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Health-Related Quality of Life in Survivors of Wilms’ Tumor and Advanced Neuroblastoma: A Cross-Sectional Study

From the McMaster University, Hamilton; Health Utilities Inc, Dundas; University of Toronto, Toronto; and University of Alberta and Institute of Health-Economics, Edmonton, Ontario, Canada; and University of Aberdeen, Aberdeen, Scotland.

Address reprint requests to Ronald D. Barr, MD, Room 3N27B, McMaster University, Health Sciences Centre, 1200 Main St W, Hamilton, Ontario, Canada L8S 4J9; email rbarr{at}fhs.csu.mcmaster.ca

PURPOSE: In pediatric oncology, Wilms’ tumor and advanced neuroblastoma represent opposite ends of the spectra of survival probability and therapeutic intensity. Consequently, it was envisaged that survivors of Wilms’ tumor would enjoy better health status and health-related quality of life (HRQL) than survivors of advanced neuroblastoma.

PATIENTS AND METHODS: Health status questionnaires were sent to the parents of all eligible children and to the children themselves if they were 8 years of age. Responses were received from 84% of 93 eligible families. Responses were converted by established algorithms into levels of two multiattribute health status classification systems known as Health Utilities Index Mark 2 and Mark 3. These systems are linked to measures of preference, in the form of multiattribute utility functions, which provide scores of morbidity for single-attribute levels and of global HRQL for comprehensive health states.

RESULTS: A greater burden of morbidity was identified in the survivors of advanced neuroblastoma than in survivors of Wilms’ tumor based on the assessments of the parents of these children. In particular, survivors of advanced neuroblastoma exhibited deficits in hearing and speech. It is possible that this morbidity burden reflects the prevalent use of platinum compounds (causing ototoxicity) in this group. Within parent-child dyads there was a high level of percentage agreement on responses in all attributes except cognition.

CONCLUSION: Extension of this study to a larger sample size of patients will provide clarification of these observations.

This study was presented in part at the annual meeting of the International Society of Pediatric Oncology in Istanbul, Turkey, September 23-27, 1997, and at the Fifth International Conference on the Long-Term Complications of Treatment of Children and Adolescents for Cancer in Niagara-on-the-Lake, Ontario, Canada, June 11-13, 1998.

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