Several factors may impact health-related quality of life (HRQOL) in children with chronic phase chronic myeloid leukemia (CML), according to a study published in the Journal of Cancer Research and Clinical Oncology.

The study suggested that patients’ age, sex, and treatment-related symptoms, as well as mothers’ education level, were significantly associated with HRQOL. The study also indicated that patients and their parents have different priorities with regard to HRQOL.

Researchers studied patients with chronic phase CML treated at 43 hospitals in China from July 2018 to December 2019. The study included 240 children, 62.1% of whom were male. The patients’ median age was 9 years (range, 0.2-17.5 years) at diagnosis and 13 years (range, 2.0-18.9 years) at the time of the study.

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For tyrosine kinase inhibitor (TKI) treatment, 90.8% of patients received imatinib, 7.1% received dasatinib, and 2.1% received nilotinib. The median treatment duration was 30 months (range, 6-95 months), and 57% of patients reported TKI-related symptoms.

Children and parents were given a 3-part questionnaire to assess demographic, clinical, and HRQOL information, the latter assessed through the Chinese version of the Pediatric Quality of Life Inventory Cancer Module 3.0.

The researchers analyzed child and parent responses across 8 dimensions: pain and hurt, nausea, procedural anxiety, treatment anxiety, worry, cognition problems, perceived physical appearance, and communication problems.

Communication was the least impacted dimension of HRQOL, according to patients, with a mean score of 93.8. Procedural anxiety was the most impacted, with a mean score of 58.8. Parents largely agreed with their children, scoring communication at 92.8 and anxiety at 59.1.

Although there was a strong correlation between parent and patient reports, there were some differences. Patients tended to be more concerned about their appearance, while parents were more concerned about their children’s gastrointestinal symptoms and future. 

In a multivariable analysis, the presence of TKI-related symptoms was significantly associated with worse pain, nausea, treatment anxiety, communication, self-assessment of appearance, and overall HRQOL.

Patients who were younger at the time of the study had more procedural anxiety, treatment anxiety, and cognition problems, as well as worse HRQOL. Patients who were older at the time of diagnosis were more likely to worry about the future, had worse self-assessment of their appearance, and had worse HRQOL.

Girls had more procedural anxiety, worse self-assessment of their appearance, and worse HRQOL. Children with mothers who had low levels of education had worse pain, cognitive problems, communication problems, and HRQOL, and they were more likely to worry about the future.

“In conclusion, our study in children with CML showed that female gender, older age at the time of diagnosis, younger age at study, low mother’s educational qualification, and TKI-related symptoms had a negative effect on their HRQOL,” the researchers wrote.

The team suggested that, due to the discrepancy between parent and patient perceptions, patients may benefit from psychological counseling.


Zheng F, Dou X, Zhang L, et al. Health‐related quality of life in children with chronic myeloid leukemia in the chronic phase. J Cancer Res Clin Oncol. Published online October 29, 2021. doi:10.1007/s00432-021-03832-y