Introduction
Symptom distress and decreased quality of life (QOL) has been well
documented among children with cancer,1 but little is
known regarding the demographic characteristics that could be targeted
for interventions. The few studies in the literature examining
demographic differences in the QOL of children with cancer are limited
to children with leukemia,2-4 children with advanced
cancer,5,6 and survivors of childhood
cancer.7 Although the results are mixed, it appears
that female gender and younger age are related to worse QOL, and older
age is associated with more nausea.2,5-7 Thus, we
sought to examine sex, race/ethnicity, age, and socio-economic (SES)
differences in QOL in children in the first year of treatment for any
type of cancer. We used questionnaires and a novel objective biologic
measure to examine QOL.
QOL is usually measured with questionnaires in children with cancer.
This practice is inherently limited by subjectivity, age, and
developmental stage. An objective measure could reduce the time and
possible distress associated with questionnaires and more efficiently
and accurately determine the outcomes of interventions to improve
QOL.8,9 Systematic review of standing posture measured
as thoracic kyphosis shows promise as a marker of QOL (manuscript under
review). Indeed, posture has been studied in survivors of pediatric
cancer as an outcome variable of neurologic injury, but not for overall
QOL.10,11 In terms of the variables that may affect
posture, studies have examined adults and healthy children. Posture did
not differ by sex in older adults with kyphosis,12 but
did differ by age13 and sex in healthy
children;14,15 however this relationship has not been
examined in children with cancer.
Disparities in SES, race, and ethnicity can no longer be ignored in
health care research. New work is emerging on the association of
financial burden with worse QOL in children newly diagnosed with
cancer,16 children undergoing stem cell
transplant,17 children with advanced
cancer,6,18 and children who have completed cancer
therapy.19 In our data set, education level of parent
and zip code were included as surrogate variables for
SES.20 Race and ethnicity have been studied as
predictors of overall survival in various pediatric
cancers,21,22 QOL of children with
leukemia,23 experiences in end-of-life
care,24 and QOL of childhood cancer
survivors.25 Less is known of SES as a predictor of
QOL in children in early treatment for any type of cancer.
Finally, although the Faces Scale for pain26 has been
validated to measure nausea,27fatigue,28 and anxiety,29 it is not
known if it can be used as a surrogate for global QOL.
To evaluate the inter-relationships of demographic variables, measures
of QOL, and posture, a cross-sectional secondary analysis of a study
including 100 children with cancer was completed to inform potential
targets for future intervention studies. An exploratory analysis was
also used to query the data for potential relationships between posture,
the Faces Scale, and the PedsQL Cancer scales.