Quality of life trajectories in children aged 2-4 years with acute lymphoblastic leukemia

This study examines changes in quality of life (QoL) in children with acute lymphoblastic leukemia (ALL). We investigated the QoL and determinants of Toddlers with ALL aged 2-4 years. We applied a cross-sectional design with repeated measurements. We invited proxies of ALL patients aged 2-4 years in three hospitals in Vietnam. Proxy reports were collected for toddlers using the PedsQL Generic Core Scales (PedQL-G) and the PedsQL Cancer module (PedsQL-C) Vietnamese version. The QoL function over time was estimated using the Gaussian kernel smoothing method. Linear mixed effect models were constructed to explore the determinants of QoL among individual subjects. One hundred four proxies with a mean age of 33.53 ± 5.89 years completed the PedsQL-G and PedsQL-C for their children, with 152 repeated measurements. The physical, emotional, and social scores of these children were found to improve consistently during the first 3 years after diagnosis, except for procedural anxiety, where it was found that toddlers frequently worried for the first 18 months after diagnosis but gradually improved up to the third year. Toddlers with a proxy of higher education showed lower scores in the emotional domain. In contrast, those with the father as a proxy scored high on their children's emotional domain and had lower scores on worry about medical procedures.

Toddlers with ALL frequently exhibited anxiety about medical procedures during the first 1.5 years but improved over time. Their scores were modified by the proxy's education and relationship with the children.

• Almost all studies on quality of life (QoL) in children with acute lymphoblastic leukemia (ALL) focus on groups older than five years old. • Treatment abandonment has been frequently encountered in toddlers aged 2-4 years diagnosed with ALL.

• During the first 1.5 years, the QoL of toddlers with ALL in the physical, emotional, and social dimensions improved consistently after treatment, except for anxiety about medical procedures.  • Proxy with a higher level of education graded lower scores on their toddler's emotions, and fathers or relatives as the proxy graded higher scores on their children's emotions but lower scores on procedural anxiety than mothers.