Examining Health-Related Quality of Life in Pediatric Cancer Patients with Febrile Neutropenia: Factors Predicting for Poor Recovery in Children and the Parents

Background: The impact of febrile neutropenia (FN) on the health-related quality of life (HRQoL) of children with cancer is poorly understood. We sought to characterise the course of child and parent HRQoL during and following FN episodes. Method: Data on HRQoL were collected in the multisite Australian PICNICC study. Multiple, discrete FN episodes per patient were allowed. HRQoL was assessed using the Child Health Utility (CHU9D) in children (n=167) and the Assessment of Quality of Life (AQoL-8D) in their parents (N=218) at three time points: 0-3 days, 7-days and 30-days following FN onset. Group-based trajectory modelling (GBTM) was used to characterise the course of HRQoL. Findings: For children, three distinct groups were identified: persistently low HRQoL over 30-days (chronic, 47%), increasing HRQoL from FN onset to 30-days (recovery, 22%), and persistently high HRQoL at all three timepoints (resilient, 32%). Applying these definitions, parents were classified into two distinct groups: chronic (49%) and resilient (51%).The child being male, having solid cancers, the presence of financial stress and relationship difficulties between the parent and child were significant predictors of chronic group membership for parents and children. Children classified as high-risk FN were significantly more likely to belong to the recovery group. Being female, having blood cancers and the absence of financial or relationship difficulties were predictive of being in the resilient group for both parents and children Interpretation: Approximately half the children and parents had chronically low HRQoL scores, which did not improve following resolution of the FN episode. The child’s sex, cancer type, and presence of financial and relationship stress were predictive of chronic group membership for both parents and children. These families may benefit from increased financial and psychosocial support during anti-cancer treatment. Trial Registration: The Australian PICNICC study is a prospective, multicentre, observational study (Australian New Zealand Clinical Trials Registry 12616001440415). Funding: This study was funded by a National Health and Medical Research Council (NHMRC) Project Grant (APP1104527). Declaration of Interest: GMH was supported by a Victorian Cancer Agency early career fellowship. FEB was part funded by a grant from the Royal Children's Hospital Foundation, Melbourne and the NHMRC. RP was funded by a Post-Doctoral Research Fellow grant from the NIHR, UK (PDF10872). MS has received grants from Merck, Gilead Sciences, F2G and Pfizer. KAT, RDAL, ZA and FM. and RP have no disclosures. Ethical Approval: This study utilised data from the PICNICC RCT, HREC Number (36040A, Royal Children’s Hospital Melbourne Human Research Ethics Committee) and ratified by the UTS HREC (ETH17-1128).