Skip to main content
SpringerLink
Log in

Health-related quality of life predicts length of hospital stay and survival rates for pediatric patients receiving allogeneic hematopoietic cell transplantation

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

We examined the association between health-related quality of life (HRQoL) of pediatric patients during hospitalization for allogeneic hematopoietic cell transplantation (HCT) and length of hospital stay, and 1-year survival.

Methods

Primary family caregivers were proxy-assessors for the Pediatric Quality of Life (PedsQL) Stem Cell Transplant Module at three time points: 5-days pre-HCT (T0); 14-days post-HCT (engraftment, T1); and 1-week before hospital discharge (T2). Cox regression analyses determined predictors of the overall 1-year survival after allogeneic HCT.

Results

Thirty-nine eligible caregivers completed all assessments. The mean age of the pediatric patients was 9.07 years (SD = 5.2). PedsQL Stem Cell Transplant Module scores decreased from 71.33 (SD = 13.26) at T0 to 55.41(SD = 13.05) at T1 (p < 0.001) and increased to 68.46 (SD = 13.97) at T2 (p < 0.001). There was no significant difference between scores at T0 and T2. Longer length of hospital stay was associated with children who were younger and had greater relative changes in scores on the caregiver-proxy PedsQL Stem Cell Transplant Module from T0 to T1. PedsQL Stem Cell Transplant Module scores ≥ 58.07 at T2 were associated with higher 1-year survival rates (Hazard Ratio = 0.12, 95% Confidence Interval = 0.02–0.78; p = 0.03).

Conclusion

Our findings suggest that assessment of HRQoL during early HCT can add prognostic value beyond demographic and HCT factors. Understanding the HRQoL status during hospitalization for HCT could help identify pediatric patients with low prospects of 1-year survival in order to provide support interventions to improve HRQoL and survival rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nava, T., Ansari, M., Dalle, J. H., de Heredia, C. D., Güngör, T., Trigoso, E., Falkenberg, U., Bertaina, A., Gibson, B., Jarisch, A., & Balduzzi, A. (2020). Supportive care during pediatric hematopoietic stem cell transplantation: Beyond infectious diseases. A report from workshops on supportive care of the pediatric diseases working party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplantation, 55, 1126–1136.

    Article  Google Scholar 

  2. Rangarajan, H. G., Smith, L. C., Stanek, J. R., Hall, M., Abu-Arja, R., Auletta, J. J., & O’Brien, S. H. (2019). Increased health care utilization and costs during allogeneic hematopoietic cell transplantation for acute leukemia and myelodysplastic syndromes in adolescents and young adults compared with children: A multicenter study. Biology of Blood and Marrow Transplantation, 25(5), 1031–1038.

    Article  Google Scholar 

  3. World Health Organization. Transplantation. Retrieved March 9, 2021, from http://www.who.int/transplantation/hsctx/en/

  4. D'Souza, A., Fretham, C. Current uses and outcomes of hematopoietic cell transplantation (HCT): CIBMTR Summary Slides 2019. Retrieved March 9, 2021, from https://www.cibmtr.org

  5. Preussler, J. M., Mau, L. W., Majhail, N. S., Bevans, M., Clancy, E., Messner, C., Parran, L., Pederson, K. A., Ferguson, S. S., Walters, K., & Murphy, E. A. (2019). Caregiver availability and patient access to hematopoietic cell transplantation: Social worker perspectives inform practice. Supportive Care in Cancer, 27(11), 4253–4264.

    Article  Google Scholar 

  6. Minculescu, L., Marquart, H. V., Friis, L. S., Petersen, S. L., Schiødt, I., Ryder, L. P., Andersen, N. S., & Sengeloev, H. (2016). Early natural killer cell reconstitution predicts overall survival in T cell–replete allogeneic hematopoietic stem cell transplantation. Biology of Blood and Marrow Transplantation, 22(12), 2187–2193.

    Article  CAS  Google Scholar 

  7. Wobma, H., Jin, Z., Moscoso, S., Bhatia, M., Broglie, L., George, D., Garvin, J., & Satwani, P. (2020). Risk factors, clinical outcomes, and cost-of-care related to graft failure in pediatric allogeneic hematopoietic cell transplant recipients. Biology of Blood and Marrow Transplantation, 26(7), 1318–1325.

    Article  CAS  Google Scholar 

  8. Broder, M. S., Quock, T. P., Chang, E., Reddy, S. R., Agarwal-Hashmi, R., Arai, S., & Villa, K. F. (2017). The cost of hematopoietic stem-cell transplantation in the United States. American Health & Drug Benefits, 10(7), 366–374.

    Google Scholar 

  9. Godara, A., Siddiqui, N. S., Munigala, S., Dhawan, R., Kansagra, A. J., Rapoport, A. P., Yared, J. A., & Dahiya, S. (2020). Length of stay and hospital costs for patients undergoing allogeneic stem-cell transplantation. JCO Oncology Practice, 17(3), e355–e368.

    Article  Google Scholar 

  10. Kaziunas, E., Hanauer, D. A., Ackerman, M. S., & Choi, S. W. (2016). Identifying unmet informational needs in the inpatient setting to increase patient and caregiver engagement in the context of pediatric hematopoietic stem cell transplantation. Journal of the American Medical Informatics Association, 23(1), 94–104.

    Article  Google Scholar 

  11. Brice, L., Weiss, R., Wei, Y., Satwani, P., Bhatia, M., George, D., Garvin, J., Morris, E., Harrison, L., Cairo, M. S., & Sands, S. A. (2011). Health-related quality of life (HRQoL): The impact of medical and demographic variables upon pediatric recipients of hematopoietic stem cell transplantation. Pediatric Blood & Cancer, 57(7), 1179–1185.

    Article  Google Scholar 

  12. Loiselle, K. A., Rausch, J. R., Bidwell, S., Drake, S., Davies, S. M., & Pai, A. L. (2016). Predictors of health-related quality of life over time among pediatric hematopoietic stem cell transplant recipients. Pediatric Blood & Cancer, 63(10), 1834–1839.

    Article  Google Scholar 

  13. Shaw, B. E., Brazauskas, R., Millard, H. R., Fonstad, R., Flynn, K. E., Abernethy, A., Vogel, J., Petroske, C., Mattila, D., Drexler, R., & Lee, S. J. (2017). Centralized patient-reported outcome data collection in transplantation is feasible and clinically meaningful. Cancer, 123(23), 4687–4700.

    Article  CAS  Google Scholar 

  14. Grant, A., Chapman, L., Mitchel, R., & O’Brien, T. (2020). Engraftment syndrome following haematopoietic stem cell transplant: A review of the literature. Clinical Transplantation. https://doi.org/10.1111/ctr.13875

    Article  PubMed  Google Scholar 

  15. Clarke, S. A., Skinner, R., Guest, J., Darbyshire, P., Cooper, J., Vora, A., Urquhart, T., Jenney, M., Powell, J., & Eiser, C. (2011). Clinical outcomes and health-related quality of life (HRQOL) following haemopoietic stem cell transplantation (HSCT) for paediatric leukaemia. Child: Care, Health & Development, 37(4), 571–580.

    Google Scholar 

  16. Liu, Y. M., Jaing, T. H., Chen, Y. C., Tang, S. T., Li, C. Y., Wen, Y. C., Chang, H. L., & Chen, M. L. (2016). Quality of life after hematopoietic stem cell transplantation in pediatric survivors: Comparison with healthy controls and risk factors. Cancer Nursing, 39(6), 502–509.

    Article  Google Scholar 

  17. Graef, D. M., Phipps, S., Parris, K. R., Martin-Elbahesh, K., Huang, L., Zhang, H., & Crabtree, V. M. (2016). Sleepiness, fatigue, behavioral functioning, and quality of life in survivors of childhood hematopoietic stem cell transplant. Journal of Pediatric Psychology, 41(6), 600–609.

    Article  Google Scholar 

  18. Lawitschka, A., Güclü, E., Varni, J., Putz, M., Wolff, D., Pavletic, S., Greinix, H., Peters, C., & Felder-Puig, R. (2014). Health-related quality of life in pediatric patients after allogeneic SCT: Development of the PedsQL stem cell transplant module and results of a pilot study. Bone Marrow Transplantation, 49(8), 1093–1097.

    Article  CAS  Google Scholar 

  19. Rodgers, C., Wills-Bagnato, P., Sloane, R., & Hockenberry, M. (2015). Health-related quality of life among children and adolescents during hematopoietic stem cell transplant recovery. Journal of Pediatric Oncology Nursing, 32(5), 329–336.

    Article  Google Scholar 

  20. Rodday, A. M., Terrin, N., Leslie, L. K., Graham, R. J., & Parsons, S. K. (2017). Understanding the relationship between child health-related quality of life and parent emotional functioning in pediatric hematopoietic stem cell transplant. Journal of Pediatric Psychology, 42(7), 804–814.

    Article  Google Scholar 

  21. Rodday, A. M., Terrin, N., Chang, G., & Parsons, S. K. (2013). Performance of the parent emotional functioning (PREMO) screener in parents of children undergoing hematopoietic stem cell transplantation. Quality of Life Research, 22(6), 1427–1433.

    Article  Google Scholar 

  22. Rodday, A. M., Terrin, N., & Parsons, S. K. (2013). Measuring global health-related quality of life in children undergoing hematopoietic stem cell transplant: A longitudinal study. Health and Quality of Life Outcomes, 11(1), 26.

    Article  Google Scholar 

  23. Terrin, N., Rodday, A. M., & Parsons, S. K. (2015). Joint models for predicting transplant-related mortality from quality of life data. Qual of Life Research, 24(1), 31–39.

    Article  Google Scholar 

  24. Johnston, D. L., Nagarajan, R., Caparas, M., Schulte, F., Cullen, P., Aplenc, R., & Sung, L. (2013). Reasons for non-completion of health related quality of life evaluations in pediatric acute myeloid leukemia: A report from the children’s oncology group. PLoS ONE, 8(9), e74549.

    Article  CAS  Google Scholar 

  25. Parsons, S. K., Tighiouart, H., & Terrin, N. (2013). Assessment of health-related quality of life in pediatric hematopoietic stem cell transplant recipients: Progress, challenges and future directions. Expert Review of Pharmacoeconomics & Outcomes Research, 13(2), 217–225.

    Article  Google Scholar 

  26. Wood, W. A., Le-Rademacher, J., Syrjala, K. L., Jim, H., Jacobsen, P. B., Knight, J. M., Abidi, M. H., Wingard, J. R., Majhail, N. S., Geller, N. L., & Rizzo, J. D. (2016). Patient-reported physical functioning predicts the success of hematopoietic cell transplantation (BMT CTN 0902). Cancer, 122(1), 91–98.

    Article  Google Scholar 

  27. Schwimmer, J. B., Burwinkle, T. M., & Varni, J. W. (2003). Health-related quality of life of severely obese children and adolescents. JAMA, 289(14), 1813–1819.

    Article  Google Scholar 

  28. Varni, J. W., Burwinkle, T. M., & Seid, M. (2005). The PedsQLTM as a pediatric patient-reported outcome: Reliability and validity of the PedsQLTM Measurement Model in 25,000 children. Expert Review of Pharmacoeconomics & Outcomes Research, 5(6), 705–719.

    Article  Google Scholar 

  29. Varni, J. W., Burwinkle, T. M., Seid, M., & Skarr, D. (2003). The PedsQLTM* 4.0 as a pediatric population health measure: Feasibility, reliability, and validity. Ambulatory Pediatrics, 3(6), 329–341.

    Article  Google Scholar 

  30. Liu, Y. M., Wen, Y. C., Weng, P. Y., Jaing, T. H., & Chen, S. H. (2020). Effectiveness of a three-stage intervention in reducing caregiver distress during pediatric hematopoietic stem cell transplantation: A randomized controlled trial. Journal of Pediatric Oncology Nursing, 37(6), 377–389.

    Article  Google Scholar 

  31. Gyurkocza, B., & Sandmaier, B. M. (2014). Conditioning regimens for hematopoietic cell transplantation: One size does not fit all. Blood, 124(3), 344–353.

    Article  CAS  Google Scholar 

  32. Przepiorka, D., Weisdorf, D., Martin, P., Klingemann, H., Beatty, P., Hows, J., & Thomas, E. D. (1995). 1994 Consensus conference on acute GVHD grading. Bone Marrow Transplantation, 15(6), 825–828.

    CAS  PubMed  Google Scholar 

  33. Varni, J. W. PedsQLTM Translatios. The PedsQL™ Measurement Model for the Pediatric Quality of Life InventoryTM. Retrieved March 9, 2021, from https://www.pedsql.org/translations.html

  34. Vetter, T. R. (2017). Fundamentals of research data and variables: The devil is in the details. Anesthesia & Analgesia, 125(4), 1375–1380.

    Article  Google Scholar 

  35. Bursac, Z., Gauss, C. H., Williams, D. K., & Hosmer, D. W. (2008). Purposeful selection of variables in logistic regression. Source Code for Biology and Medicine, 3(1), 17.

    Article  Google Scholar 

  36. Leys, C., Klein, O., Dominicy, Y., & Ley, C. (2018). Detecting multivariate outliers: Use a robust variant of the mahalanobis distance. Journal of Experimental Social Psychology, 74, 150–156.

    Article  Google Scholar 

  37. Cox, D. R. (1972). Regression models and life-tables. Journal of the Royal Statistical Society, 34(2), 187–202.

    Google Scholar 

  38. Bishara, A. J., & Hittner, J. B. (2012). Testing the significance of a correlation with nonnormal data: Comparison of Pearson, Spearman, transformation, and resampling approaches. Psychological Methods, 17(3), 399–417.

    Article  Google Scholar 

  39. Martin, P. J., Rizzo, J. D., Wingard, J. R., Ballen, K., Curtin, P. T., Cutler, C., Litzow, M. R., Nieto, Y., Savani, B. N., Schriber, J. R., & Shaughnessy, P. J. (2012). First-and second-line systemic treatment of acute graft-versus-host disease: Recommendations of the American Society of Blood and Marrow Transplantation. Biology of Blood and Marrow Transplantation, 18(8), 1150–1163.

    Article  Google Scholar 

  40. Jamil, M. O., & Mineishi, S. (2015). State-of-the-art acute and chronic GVHD treatment. International Journal of Hematology, 101(5), 452–466.

    Article  CAS  Google Scholar 

  41. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). . Lawrence Erlbaum.

    Google Scholar 

  42. Chow, S., Shao, J., & Wang, H. (2008). Sample size calculations in clinical research (2nd ed.). . CRC Press.

    Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge Lan-Yan Yang, Ph.D., Biostatistics Unit of Clinical Trial Center, Chang Gung Memorial Hospital, for statistical consultations.

Funding

Ministry of Science and Technology, Taiwan (MOST 104-2314-B-255-004 & MOST 105-2314-B-255-003) and Chang Gung Memorial Hospital, Taiwan (CMRPF3G0071).

Author information

Authors and Affiliations

  1. Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan

    Ying-Mei Liu & Chia-Ling Wu

  2. Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Ying-Mei Liu, Tang-Her Jaing & Shih-Hsiang Chen

  3. Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Yu-Chuan Wen & Pei-Yin Weng

  4. School of Nursing, University of California San Francisco, San Francisco, CA, USA

    Lin Lin

  5. No. 261, Wen-Hwa 1st Road, Guishan District, Taoyuan, Taiwan

    Ying-Mei Liu

Authors
  1. Ying-Mei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tang-Her Jaing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu-Chuan Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shih-Hsiang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pei-Yin Weng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lin Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chia-Ling Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ying-Mei Liu.

Ethics declarations

Conflict of interest

All authors have no conflicts of interest relevant to this article to disclose.

Ethical approval

Approval was obtained from the Institutional Review Board of Chang Gung Medical Foundation (IRB No. 104-6136C).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 181 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, YM., Jaing, TH., Wen, YC. et al. Health-related quality of life predicts length of hospital stay and survival rates for pediatric patients receiving allogeneic hematopoietic cell transplantation. Qual Life Res 30, 3421–3430 (2021). https://doi.org/10.1007/s11136-021-02887-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-021-02887-1

Keywords

Search

Navigation