Pediatric Quality of Life Inventory (PedsQL) in children with cancer: Article Summary
Study
Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P. The PedsQL™ in pediatric cancer: Reliability and validity of the pediatric quality of life inventory™ generic core scales, multidimensional fatigue scale, and cancer module. Cancer. 2002;94(7):2090-2106. doi:10.1002/cncr.10428
Purpose
The study was conducted to examine the clinical relevance of the use of the Pediatric Quality of Life Inventory 4.0 (PedsQL) in pediatric patients with cancer. The PedsQL administered included the Generic Core scales, Multidimensional Fatigue Scale, and Cancer Module.
Population
339 families were given the 3 questionnaires. Patients were of ages 2-18, 56% male and 44% female, and considered heterogenous in terms of ethnicity and race. The most common diagnoses included leukemia, brain tumor, lymphoma (both non-Hodgkin and Hodgkin), and Wilms’ tumor. Patients had no other comorbidities and were eligible to participate at all stages of treatment, from newly diagnosed to recently in remission.
Methods
Patients were recruited from oncology and cancer centers in two childrens’ hospitals in the San Diego and Los Angeles areas. All families were given the parent proxy report, and patients ages 5 and up were also given the child self-report. 337 families responded with parent reports and 220 families responded with child self-reports. The outcome measures were also given to 730 families of health children to compare to the oncology sample for data analysis. Researchers used internal consistency reliability coefficients, Pearson correlation coefficients, and one-way ANOVA analysis for the results.
Outcome Measures
The three outcome measures were used that are all under the umbrella of the PedsQL 4.0.
The Generic Core scales are considered applicable to any pediatric patient with chronic disease and include 23 questions regarding physical and emotional well-being and social/school interactions. The measure is scores on a scale from 0-4 based on the severity of the topic, with 0 being never a problem and 4 being almost always a problem.
The Multidimensional Fatigue scale is a new measure intended to quantify fatigue in pediatric patients with cancer, both child self-reported and parent perceptions. 18 questions cover general fatigue through the day, problems falling or staying asleep, and mental fatigue from a variety of factors (diagnoses, school, social, etc.)
The Cancer Module is the second new measure from the authors specific for pediatric patients with cancer that covers other effects of the diagnosis and treatment. 27 questions address pain, nausea, anxiety/worry about medical treatment, cognitive or communication impairments, and perceived appearance and function.
Interventions
This study was intended to examine the relevance of these 3 outcomes measures in pediatric patients with cancer. No intervention was provided.
Results
In previous studies from the authors, they concluded the PedsQL Generic Core scales were a relevant and reliable measure for all pediatric patients with chronic disease. For the general core and Multidimensional fatigue scales, there was a statistically significant difference between the pediatric patients and healthy children. The Cancer Module scales showed differences between groups for questions regarding pain, nausea, and medical anxiety in child and parent reports. All three measures met the minimum reliability standard set by researchers at 0.70, demonstrating reliability of the measures between patients.
Conclusion
Results of the study show all three measures are relevant and reliable for use in a pediatric population with cancer. In addition, child self-reports matched relatively closely with the parent proxy report, demonstrating that both methods of intake would be valid. Parent reports would also be useful and accurate in cases where the child is unable to respond for any reason.
Personal Assessment
I believe this study proves the value of using these measures in this specific population. I found the question to cover a broad range of topics that would be especially useful for a pediatric physical therapist – better understanding patient pain and fatigue will be useful in short term, while other questions allow a view of how the condition is affecting the child in the day-to-day activities. I do think the biggest limitation is that the measures currently do not have MCID values or recommendations on appropriate intervals between intake. Given that severity of disease and side effects of treatment can vary a good amount, having a better grasp on what values are important to monitor and how often to use these measures would be beneficial.
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