Comparing the impact of cancer and treatment-related late effects on the psychological well-being, hope and health-related quality of life between survivors of childhood solid tumours and leukaemia : an exploratory study

Abstract

The advanced medical developments in cancer screening and treatment have greatly improved the survival rates of childhood cancer patients. However, childhood cancer survivors are afflicted with delayed health sequelae that jeopardise their psychological well-being and health-related quality of life (HRQOL). Evidence indicates that survivors of solid tumours have poorer survival rate and shorter disease-free survival time than survivors of leukaemia, resulting in more profound negative effects on their psychological well-being. There is growing evidence that hope promotes coping with diseases and enhances psychological well-being. Nevertheless, no study has so far been conducted to examine and compare the psychological well-being, hope level and HRQOL between Hong Kong Chinese survivors of childhood solid tumours and leukaemia. Moreover, there is scant evidence on the interrelationships among psychological well-being, hope level and HRQOL of childhood cancer survivors in the Hong Kong Chinese context. This study aimed to (1) compare the impact of cancer and treatment-related late effects on psychological well-being, hope level and HRQOL between Hong Kong Chinese survivors of childhood solid tumours and leukaemia; and (2) to examine the interrelationships among depressive symptoms, self-esteem, hope level and HRQOL of Hong Kong Chinese childhood cancer survivors. The study was a mixed methods design, using cross-sectional study in phase one quantitative study and phenomenology in phase two qualitative study. Subject recruitment was carried out at the paediatric outpatient clinic of one of the largest acute hospitals in Hong Kong. A total of 65 survivors of childhood solid tumours and 70 survivors of childhood leukaemia aged 8–18 years were recruited. Participants’ depressive symptoms, self-esteem, hope level and HRQOL were assessed and compared. In addition, 22 survivors of childhood solid tumours and 15 survivors of childhood leukaemia were purposively selected for semi-structured interviews. Survivors of childhood solid tumours reported significantly lower level of hope, more depressive symptoms, lower self-esteem and poorer HRQOL than survivors of childhood leukaemia. The findings indicated that hope, depressive symptoms and self-esteem are the significant contributing factors of HRQOL. In addition, the qualitative data revealed that survivors of childhood solid tumours faced more challenges and difficulties in performing routine activities, preserving positive body image, pursuing academic achievements, building up social networks and maintaining a positive attitude towards the future when compared with survivors of childhood leukaemia. This is the first study to examine and compare the psychological well-being, hope level and HRQOL between Hong Kong Chinese survivors of childhood solid tumours and leukaemia. In particular, this study indicated that hope demonstrated the greatest contribution to HRQOL. The information can raise the awareness of healthcare professionals towards the psychological needs of survivors of childhood solid tumours. Moreover, the results of the study enrich healthcare professionals’ understanding of the different psychological needs among different groups of childhood cancer survivors. This can prevent the actual psychological needs of survivors of childhood solid tumours from being underestimated or overlooked. It is suggested that future interventions should aim at instilling hope to promote psychological well-being and HRQOL among survivors of childhood solid tumours.