Quality of life and morbidities of childhood cancer survivors in Hong Kong

Abstract

Background With improvement in medical oncology with prolonged survival of childhood cancer patients, long-term morbidity and quality of life (QOL) become increasingly important issues to address. Though systemic reviews had been conducted previously, majority of study results were generated from Western developed countries. In view of the lack in systemic review on local studies, the purpose of this paper is to provide a comprehensive systematic review of literatures studying the quality of life and morbidities of childhood cancer survivors in Hong Kong (HK), taking account into potential cultural differences and validity of quality-of-life measure in this locality. Specific objectives of this review include comparing the QOL of HK childhood cancer survivors with healthy HK people of same age and sex, investigating the determinants of QOL including the presence of comorbidities, identifying measures to prevent morbidities or low QOL or improve QOL.

Methods Literature review was performed using PubMed, Ovid Medline, Cochrane Library and Google scholar using defined keywords ‘quality of life’, ‘cancer or malignancy or neoplasm or cancer survivor’, ‘child or adolescent or paediatric’ and ‘Hong Kong’. Search was limited to publications written in English or Chinese with full text available published in the past 20 years since 1st January 1995.

Findings Cancerand its treatments have great impact on physical and psychosocial well-being as well as overall quality of life in HK Chinese childhood cancer survivors. The Chinese version of the Paediatric Quality of Life Inventory (PedsQL) 4.0 Cancer Module and the Generic Core Scales are validated measures on multiple domains of quality of life in Hong Kong Chinese childhood cancer survivors and their caretakers. Depression and low self-esteem are common psychological comorbidities in HK Chinese childhood cancer survivors. Physical comorbidities which are highly variable and dependent on cancer and treatment types, require further quantitative studies to delineate. Therapy-related symptoms, in particular oropharyngeal mucositis, can be a useful indicator screening for psychosocial distress and risk of depression. Being female, older age, longer survival time, and specific cancer diagnoses were associated with poorer physical and mental adaptation. Health-related quality of life was negatively correlated with psychological distress. Integrated adventure-based training program is effective in promoting their physical activity level, self-efficacy and quality of life.

Conclusions This is the first literature review on local publications concerning quality of life and morbidities of childhood cancer survivors in Hong Kong, which demonstrate compatible conclusions as in international studies that cancer and its treatments have long term effects on overall quality of life in Hong Kong Chinese childhood cancer survivors. Knowledge gap exists in addressing prevalence of each specific cancer-or treatment-related morbidities and their relations with QOL and evolvement with time. Further qualitative and quantitative researches are warranted for better understanding of the situation in local context. Early recognition of vulnerable disease groups, early identification and intervention of psychosocial risk factors in both patients and caretakers would improve quality of life in Hong Kong paediatric oncology patients in the long term.