Health-related quality of life in children and adolescents in remission after antineoplastic treatment: a systematic review

Purpose: The aim of this systematic review was to evaluate available evidence on the effect of childhood cancer and its treatment on survivors' health-related quality of life (HRQoL). Methods: MEDLINE, EMBASE, the Cochrane Oral Health Group's Trials Register, CENTRAL database and unpublished literature on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis databases were searched for studies, up to April 2021, reporting on HRQoL of children and adolescents in remission after antineoplastic treatment. No language or publication date restrictions were applied. Data extraction and risk of bias assessment, using the Newcastle-Ottawa scale were performed and overall quality of life was reported. Scores for specific domains were recorded along with disease- and treatment-related determinants of poor HRQoL. Results: In all, 20 cross-sectional studies including 3119 patients (aged 4-17 years) who were in remission were identified in the literature search. Quality of included studies ranged from good to excellent. Findings were contradictory, with some studies reporting a similar or even better HRQoL for survivors compared to healthy controls, and others reporting diminished values. Physical and psychosocial functioning were the domains mostly affected, followed by social functioning. Determinants of poor HRQoL were female gender, central nervous system tumors, combination of treatment modalities, and severity of late effects. Conclusion: Cancer survivors are affected by the disease and its treatment to some extent but they seem to perform well overall.