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.