventory (PedsQL) generic score scale at 3-, 15- and 27-months post-study enrolment.

Results: Trajectory of overall HRQoL for the patient group declined over time, falling below clinical cutoffs at 27 months. Subscale trajectories differed between groups, with patients' emotional and social functioning negatively diverging relative to healthy peers, while school functioning remained consistently reduced. Children treated for ALL experienced significantly poorer HRQoL compared to healthy peers at 27 months post-treatment (p = 0.027, ES = - 0.47) with moderate effect sizes, reflecting lower social functioning (p = 0.044, ES = - 0.42) and school functioning (p = 0.011, ES = - 0.52). Age and sex were not associated with overall HRQoL at 27 months; however, younger age was associated with reduced emotional functioning in the standard treatment-intensity group.

Conclusion and implications: HRQoL is impaired in children treated for ALL in early survivorship, particularly across social and school functioning domains. Screening using patient-reported outcomes is reliable at identifying young people at risk and has potential to guide psychosocial interventions in this early off-treatment period.