0
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Development and Validation of Models to Predict Poor Health-Related Quality of Life Among Adult Survivors of Childhood Cancer

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Key Points

          Question

          What is the validity of prediction models that use sociodemographic, lifestyle, and health state factors to predict health-related quality of life (HRQOL) among adult survivors of childhood cancer?

          Findings

          In this prognostic study of 4755 adult survivors of childhood cancer, chronic health conditions were associated with a decline in physical HRQOL, whereas current cigarette smoking and emotional and neurocognitive impairment were associated with a decline in mental HRQOL. Performance based on the area under receiver operator characteristic curve was 0.74 for declining physical HRQOL and 0.68 for declining mental HRQOL.

          Meaning

          These findings may help guide clinicians to screen for risk factors during follow-up appointments and provide interventions that target these risk factors to prevent poor HRQOL among adult survivors of childhood cancer.

          Abstract

          Importance

          Risk prediction models are important to identify survivors of childhood cancer who are at risk of experiencing poor health-related quality of life (HRQOL) as they age.

          Objective

          To develop and validate prediction models for a decline in HRQOL among adult survivors of childhood cancer.

          Designs, Setting, and Participants

          This prognostic study included 4755 adults from the Childhood Cancer Survivor Study (CCSS) diagnosed between January 5, 1970, and December 31, 1986, who completed baseline (time 0 [November 3, 1992, to August 28, 2003]) and 2 follow-up (time 1 [February 12, 2002, to May 21, 2005] and time 2 [January 6, 2014, to November 30, 2016]) surveys. Data were analyzed from June 19, 2019, to February 2, 2022.

          Exposures

          Sociodemographic, lifestyle, and emotional factors, and chronic health conditions (CHCs) were assessed at time 0 and time 1, and neurocognitive factors were assessed at time 1 to predict HRQOL at time 2 and a decline in HRQOL between time 1 and time 2. Impaired health states were defined as CHC grades 2 to 4 using the modified Common Terminology Criteria for Adverse Events, version 4.03, and mental and neurocognitive status as 1 SD or more below reference levels.

          Main Outcomes and Measures

          Health-related quality of life was operationalized using the Medical Outcomes Study 36-Item Short Form Health Survey Physical (PCS) and Mental (MCS) Component Summary and classified by optimal (≥40) or suboptimal (<40) at each point (main outcome). A decline in HRQOL was defined as a change from optimal to suboptimal between time 1 and time 2. Multivariable logistic regression identified factors associated with HRQOL decline. The cohort was randomly split into training (80%) and test (20%) data sets for model development and validation; the area under the receiver operating characteristic curve was used to evaluate prediction performance.

          Results

          A total of 4755 adults (mean [SD] age at time 0, 24.3 [7.6] years; 2623 [55.2%] women) were included in the analysis. Between time 1 and time 2, 285 of 3294 survivors (8.7%) had declining PCS and 278 of 3294 (8.4%) had declining MCS. Risk factors associated with PCS decline included female sex (odds ratio [OR], 1.67 [95% CI, 1.25-2.24]), family income less than $20 000 vs $80 000 or more (OR, 2.00 [95% CI, 1.21-3.30]), presence of CHCs (OR for neurological, 2.16 [95% CI, 1.51-3.10]; OR for endocrine, 2.25 [95% CI, 1.44-3.52]; OR for gastrointestinal tract, 1.89 [95% CI, 1.32-2.69]; OR for respiratory, 1.66 [95% CI, 1.06-2.59]; OR for cardiovascular, 1.53 [95% CI, 1.14-2.06]), and depression (OR, 1.79 [95% CI, 1.20-2.67]). Risk factors associated with MCS decline included unemployment vs full-time employment (OR, 1.68; [95% CI, 1.19-2.38]), current vs never cigarette smoking (OR, 2.03 [95% CI, 1.37-3.00]), depression (OR, 4.29 [95% CI, 2.44-7.55]), somatization (OR, 1.63 [95% CI, 1.05-2.53]), impaired task efficiency (OR, 1.90 [95% CI, 1.34-2.68]), and impaired organization (OR, 1.67 [95% CI, 1.12-2.48]). The areas under the receiver operating characteristic curve for the test models were 0.74 (95% CI, 0.67-0.81) for declining PCS and 0.68 (95% CI, 0.60-0.75) for declining MCS.

          Conclusions and Relevance

          In this prognostic study of adult survivors of childhood cancer who experienced declining HRQOL, CHCs were associated with a decline in physical HRQOL, whereas current smoking and emotional and neurocognitive impairment were associated with a decline in mental HRQOL. These findings suggest that interventions targeting modifiable risk factors are needed to prevent poor HRQOL in this population.

          Abstract

          This prognostic study identifies sociodemographic, lifestyle, and health state factors associated with declining health-related quality of life and examines the performance of models developed to predict these associations among adult survivors of childhood cancer.

          Related collections

          Most cited references41

          • Record: found
          • Abstract: found
          • Article: not found

          The weirdest people in the world?

          Behavioral scientists routinely publish broad claims about human psychology and behavior in the world's top journals based on samples drawn entirely from Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies. Researchers - often implicitly - assume that either there is little variation across human populations, or that these "standard subjects" are as representative of the species as any other population. Are these assumptions justified? Here, our review of the comparative database from across the behavioral sciences suggests both that there is substantial variability in experimental results across populations and that WEIRD subjects are particularly unusual compared with the rest of the species - frequent outliers. The domains reviewed include visual perception, fairness, cooperation, spatial reasoning, categorization and inferential induction, moral reasoning, reasoning styles, self-concepts and related motivations, and the heritability of IQ. The findings suggest that members of WEIRD societies, including young children, are among the least representative populations one could find for generalizing about humans. Many of these findings involve domains that are associated with fundamental aspects of psychology, motivation, and behavior - hence, there are no obvious a priori grounds for claiming that a particular behavioral phenomenon is universal based on sampling from a single subpopulation. Overall, these empirical patterns suggests that we need to be less cavalier in addressing questions of human nature on the basis of data drawn from this particularly thin, and rather unusual, slice of humanity. We close by proposing ways to structurally re-organize the behavioral sciences to best tackle these challenges.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.

            A number of studies have computed the minimally important difference (MID) for health-related quality of life instruments. To determine whether there is consistency in the magnitude of MID estimates from different instruments. We conducted a systematic review of the literature to identify studies that computed an MID and contained sufficient information to compute an effect size (ES). Thirty-eight studies fulfilled the criteria, resulting in 62 ESs. For all but 6 studies, the MID estimates were close to one half a SD (mean = 0.495, SD = 0.155). There was no consistent relationship with factors such as disease-specific or generic instrument or the number of response options. Negative changes were not associated with larger ESs. Population-based estimation procedures and brief follow-up were associated with smaller ESs, and acute conditions with larger ESs. An explanation for this consistency is that research in psychology has shown that the limit of people's ability to discriminate over a wide range of tasks is approximately 1 part in 7, which is very close to half a SD. In most circumstances, the threshold of discrimination for changes in health-related quality of life for chronic diseases appears to be approximately half a SD.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes.

              Our model proposes a taxonomy or classification scheme for different measures of health outcome. We divide these outcomes into five levels: biological and physiological factors, symptoms, functioning, general health perceptions, and overall quality of life. In addition to classifying these outcome measures, we propose specific causal relationships between them that link traditional clinical variables to measures of HRQL. As one moves from left to right in the model, one moves outward from the cell to the individual to the interaction of the individual as a member of society. The concepts at each level are increasingly integrated and increasingly difficult to define and measure. AT each level, there are an increasing number of inputs that cannot be controlled by clinicians or the health care system as it is traditionally defined.
                Bookmark

                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                17 August 2022
                August 2022
                17 August 2022
                : 5
                : 8
                : e2227225
                Affiliations
                [1 ]Department of Oncology, University of Calgary, Calgary, Alberta, Canada
                [2 ]Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
                [3 ]Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
                [4 ]Department of Pediatric Hematology/Oncology, MemorialCare Miller Children’s & Women’s Hospital Long Beach,Long Beach, California
                [5 ]Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
                [6 ]Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
                [7 ]Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
                [8 ]Department of Medicine, Duke University, Durham, North Carolina
                [9 ]Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
                [10 ]Department of Psychology, St Jude Children’s Research Hospital, Memphis, Tennessee
                Author notes
                Article Information
                Accepted for Publication: June 30, 2022.
                Published: August 17, 2022. doi:10.1001/jamanetworkopen.2022.27225
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Schulte F et al. JAMA Network Open.
                Corresponding Authors: Fiona Schulte, PhD, Department of Oncology, University of Calgary, 2202 2 St SW, Calgary, AB T2S 3C3, Canada ( fsmschul@ 123456ucalgary.ca ); I-Chan Huang, PhD, Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Mail Stop 735, 262 Danny Thomas Place, Memphis, TN 38105 ( i-chan.huang@ 123456stjude.org ).
                Author Contributions: Ms Chen and Dr Yasui had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: Schulte, Ruiz, Leisenring, Oeffinger, Hudson, Armstrong, Robison, Krull, Huang.
                Acquisition, analysis, or interpretation of data: Schulte, Chen, Yasui, Leisenring, Gibson, Nathan, Oeffinger, Hudson, Armstrong, Robison, Krull, Huang.
                Drafting of the manuscript: Schulte, Chen, Ruiz, Huang.
                Critical revision of the manuscript for important intellectual content: Schulte, Yasui, Ruiz, Leisenring, Gibson, Nathan, Oeffinger, Hudson, Armstrong, Robison, Krull, Huang.
                Statistical analysis: Schulte, Chen, Yasui, Huang.
                Obtained funding: Armstrong.
                Administrative, technical, or material support: Ruiz, Leisenring, Armstrong, Robison, Krull, Huang.
                Supervision: Leisenring, Krull, Huang.
                Conflict of Interest Disclosures: Dr Leisenring reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Oeffinger reported serving as advisor for GRAIL outside the submitted work. Dr Hudson reported receiving grants from the National Cancer Institute (NCI) during the conduct of the study. Dr Armstrong reported receiving grants from St Jude Children’s Research Hospital and the NIH during the conduct of the study. Dr Robison reported receiving grants from the NIH outside the submitted work. Dr Krull reported receiving grants from the NCI during the conduct of the study. No other disclosures were reported.
                Funding/Support: This study was supported by award U24CA055727 (Gregory T. Armstrong, MD, MSCE, principal investigator) from the NCI, the American Syrian Lebanese Associated Charities, and the award P30CA21765 Cancer Center Support from the NCI (Charles W. M. Roberts, MD, PhD, principal investigator).
                Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                Article
                zoi220771
                10.1001/jamanetworkopen.2022.27225
                9386537
                35976647
                42f0fffb-5a34-402b-ac73-4f2ed0235310
                Copyright 2022 Schulte F et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 15 March 2022
                : 30 June 2022
                Categories
                Research
                Original Investigation
                Online Only
                Oncology

                Comments

                Comment on this article