Adaptive Functioning of Preschooler Children with Leukemia Post 1 Year of Therapies Compared with Sane Peers

Background: Due to advances in chemotherapy and supportive care, about 83% of childhood cancer survivors aged 0-19 years will survive 5 years. More attention has been paid to understand the impact of cancer treatments on children’s development, in particular with respect to late effects on academic, physical and social functioning, essential for optimization of long-term outcome. Scant literature addresses the functioning of children during acute treatment, mainly focusing on childhood cancer survivors.

Aims: This study was aimed at comparing the adaptive functioning in preschooler children with leukemia post 1 year of treatment and a control group of peers who had no history of serious illness. The link between medical factors and adaptive outcomes were investigated.

Study Design: Case control study.

Place and Duration of Study: Department of Child and Woman Health (Oncology Hematology Division), University of Padua, and pediatricians’ ambulatories in the region of Trentino Alto Adige, between January 2007 and January 2008.

Methodology: The participants in this study included 48 leukemic children and their families, recruited at the Haematology-Oncologic Clinic of the Department of Child and Woman Health, University of Padua. Children’s mean age was 52.35 months (SD = 12.85, range = 23-72 months), 22 males and 26 females. Most children had Acute Lymphoblastic Leukemia (ALL) (N = 44), while 4 had Acute Myeloid Leukemia (AML) with a mean days of hospitalization of 56.13 (SD = 49.36, range: 28-315). Sane peers (N=48) were recruited at pediatricians’ ambulatories in the region of Trentino Alto Adige. Each family was interviewed about their children’s adaptive functioning by Vineland Adaptive Behavior Scales.

Results: The two samples were homogeneous both for children’s characteristics (age in months and gender) and for their parents’ socio-demographic characteristics. Paired-sample t-tests revealed that parents of children with leukemia reported in their children significantly less adaptive functioning both composite and in three of the four domains: Communication, Socialization and Motor Abilities. The results of a series of ANCOVAs showed that the adaptive functioning in children with leukemia had the following at-risk factors: children aged 37-48 months, major days of hospitalization and the high risk therapy.

Conclusion: Future studies should understand better, with an ampler sample and using a multimethod approach, these lower adaptive outcomes in children with leukemia. These findings can guide specific interventions for parents and for children to support the potential developmental delay due to therapies, such as occupational therapy and socialization/educational programs during hospitalization, in occasion of day-hospital follow-ups and at school.