Impact of Cancer on the Physical and Psychological Well-being of Children in Mainland China
Condition: Child
Study type: Observational

Summary: 
      The aim of this study is to explore the impact of cancer and therapy-related symptoms on
      Mainland Chinese children's physical and psychological well-being.
    

Detailed description: 
      According to WHO, the annual cancer death has increased to 13 million a year . The cancer
      incidence of children has also been growing. As the advancement of diagnostic procedure and
      treatment, the chance of survival has risen considerably over the past decades. The mortality
      rate of childhood cancer in mainland China has also dramatically decreased during the recent
      decades.

      Nonetheless, the survivors experience low quality of life. When undergoing diagnostic
      procedures and treatments, children often suffer from multiple symptoms concurrently, such as
      nausea, fatigue, decreased appetite, pain, and feeling drowsy. These physical symptoms may
      have long-lasting effects as the treatments last longer. The increase in severity, duration
      and frequency of physical symptoms may negatively affect recovery of patients in terms of
      their functional status and positivity, subsequently leading to sadness and anger .
      Therefore, children will be anxious and stressful when they have cancer. There is
      considerably evidence to show that children who experience more symptoms have higher levels
      of depressiveness as well as lower level of physical and psychological functions.

      As a matter of fact, studies have found that coping strategies may affect the quality of
      life. When going through these therapies-related symptoms, children with cancer will feel
      helpless and have extreme reactions. They may adopt different types of coping strategies,
      such as screaming, refusing to have treatments or seeking comfort from parents. Some of the
      strategies may reduce the psychological pressure temporarily, while some other coping
      strategies can minimize physical pain. All of these may have their impact on quality of life
      in different degrees. Therefore, recognizing the effect of different coping strategies on
      both therapy-related symptoms and quality of life is a crucial step to design appropriate
      interventions that help cancer children to ease treatment related symptoms, improve their
      quality of life and promote their psychological well-being. On the other hand, a review of
      the literature has revealed that physical activity is beneficial to cancer patients in terms
      of their QoL as well as symptom management. Indeed, promoting regular physical activity has
      been incorporated to rehabilitation guideline for childhood cancer survivors in recent years,
      so as to enhance both their physical and functional well-beings, as well as, their
      psychological and emotional well-beings. In fact, the result of a cross-sectional study did
      show that there is a positive correlation between physical activity level and health-related
      quality of life . Another study conducted in western country also demonstrated that physical
      activity level is related to severity of fatigue and health-related quality of life of cancer
      patients.

      Notwithstanding the fact that regular physical activity is beneficial to cancer patients in
      terms of their psychological health, many children with cancer are recommend not to engage in
      regular physical activity. They are often advised to take more rest so as to avoid
      cancer-related or treatment-related fatigue. Given that, it seems also important for us, as
      health care professionals to examine the physical activity of children hospitalized with
      cancer before we will be able to design appropriate interventions to promote the adoption and
      maintenance of regular physical activity, with an ultimate goal to enhance their QoL and
      psychological well-being.

      Although there is compelling evidence to support that therapy-related symptoms, coping
      strategies and physical activity may have a significant impact on children's quality of life,
      all of these studies were conducted in western countries, in which, it is hard to reflect the
      phenomenon in China. On the other hand, notwithstanding the fact that there were several
      studies conducted in Hong Kong to examine relationship between therapy-related symptoms,
      coping strategies, physical activity and QoL in cancer children, cultural discrepancies
      between Hong Kong and China have made applying this finding to be difficult.

      this study will explore explore the Impact of Cancer and Therapy-related symptoms on Mainland
      Chinese Children's Physical and Psychological well-being.

      Mainland Chinese hospitalized Children with cancer in the wards of 3 tertiary public
      hospitals in Beijing will be invited to participate in the study. The pediatric oncology
      units of these three hospitals will be similar in nature and setting.

      The hospitalized children with cancer, who met the inclusion criteria for the study, will be
      invited to participate. The inclusion criteria are: (1) all children should be ages 9-16
      years, (2) they should be able to speak and read Chinese, (3) they should have been diagnosed
      with cancer for at least 2 months and be currently undergoing active treatment, and (4) they
      should aware of their diseases (cancer). We excluded children with cognitive and learning
      problems identified from their medical records.

      To compare the impact of therapy-related symptoms on children's quality of life and physical
      activity level, a group of healthy children having similar standard of living in Mainland
      China will be invited to participate in the study. The inclusion criteria are: (1) all
      children should be ages 9-16 years, (2) they should be able to speak and read Chinese, and
      (3) they should not have cancer or any other chronic illness.

      Approval of the study will be obtained from the hospital ethics committees in Mainland China
      and the University of Hong Kong.

      Firstly, the research student will check the eligibility of cancer children by screening
      their medical records. The research student will then approach the eligible children who are
      hospitalized in the wards of the pediatric oncology unit. Written consent will be obtained
      from their parents after they are told about the details of this study. They will be given an
      option to participate or refuse their child's involvement in the study. In addition, the
      children who agree to participate will be also invited to put their names on a special child
      assent form. Both of them will be assured that their participation is totally voluntary and
      they are allowed to withdraw from the study at any time. After obtaining the participants'
      demographics from the parents, the children will be asked to complete a set of questionnaires
      which consists of the Chinese version of Pediatric Quality of life Inventory, Chinese
      University of Hong Kong: Physical Activity Rating for Children and Youth and Coping Behavior
      Checklist. About 20 of them will also be selected at random to have a one-to-one, 20 to 30
      minutes, semi-structured interview, and all the interviews will be tape-recorded.

      Another group of healthy children will be recruited by similar procedures in the community
      and they will be asked to respond to the same set of questionnaires except the Coping
      Behavior Checklist.

      The independent t-test and chi-square will be used to assess the factors. Descriptive
      statistics will be used to calculate the mean scores and standard deviation of different
      scales.

      The qualitative data will be analyzed and reported followed by the seven-step analytical
      procedure of Colaizzi.
    

Intervention name(s): Questionnaires set 1; Questionnaires set 2
Intervention type(s): Other; Other
Intervention description(s): Participants were asked to respond to the Chinese version of the Coping Behavior Checklist for Chinese Children, the Chinese University of Hong Kong: Physical Activity Rating for Children and Youth, and the Pediatric Quality of life Inventory: cancer module.; Participants were asked to respond to the Chinese version of the Chinese University of Hong Kong: Physical Activity Rating for Children and Youth,and the Pediatric Quality of life Inventory: generic module
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Mainland Chinese hospitalized Children with cancer in the wards of 3 tertiary public
        hospitals in Beijing.
      
Keywords: Cancer; Quality of life; Child