The Impact of Limitations in Physical, Executive, and Emotional Function on Health-Related Quality of Life Among Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Ness KK, Gurney JG, Zeltzer LK, Leisenring W, Mulrooney DA, Nathan PC, Robison LL, Mertens AC. The impact of limitations in physical, executive, and emotional function on health-related quality of life among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.ObjectiveTo examine associations between limitations in physical performance, executive function, and emotional health (activity domains) and either social role attainment or health-related quality of life (HRQOL) in adult survivors of childhood cancer.DesignCross-sectional analysis.SettingCancer survivors living in the community; previously treated for childhood cancer at one of 26 institutions.ParticipantsSubjects included 7147 (76.8%) of 9307 eligible adult members of the Childhood Cancer Survivor Study who completed a follow-up questionnaire between 2002 and 2004.InterventionsNot applicable.Main Outcome MeasuresDemographic information was used to classify social roles and the Medical Outcomes Survey 36-Item Short-Form Health Survey to ascertain HRQOL. Questions from the National Health Interview Survey were used to represent physical performance; from the Brief Symptom Inventory to classify emotional health; and from the Behavioral Rating of Executive Function to describe executive function. Multivariate logistic regression was used to examine the association between limitations in activity domains, role attainment, and HRQOL.ResultsIn this cohort, 18.1% reported deficits in physical performance, 10.5% in emotional health, and 14.0% in executive function. In adjusted models, when compared with survivors who reported no limitations, those with physical performance, executive function, or emotional health deficits were less likely to be employed, married, or have incomes greater than $20,000 a year. Limitations in executive function or emotional health were associated with no health insurance. Limitations in any activity domain were associated with poor HRQOL. Emotional health limitations had the most impact, with odds ratios from 3.18 (physical performance summary) to 25.81 (mental health).ConclusionsThe results of these analyses show the need for development and testing of interventions to remediate limitations in activity domains, because they negatively impact role attainment and HRQOL.