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Published on: October 17, 2025
Determinants of quality of life during induction therapy in pediatric acute lymphoblastic leukemia
Raphaële R L van Litsenburg1, Jaap Huisman, Rob Pieters
1Department of Pediatrics, VU University Medical Center Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands, litsenburg@vumc.nl.
Insights
Pediatric acute lymphoblastic leukemia (ALL) patients experience impaired quality of life (QoL) during induction therapy, particularly older girls. Early interventions are needed to improve QoL for at-risk children.
Area of Science:
- Pediatric Oncology
- Quality of Life Research
- Childhood Cancer Treatment
Background:
- Improved survival rates in pediatric acute lymphoblastic leukemia (ALL) necessitate a focus on quality of life (QoL).
- QoL is known to be affected during maintenance therapy, but less is understood about its impact during induction therapy.
- Identifying children with poor QoL early in induction allows for timely interventions to enhance overall well-being.
Purpose of the Study:
- To evaluate the quality of life (QoL) in children undergoing induction therapy for acute lymphoblastic leukemia (ALL).
- To identify key determinants influencing QoL during this critical treatment phase.
- To inform the development of targeted support strategies for pediatric ALL patients.
Main Methods:
- A national, multi-center study involving 130 parents of children with ALL.
- Utilized proxy reports from the Child Health Questionnaire (CHQ) and PedsQL cancer module.
- Analyzed child, treatment, and parental characteristics using multiple regression models to identify QoL determinants.
Main Results:
- QoL scores were significantly lower than normative data, with large effect sizes and clinical relevance.
- Physical QoL was more frequently impacted than psychosocial QoL.
- Older children, girls, and those further along in their diagnosis showed poorer QoL; father respondents reported lower QoL perception than mothers.
Conclusions:
- Children with acute lymphoblastic leukemia (ALL) experience significantly impaired quality of life (QoL) during induction therapy.
- Older age, female gender, and longer time since diagnosis are associated with lower QoL.
- Targeted counseling and interventions are recommended for high-risk pediatric ALL patients to improve QoL during early treatment phases.
Purpose:
Improvement in survival of pediatric acute lymphoblastic leukemia (ALL) has increased the attention to quality of life (QoL) . QoL is impaired during maintenance treatment, but little is known about QoL during induction therapy. Identification of patients with poor QoL during induction will provide opportunities for early interventions, and may subsequently improve future QoL. This national multi-center study aimed to assess QoL and its determinants during ALL induction treatment.
Methods:
Proxy reports of the Child Health Questionnaire (CHQ) and the PedsQL cancer version were collected. Child, treatment, and parental characteristics were analyzed as potential determinants in a multiple regression model.
Results:
One hundred thirty parents of children participated (response rate 82 %), median child age was 5.7 years and 48 % were female. QoL, as measured with the CHQ, was significantly lower than the norm, the effect sizes were large, and the differences were clinically relevant. Physical QoL was more often affected than psychosocial QoL. Regression models could be constructed for 4/ 10 CHQ scales and 6/ 8 PedsQL cancer scales, accounting for 7 to 36 % of the variance in scores. Impaired QoL was most often associated with older children, girls, and time since diagnosis. Also, father respondents seem to have a lower QoL perception compared to mother respondents although this needs to be confirmed in future research.
Conclusions:
Specific counseling for subsets of patients with a higher risk of low QoL during the early phases of therapy is warranted.
