A CAUSAL MODEL OF HEALTH-RELATED QUALITY OF LIFE IN THAI CHILDREN WITH CANCER
Keywords:
Causal model, health-related quality of life, Thai children, cancerAbstract
The path analytic study aims to test a causal model of health-related quality of life (HRQOL) in Thai children with cancer. The revised Wilson and Clary conceptual model of HRQOL by Ferrans et al. (2005) and previous evidences were used to develop the model. Seven independent variables including family functioning, coping, symptom distress, trait anxiety, state anxiety, functional status, and self-care behavior were examined in the model. Data were collected using a set of questionnaires. Back translation technique was performed with two questionnaires developed in English. Testing of the reliability of instruments showed that all instruments had an acceptable value of reliability between 0.82 and 0.93. Purposive sampling was used to recruit 199 children with cancer and 199 caregivers from eight tertiary hospitals in three parts of Thailand. Data were analyzed using path analysis. The modified model revealed that five independent variables including coping, symptom distress, trait anxiety, state anxiety, and functional status significantly accounted for 33% of variance in HRQOL. Trait anxiety had both significant direct and indirect negative effects on HRQOL via state anxiety and functional status. Functional status had a significant positive direct effect on HRQOL. Coping, symptom distress, and state anxiety had no significant direct effects on HRQOL. However, coping had an indirect effect on HRQOL through state anxiety and functional status. Both symptom distress and state anxiety had negative indirect effects on HRQOL via functional status. The findings provide useful information for nurses to develop effective interventions to enhance HRQOL in Thai children with cancer.
References
Baggott, C., Dodd, M., Kennedy, C., Marina, N., Matthay, K., Cooper, B., and Miaskowski, C. (2011). Anevaluation of the factors that affect the health-related quality of life of children followingmyelosuppressive chemotherapy. Support CareCancer [serial online]; 19(3):353-361. Availablefrom: Springer. Accessed date: Nov 12, 2017.
Barakat, L.P., Marmer, P.L., and Schwartz, L.A. (2010). Quality of life of adolescents with cancer: Family risk and resource. Health Qual. Life Outcomes, 8(63):1-8.
Burdenski, T. (2000). Evaluating univariate, bivariate, and multivariate normality using graphical and statistical procedures. MLRV, 26(2), 15-28.
Chaiyawat, W. and Brown, J.K. (2000). Psychometric properties of the Thai versions of state-trait anxiety inventory for children and child medical fear scale. Res. Nurs. Health, 23(5):406-414.
Chou, L.N. and Hunter, A. (2009). Factors affecting quality of life in Taiwanese survivors of childhood cancer. J. Adv. Nurs., 65(10):2131-2141.
Collins, J.J., Byrnes, M.E., Dunkel, I.J., Lapin, J., Nadel, T., Thaler, H.T., Polyak, T., Rapkin, B, and Portenoy, R.K. (2000). The measurement of symptoms in children with cancer. J. Pain Symptom Manage., 19(5):363-377.
Compas, B.E., Desjardins, L., Vannatta, K., Young-Saleme, T., Rodriguez, E.M., Dunn, M., Bemis, H., Snyder, S., Gerhardt, C.A. (2014). Children and adolescents coping with cancer: self- and parent reports of coping and anxiety/depression. Health Psychol., 33(8):853-861.
De Clercq, B., De Fruyt, F., Koot, H.M., and Benoit, Y. (2004). Quality of life in children surviving cancer: A personality and multi-informant perspective. J. Pediatr. Psychol., 29(8):579-590.
Dodd, M.J., Cho, M.H., Cooper, B.A., and Miaskowski, C.(2010). The effect of symptom clusters on functional status and quality of life in women with breast cancer. Eur. J. Oncol. Nurs., 14(2):101-110.
Dodd, M.J., Miaskowski, C., and Paul, S.M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncol. Nurs. Forum., 28(3):465-470.
Eilertsen, B.M., Jozefiak, T., Rannestad, T., Indredavik, M.S., and Vik, T. (2012). Quality of life in childrenand adolescents surviving cancer. Eur. J. Oncol.Nurs., 16:185-193.
Eiser, C., Eiser, J.R., and Stride, C.B. (2005). Quality of life in children newly diagnosed with cancer and their mothers. Health Qual. Life Outcomes, 3(29):1-5.
Epstein, N.B., Baldwin, L.M., and Bishop, D.S. (1983). The McMaster family assessment device. J. Marital. Fam. Ther., 9(2):171-180.
Ferrans, C.E., Zerwic, J.J., Wilbur, J.E., and Larson, J.L. (2005). Conceptual model of health-related quality of life. J. Nurs. Scholarsh., 37(4):336-342.
Ferreira, K.A.S.L., Kimura, M., Teixeira, M.J., Mendoza, T.R., da Nóbrega, J.C.M., Graziani, S.R., and Takagaki, T.Y. (2008). Impact of cancer-related symptom synergisms on health-related quality of life and performance status. J. Pain Symptom Manage., 35(6):604-616.
Fortier, M.A., Batista, M.L., Wahi, A., Kain, A., Strom, S., and Sender, L.S. (2013). Illness uncertainty and quality of life in children with cancer. J. Pediatr. Hematol. Oncol., 35(5):366-370.
Ghasemi, A., & Zahediasl, S. (2012). Normality tests for statistical analysis: A guide for non-statisticians. Int. J. Endocrinol. Metab., 10(2):486–489.
Hampel P. and Petermann F. Age and gender effects on coping in children and adolescents. J. Youth Adolesc., 34(2):73-83.
Hilton, A. and Skrutkowski, M. (2002). Translating instruments into other languages: Development and testing processes. Cancer Nurs., 25(1):1-7.
Hinds, P.S., Billups, C.A., Cao, X., Gattuso, J.S., Burghen, E., West, N., Rubnitz, J.E., and Daw, N.C. (2009). Health-related quality of life in adolescents at the time of diagnosis with osteosarcoma or acute myeloid leukemia. Eur. J. Oncol. Nurs., 13(3):156-163.
Jitnumsub, P. (2009). Quality of life in acute leukemia patients in Siriraj hospital, [MSc. Thesis]. Silpakorn University, Bangkok, Thailand, 92 p.
Klassen, A., Anthony, S., Khan, A., Sung, L., and Klaassen, R. (2011). Identifying determinants of quality of life of children with cancer and childhood cancer survivors: A systematic review. Support Care Cancer [serial online]; 19(9):1275-1287. Available from: Springer. Accessed date: Dec 15, 2017.
Landolt, M.A., Vollrath, M., Niggli, F.K., Gnehm, H.E., and Sennhauser, F.H. (2006). Health-related quality of life in children with newly diagnosed cancer: A one year follow-up study. Health Qual. Life Outcomes, 4(64):1-8.
Lansky, S.B., List, M.A., Lansky, L.L., Ritter-Sterr, C., and Miller, D.R. (1987). The measurement of performance in childhood cancer patients. Cancer, 60(7):1,651-1,656.
Li, H. C. W., Lopez, V. (2005). Do trait anxiety and age predict state anxiety of school-age children? J. Clin. Nurs., 14(9): 1,083-1,089.
Li, H.C.W., Lopez, V., Chung, J.O.K., Ho, K.Y., and Chiu, S.Y. (2013). The impact of cancer on the physical, psychological and social well-being of childhood cancer survivors. Eur. J. Oncol. Nurs., 17(2):214-219.
Maurice-Stam, H., Grootenhuis, M.A., Brons, P.P.T., Caron, H.N., and Last, B.F. (2007). Psychosocial indicators of health-related quality of life in children with cancer 2 months after end of successful treatment. J. Pediatr. Hematol. Oncol., 29(8):540-550.
Maurice-Stam, H., Oort, F., Last, B., Brons, P., Caron, H., and Grootenhuis, M. (2009). School-aged children after the end of successful treatment of non-central nervous system cancer: Longitudinal assessment of health-related quality of life, anxiety and coping. Eur. J. Cancer Care, 18(4):401-410.
McCaffrey, C.N. (2006). Major stressors and their effects on the well-being of children with cancer. J. Pediatr. Nurs., 21(1):59-66.
Miller, I.W., Epstein, N.B., Bishop, D.S., and Keitner, G.I. (1985). The McMaster family assessment device: Reliability and validity. J. Marital. Fam. Ther., 11(4):345-356.
National Cancer Institute. (2017). Hospital-based Cancer Registry 2015. Rumthaiplace, Bangkok, 72p.
Nunnally, J.C. and Bernstein, I.H. (1994). Psychometric Theory. 3rd ed. McGraw-Hill, NY, 741p.
Oupramand, R. (1994). Family functioning in the families of depressed and nondepressed children, [MSc. Thesis]. Chulalongkorn University, Bangkok, Thailand, 134 p.
Pao M. and Bosk A. (2011). Anxiety in medically ill children/adolescents. Depress. Anxiety, 28(1):40-9.
Punthmatharith, B., Buddharat, U., and Wattanasit, P. (2008). Quality of life and factors influencing quality of life of cancer children in southern Thailand. SMJ., 26(5):501-511.
Punthmatharith, B., Buddharat, U., and Wattanasit, P. (2013). Predictive factors for quality of life of among children with cancer in Thailand. Thai Cancer J., 34(1):3-17.
Reimers, T.S., Mortensen, E.L., Nysom, K., and Schmiegelow, K. (2009). Health-related quality of life in long-term survivors of childhood brain tumors. Pediatr Blood Cancer, 53(6):1086-1091.
Ruccione, K., Lu, Y., and Meeske, K. (2013). Adolescents' psychosocial health-related quality of life within 6 months after cancer treatment completion. Cancer Nurs [serial online]; 36(5): E61-E72. Available from: Wolters Kluwer Health | Lippincott Williams & Wilkins. Accessed date: Nov 29, 2017.
Ruland, C.M., Hamilton, G.A., and Schjødt-Osmo, B. (2009). The complexity of symptoms and problems experienced in children with cancer: A review of the literature. J. Pain Symptom Manage., 37(3):403-418.
Sato, I., Higuchi, A., Yanagisawa, T., Mukasa, A., Ida, K., Sawamura, Y., Sugiyama, K., Saito, N., Kumabe, T., Terasaki, M., Nishikawa, R., Ishida, Y., and Kamibeppu, K. (2013). Factors influencing self- and parent-reporting health-related quality of life in children with brain tumors. Qual. Life Res., 22(1):185-201.
Shankar, S., Robison, L., Jenney, M.E., Rockwood, T.H., Wu, E., Feusner, J., Friedman, D., Kane, R.L., and Bhatia, S. (2005). Health-related quality of life in young survivors of childhood cancer using the Minneapolis-Manchester Quality of Life-Youth Form. Pediatrics, 115(2):435-442.
Silapavitayatorn, B. (2008). Uncertainty in illness and coping strategies among children with cancer, [M.N.S. Thesis]. Chiang Mai University, Chiang Mai, Thailand, 85p.
Simons, L.E., Sieberg, C.B., and Claar, R.L. (2012). Anxiety and functional disability in a large sample of children and adolescents with chronic pain. Pain Res. Manag., 17(2):93–97.
Speechley, K.N., Barrera, M., Shaw, A.K., Morrison, H.I., and Maunsell, E. (2006). Health-related quality of life among child and adolescent survivors of childhood cancer. J. Clin. Oncol., 24(16):2536-2443.
Spielberger, C.D. and Reheiser, E.C. (2004). Measuring anxiety, anger, depression, and curiosity as emotional states and personality traits with the STAI, STAXI, and STPI. In: Comprehensive Handbook of Psychological Assessment: Personality Assessment, Volume 2. Hersen, M., Hilsenroth, M. J. and Segal D. L., (eds.). John Wiley and Sons, NJ, p. 70-86.
Stam, H., Grootenhuis, M.A., Caron, H.N., and Last, B.F. (2006). Quality of life and current coping in young adult survivors of childhood cancer: Positive expectations about the further course of the disease were correlated with better quality of life. Psycho-Oncology, 15(1):31-43.
Statistics Solutions. (2017). Homoscedasticity. Available from www.statistics solutions.com/homoscedasticity/. Accessed date: Jan 10, 2017
Suwannaosod, S. (2017). A structural equation model of spiritual well-being, depression, and health-related quality of life among Thai adolescents with cancer, [Ph.D. Thesis]. Kent State University, OH, USA, 155 p.
Taylor, R.M., Gibson, F., and Franck, L.S. (2008). A concept analysis of health-related quality of life in young people with chronic illness. J. Clinic. Nurs., 17(14):1823-1833.
Tabachnick, B.G. and Fidell, L.S. (2007). Using multivariate statistics. 5th ed. Allyn and Bacon/ Pearson, NY, 980p.
Trangkasombat, U. (2006). Family functioning in the families of psychiatric patients: A comparison with nonclinical families. J. Med. Assoc. Thai., 89(11): 1,946-1,953.
Vaezzadeh, N., Douki, Z.E., Hadipour, A., Osia, S., Shahmohammadi, S., and Sadeghi, R. (2011). The effect of performing preoperative preparation program on school age children's anxiety. Iran J. Pediatr., 21(4):461-466.
Varni J.W., Seid M., Rode C.A. (1999). The PedsQL 4.0: measurement model for the pediatric quality of life inventory. Med Care; 37(2):126-139.
Varni, J.W. (2014). The PedsQLTM measurement model for the pediatric quality of life inventoryTM. Lyon: France. Varni, J.W. Available from: www.pedsql. org. Accessed date: Dec 22, 2014.
Varni, J.W., Seid, M., and Kurtin, P.S. (2001). PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med. Care, 39(8):800-812.
Varricchio, C.G. and Ferrans, C.E. (2010). Quality of life assessments in clinical practice. Semin Oncol Nurs, 26(1):12-17.
Vlachioti, E., Perdikaris, P., Megapanou, E., Sava, F., and Matziou, V. (2016). Assessment of quality of life in adolescent patients with cancer and adolescent survivors of childhood cancer. J. Spec. Pediatr. Nurs., 21(4):178-188.
Wannapong, S., Chanpia, C., Chintanadilok, N., Chanwattana, B., and Preungwat, O. (1999). Quality of life of the child with leukemia. Thai J. Nurs. Res., 48(3):163-170.
Wenninger, K., Helmes, A., Bengel, J., Lauten, M., Völkel, S., and Niemeyer, C. M. (2013). Coping in long-term survivors of childhood cancer: Relations to psychological distress. Psycho-Oncology, 22(4):854-861.
Wu, E., Robison, L.L., Jenney, M.E.M., Rockwood, T.H., Feusner, J., Friedman, D., Kane, R.L., and Bhatia, S. (2007). Assessment of health-related quality of life of adolescent cancer patients using the Minneapolis-Manchester Quality of Life Adolescent Questionnaire. Pediatr. Blood Cancer, 48(7):678-686.
Zebrack, B.J. and Chesler, M.A. (2002). Quality of life in childhood cancer urvivors. Psycho-Oncology, 11(2):132-141.
