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Corticosteroids, behavior, and quality of life in children treated for acute lymphoblastic leukemia; a multicentered

Catherine Maude Pound1, Camillia Clark, Andy Ni

  • 1Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. cpound@cheo.on.ca

Journal of Pediatric Hematology/Oncology
|June 28, 2012
PubMed

Insights

High-dose corticosteroids significantly impact behavior and quality of life in children undergoing acute lymphoblastic leukemia (ALL) maintenance therapy. These effects, including emotional disturbances and increased pain, necessitate careful consideration during treatment.

Area of Science:

  • Pediatric Oncology
  • Clinical Psychology
  • Pharmacology

Background:

  • Children with acute lymphoblastic leukemia (ALL) often receive high-dose corticosteroids during maintenance therapy.
  • Corticosteroids are crucial for ALL treatment but may have significant side effects.
  • Understanding the impact on behavior and quality of life is essential for supportive care.

Purpose of the Study:

  • To investigate the effects of high-dose corticosteroids on behavior and quality of life in pediatric ALL patients during maintenance therapy.
  • To compare the effects of different corticosteroids (dexamethasone vs. prednisone) on behavior in older children.
  • To evaluate changes in behavior and quality of life when children are on versus off steroids.

Main Methods:

  • A cohort of 43 families (patient and/or parent) participated.
  • Children served as their own controls, completing questionnaires on and off steroids.
  • Validated instruments included the Child Behavior Checklist (CBCL) and the Pediatric Quality of Life Inventory (PedsQL) Cancer module.

Main Results:

  • Younger children (≤5 years) showed significantly higher CBCL scores for somatic complaints, affective problems, internalizing, externalizing, and total problems when on steroids.
  • Older children (≥6 years) exhibited higher CBCL scores for externalizing, aggressive, and oppositional defiant problems on steroids.
  • Parents reported increased pain, nausea, and procedural anxiety on PedsQL when children were on steroids; older children had greater behavioral changes with dexamethasone compared to prednisone.

Conclusions:

  • Corticosteroid treatment during ALL maintenance therapy is linked to behavioral and emotional disturbances.
  • These medications adversely affect the quality of life for children with ALL.
  • Dexamethasone is associated with more pronounced behavioral changes in older children, suggesting differential effects based on age and drug type.

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