Abstract 706: Impact of symptom clusters on quality of life in pediatric cancer survivors after treatment completion
Authors: Krishtee Napit, Don Coulter, Katrina Cordts, Daisy Dai, Evi Farazi, Shinobu Watanabe-Galloway
Journal: Cancer Research (2025)

Abstract Background: The advancement in pediatric cancer treatment led to an increased five-year survival. Symptoms develop due to cancer and its treatment during the treatment phase, but they can persist even after treatment completion. Cancer patients experience multiple interrelated symptoms known as symptom clusters. Compared with a single symptom, symptom clusters synergistically affect quality of life (QoL). Limited studies in pediatric cancer have assessed the association between symptom clusters and quality of life, but none were assessed after the treatment completion. Objective: To find the association between symptom clusters and QoL among pediatric cancer survivors after treatment completion. Method: We conducted a cross-sectional study of 136 pediatric cancer survivors aged 10-25 who completed treatment within eight years from 2 major hospitals in Nebraska. We used a survey to collect data during their hospital visit, the validated Memorial Symptom Assessment Scale tool to collect information on symptoms, and the PedsQoL instrument to measure the quality of life. We used exploratory factor analysis to derive symptom clusters. We conducted a multiple linear regression model to find the association between symptom clusters and quality of life at a significance level with a p-value of less than 0.05 and an adjusted beta coefficient. Results: The mean age was 14.91, the mean year since diagnosis and treatment completion was 4.66 and 3.05, respectively, and the mean number of symptoms was 6.06. Difficulty concentrating (48.53%), lack of energy (45.59%), and feeling drowsy (45.59%) were the most common symptoms. Around 80% of participants experienced more than one symptom. The mean overall quality of life score was 80.84, the psychosocial score was 79.84, and the physical score was 82.72 out of 100. The exploratory analysis derived four symptom clusters: Cluster 1: dry mouth, lack of energy, feeling drowsy, feeling irritable, and difficulty sleeping; Cluster 2: feeling nervous, worrying, feeling sad, and difficulty concentrating; Cluster 3: nausea and lack of appetite; and Cluster 4: pain, cough, numbness in hands/feet, dizziness and sweats. The multiple linear models were adjusted for possible confounders and sociodemographic and clinical characteristics. Cluster 1 (β= -4.74, 95% CI: 7.32, 2.15) and Cluster 2 (β= -3.39, 95% CI: 5.80, -0.98) were associated with lower overall quality of life. Cluster 1 (β= -3.96, 95% CI: -7.47, -0.44) was associated with lower physical quality of life. Cluster 1 (β= -5.15, 95% CI: -7.83, -2.47) and Cluster 2 (β= -4.64, 95% CI: -7.13, -2.14) were associated with lower psychosocial quality of life. Conclusion: Even after treatment completion, symptom clusters are prevalent in pediatric cancer survivors. Among the four clusters identified, Cluster 1 and Cluster 2, which include mainly psychological symptoms, affect all dimensions of quality of life. Citation Format: Krishtee Napit, Don Coulter, Katrina Cordts, Daisy Dai, Evi Farazi, Shinobu Watanabe-Galloway. Impact of symptom clusters on quality of life in pediatric cancer survivors after treatment completion [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 706.