Quality of life of children with acute lymphoblastic leukemia

  • Siti Arifah Nursing Department, Faculty of Health Science, Universitas Muhammadiyah, Surakarta, Central Java
  • Renu Pookboonmee School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
  • Autchareeya Patoomwan School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
  • Prasong Kittidumrongsuk Faculty of Public Health, Mahidol University, Bangkok
  • Mia Ratwita Andarsini Department of Pediatrics, Universitas Airlangga, East Java
Keywords: acute lymphoblastic leukemia; cancer; children; quality of life


Background Acute lymphoblastic leukemia (ALL) is the most common cancer in children worldwide, which  requires long treatment. This condition and its subsequent treatment change the body's physiology, reducing children’s quality of life. 

Objective To describe the quality of life in children with acute lymphoblastic leukemia in Java, Indonesia.

Methods This descriptive study with a cross-sectional approach included parents who had children with ALL at three referral hospitals in Java, Indonesia, between January 2021 and May 2022. We recruited 188 mothers or fathers who accompanied their children for follow-up visits or hospitalization. Children’s quality of life as the primary outcome was evaluated by parent proxy using the PedsQL 3.0 cancer module.

Results Most parents were mothers (81.9%); parents’ ages ranged from 22 to 59 years. The mean age of children was 7.63 (SD 3.85) years, with 63.3% boys and 147 (78.2%) treated in maintenance phase during the study. The mean overall children’s QoL score was 84.37 and it classified as high (73.9% of subjects), no children had very low QoL. The lowest mean sub-scale QoL score was in procedural anxiety (72.25), whereas the highest sub-scale score was in communication (91.56). 

Conclusion There is an improvement in QoL of children with ALL in Indonesia. However, the procedural anxiety sub-scale requires more interventions to reduce anxiety and alleviate pain during invasive procedures.


Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. DOI: https://doi.org/10.3322/caac.21492.
2. Bhatnagar N, Qureshi A, Hall G. Leukaemias: a review. Paediatr Child Heal (United Kingdom) [Internet]. 2017;27:489–494. DOI: https://doi.org/10.1016/j.paed.2017.08.007.
3. Steliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F, Hesseling P, Shin HY, Stiller CA, Bouzbid S, et al. International incidence of childhood cancer, 2001–10: a population-based registry study. Lancet Oncol. 2017;18:719–731. DOI: https://doi.org/10.1016/S1470-2045(17)30186-9.
4. Garniasih D, Susanah S, Sribudiani Y, Hilmanto D. The incidence and mortality of childhood acute lymphoblastic leukemia in Indonesia: A systematic review and meta-analysis. PLoS One [Internet]. 2022;17:1–13. DOI: https://doi.org/10.1371/journal.pone.0269706.
5. Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikši? M, Bonaventure A, Valkov M, Johnson CJ, Estève J, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37?513?025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391:1023–1075. DOI: https://doi.org/10.1016/S0140-6736(17)33326-3.
6. Desouky ED El, Noaman MK, Shalaby LM, Shaaban SY. Factors Affecting Quality of Life in Patients with Pediatric Leukemia during Induction Chemotherapy. Egypt J Community Med. 2017;35:15–23. DOI: https://doi.org/10.21608/ejcm.2017.5037.
7. Fardell JE, Vetsch J, Trahair T, Mateos MK, Grootenhuis MA, Touyz LM, Marshall GM, Wakefield CE. Health-related quality of life of children on treatment for acute lymphoblastic leukemia: A systematic review. Pediatr Blood Cancer. 2017;64:1–13. DOI: https://doi.org/10.1002/pbc.26489.
8. Sung L, Yanofsky R, Klaassen RJ, Dix D, Pritchard S, Winick N, Alexander S, Klassen A. Quality of life during active treatment for pediatric acute lymphoblastic leukemia. Int J Cancer. 2011;128:1213–1220. DOI: https://doi.org/10.1002/ijc.25433.
9. Kulsum DU, Mediani HS, Bangun AV. Pengaruh Swedish Massage Therapy terhadap tingkat kualitas hidup penderita leukemia usia sekolah (Effect of swedish massage on quality of life of school age children wit leukemia). J Keperawatan Padjadjaran. 2017;5:113–122. DOI: https://doi.org/10.24198/jkp.v5i2.449.
10. Novrianda D, Khairina I. The effect of educational intervention on the quality of life of acute lymphocytic leukemia who undergoing chemotherapy. Int J Res Med Sci. 2015;S69–S73. DOI: https://doi.org/10.18203/2320-6012.ijrms20151523.
11. Pratiwi E, Mulatsih S, Setiyarini S. Spirituality relationship to the quality of life of children with cancer in Dr. Sardjito general hospital. Int J Community Med Public Heal. 2018;5:880. DOI: https://doi.org/10.18203/2394-6040.ijcmph20180741.
12. Eiser C, Cotter I, Oades P, Seamark D, Smith R. Health-related quality-of-life measures for children. Int J Cancer. 1999;83:87–90. DOI: https://doi.org/10.1002/(sici)1097-0215(1999)83:12+<87::aid-ijc16>3.0.co;2-o.
13. Eiser C, Morse R. A review of measures of quality of life for children with chronic illness. Arch Dis Child. 2001;84:205–211. DOI: https://doi.org/10.1136/adc.84.3.205.
14. Ness KK, Armenian SH, Kadan-Lottick N, Gurney JG. Adverse effects of treatment in childhood acute lymphoblastic leukemia: General overview and implications for long-term cardiac health. Expert Rev Hematol. 2011;4:185–197. DOI: https://doi.org/10.1586/ehm.11.8.
15. Varni JW. Scaling and scoring of the Pediatric Quality of Life InventoryTM PedsQL TM [Internet]. Lyon; 2017. Available from: https://www.pedsql.org/PedsQL-Scoring.pdf.
16. Sitaresmi MN, Mostert S, Gundy CM, Sutaryo S, Veerman AJ. Health-related quality of life assessment in Indonesian childhood acute lymphoblastic leukemia. Health Qual Life Outcomes. 2008;6:1–8. DOI: https://doi.org/10.1186/1477-7525-6-96.
17. Vieira AC, da Rocha Cunha ML. My role and responsibility: Mothers’ perspectives on overload in caring for children with cancer. Rev da Esc Enferm. 2020;54:1–9. DOI: https://doi.org/10.1590/S1980-220X2018034603540.
18. Racine NM, Khu M, Reynolds K, Guilcher GMT, Schulte FSM. Quality of life in pediatric cancer survivors: Contributions of parental distress and psychosocial family risk. Curr Oncol. 2018;25:41–48. DOI: https://doi.org/10.3747/co.25.3768.
19. Mawaddah H, Suyitno S, Suhita R. Javanese Women’s Efforts to Face Patriarchal Culture in the Novel Para Priyayi by Umar Kayam. Int J Multicult Multireligious Underst. 2021;8:100. DOI: https://doi.org/10.18415/ijmmu.v8i1.2267.
20. Mwirigi A, Dillon R, Raj K. Acute leukaemia. Med (United Kingdom) [Internet]. 2017;45:280–286. DOI: https://doi.org/10.1016/j.mpmed.2017.02.010.
21. Al-Asadi JN, Ibrahim SJ. Childhood cancer in Basrah, Iraq during 2012-2016: Incidence and mortality. Asian Pacific J Cancer Prev. 2018;19:2337–2341. DOI: https://doi.org/10.22034/APJCP.2018.19.8.2337.
22. Brown P, Inaba H, Annesley C, Beck J, Colace S, Dallas M, DeSantes K, Kelly K, Kitko C, Lacayo N, et al. Pediatric acute lymphoblastic leukemia, version 2.2020. JNCCN J Natl Compr Cancer Netw. 2020;18:81–112. DOI: https://doi.org/10.6004/jnccn.2020.0001.
23. Önal G, Güney G, Huri M. Quality of life and occupational performance of children with cancer in the era of the COVID-19 pandemic in terms of rehabilitation. Qual Life Res [Internet]. 2021;30:2783–2794. DOI: https://doi.org/10.1007/s11136-021-02857-7.
24. Andid R, Nurdiani N, Lubis B, Sutjipto A. Relationship between the general condition of acute lymphoblastic leukemia patients with remission rate and convulsion as an adverse effect chemotherapy. Paediatr Indones. 2017;41:33. DOI: https://doi.org/10.14238/pi41.1.2001.33-7.
25. Panagiotakopoulou I, Moschovi M, Koutelekos I, Baka M, Polychronopoulou S, Petsios K, Dousis E. Quality of life and psychosocial functioning in Greek children with cancer. Int J Caring Sci [Internet]. 2022;15:633–643. DOI: https://doi.org/10.1016/j.canep.2019.01.022.
26. Zheng F, Dou X, Zhang L, Jin J, Zhang Y, Liu B, Meng L, Zhu X, Lu Z, Jia Y, et al. Health-related quality of life in children with chronic myeloid leukemia in the chronic phase. J Cancer Res Clin Oncol [Internet]. 2022;148:341–350. DOI: https://doi.org/10.1007/s00432-021-03832-y.
27. Andria N, Moelyo AG, Riza M. During induction phase chemotherapy in childhood acute lymphoblastic leukemia. Paediatr Indones Indones. 2020;60:192–197. DOI: https://doi.org/10.14238/pi60.4.2020.192-7.
28. Sajith M, Pawar A, Bafna V, Bartakke S, Subramanian K, Vaidya N. Serum Methotrexate Level and Side Effects of High Dose Methotrexate Infusion in Pediatric Patients with Acute Lymphoblastic Leukaemia (ALL). Indian J Hematol Blood Transfus [Internet]. 2020;36:51–58. DOI: https://doi.org/10.1007/s12288-019-01144-3.
29. Cakan P, Yildiz S, Akyay A, Öncül Y. Intensive chemotherapy perturbs heart rate variability in children with cancer. Neurophysiol Clin. 2022;52:69–80. DOI: https://doi.org/10.1016/j.neucli.2021.11.001.
30. Radhakrishnan V, Joshi A, Ramamoorthy J, Rajaraman S, Ganesan P, Ganesan TS, Dhanushkodi M, Sagar TG. Intravenous fosaprepitant for the prevention of chemotherapy-induced vomiting in children: A double-blind, placebo-controlled, phase III randomized trial. Pediatr Blood Cancer. 2019;66:1–8. DOI: https://doi.org/10.1002/pbc.27551.
31. Hoag JA, Karst J, Bingen K, Palou-Torres A, Yan K. Distracting Through Procedural Pain and Distress Using Virtual Reality and Guided Imagery in Pediatric, Adolescent, and Young Adult Patients: Randomized Controlled Trial. J Med Internet Res. 2022;24. DOI: https://doi.org/10.2196/30260.
32. Shave K, Ali S, Scott SD, Hartling L. Procedural pain in children: A qualitative study of caregiver experiences and information needs. BMC Pediatr. 2018;18:1–10. DOI: https://doi.org/10.1186/s12887-018-1300-y.
How to Cite
Arifah S, Pookboonmee R, Patoomwan A, Kittidumrongsuk P, Andarsini M. Quality of life of children with acute lymphoblastic leukemia. PI [Internet]. 13Nov.2023 [cited 30Nov.2023];63(5). Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/3234
Pediatric Hemato-Oncology
Received 2022-11-08
Accepted 2023-11-13
Published 2023-11-13