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      Patient‐reported quality of life in adolescents and young adults with cancer who received radiation therapy


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          Radiation therapy (RT) is a common treatment for adolescents and young adults (AYAs, 15–39 years old) with cancer; however, it may cause toxicities that affect health‐related quality‐of‐life (HRQOL). Thus, we assessed HRQOL in AYAs before, during, and after RT.


          We identified 265 AYAs who completed HRQOL PROMIS® surveys before ( n = 87), during ( n = 84), or after ( n = 94) RT. Higher PROMIS® score represents more of the concept. Mean scores were compared to the general US population and minimally important differences (MIDs) were used to evaluate the impact of cancer on HRQOL. Linear regression modeling was used to evaluate the effect of clinical and demographic factors on PROMIS scores.


          Median [IQR] age was 26 [20–31] years. Cancer types varied; most had sarcoma (26%) or CNS malignancy (23%). Compared to the general US population, the before RT cohort had worse anxiety (mean score 55.2 vs. 50, MID 3, p < 0.001) and the during RT cohort had worse global physical health (mean score 44.9 vs. 50, MID 5, p < 0.001). In the during RT cohort, patients with regional/distant disease had significantly worse pain ( B = 15.94, p < 0.01) and fatigue ( B = 14.20, p = 0.01) than patients with localized disease. In the after RT cohort, adolescents (15–18 years) and young adults (26–39 years) had worse global physical health ( B = ‐6.87, p < 0.01, and B = ‐7.87, p < 0.01, respectively) and global mental health ( B = ‐6.74, p < 0.01, and B = ‐5.67, p = 0.01, respectively) than emerging adults (19–25 years).


          AYAs with cancer receiving RT experience impairments in various domains of HRQOL. Advanced cancer stage may contribute to poorer short‐term HRQOL and developmental stage may contribute to differing long‐term HRQOL.

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          Most cited references41

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          Emerging adulthood: A theory of development from the late teens through the twenties.

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            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.
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              Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment.


                Author and article information

                Cancer Med
                Cancer Med
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                18 May 2023
                July 2023
                : 12
                : 13 ( doiID: 10.1002/cam4.v12.13 )
                : 14157-14170
                [ 1 ] Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
                [ 2 ] Department of Population Health Sciences, Department of Pediatrics, Center for Health Measurement Duke University School of Medicine Durham North Carolina USA
                [ 3 ] Department of Social Sciences and Health Policy Wake Forest University Winston‐Salem North Carolina USA
                [ 4 ] Institution of Health System Science, Northwell Health Manhasset New York USA
                [ 5 ] Department of Pediatrics The University of Texas MD Anderson Cancer Center Houston Texas USA
                [ 6 ] Department of Sarcoma Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
                [ 7 ] Department of Behavioral Science The University of Texas MD Anderson Cancer Center Houston Texas USA
                Author notes
                [*] [* ] Correspondence

                Michael Roth, Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.

                Email: mroth1@ 123456mdanderson.org

                Author information
                CAM46082 CAM4-2022-12-5470.R2
                © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                : 24 April 2023
                : 09 December 2022
                : 04 May 2023
                Page count
                Figures: 2, Tables: 4, Pages: 14, Words: 6263
                Funded by: NIH Cancer Center Support
                Award ID: P30 CA016672
                Research Article
                RESEARCH ARTICLES
                Clinical Cancer Research
                Custom metadata
                July 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.2 mode:remove_FC converted:20.07.2023

                Oncology & Radiotherapy
                adolescents and young adults,cancer,health‐related quality of life,patient‐reported outcomes,radiation therapy


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