Keywords
Cancer;
Cut-off points;
Parents;
Quality of life;
SF-36 Health survey
Cut-off points;
Parents;
Quality of life;
SF-36 Health survey
Abstract
Background: Poor health-related quality of life (HRQOL) of parents of children with cancer as their main caregivers can adversely affect child’s HRQOL. Short Form-36 Health Survey (SF-36) is a widely used instrument to measure HRQOL. However, there are no clearly defined cut-off points for screening for parents with poor HRQOL. This study aimed to find appropriate cut-off points for the SF-36 questionnaire in a sample of parents of children with cancer using latent profile analysis to add another possibility to use it.
Methods: In this cross-sectional study, 110 couples (110 mothers and 110 fathers) of children diagnosed with cancer selected by simple random sampling method from the patients' files were included. The study was conducted at two settings, pediatric hematology ward and pediatric hematology clinic of a university hospital in 2016-2017. Latent Profile analysis method was used to determine appropriate cut-off points for the SF-36 questionnaire. Data was analyzed by Mplus and R3.3.0 software.
Results:
Based on the results, scores ≤44, 45-63 and ≥64 for mental health, and scores ≤43, 44-59 and ≥60 for physical health classes indicate weak, medium, and good, respectively. These cut-off points showed acceptable accuracy in classification of individuals. For the total quality of life, correct classification rates were 88%, 65% and 53% for each class respectively. For mental health (physical health), they were 79 (63), 50 (62) and 52 (63) for each class respectively.
Conclusion: The cut-off points for the classes identified here can be useful in screening parents of children with cancer in clinical setting to provide clinical interventions to protect vulnerable parents from negative outcomes.
References
References:
1. World Health Organization. Cancer in children. [Available from: https://www.who.int/news-room/fact-sheets/detail/cancer-in-children.
2. Steliarova-Foucher E, Colombet M, Ries LA, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001–10: a population-based registry study. The Lancet Oncology. 2017;18(6):719-31.
3. World Health Organization. Global Health Observatory. Geneva: World Health Organization; [Available from: http://gco.iarc.fr.
4. Khazaei S, Khazaei S, Mansori K, Ayubi E. Childhood cancer patterns in Iran: Challenges and future directions. Iranian journal of public health. 2017;46(8):1145-6.
5. Morgan D. Caring for dying children: assessing the needs of the pediatric palliative care nurse. Pediatric nursing. 2009;35(2):86.
6. CURESEARCH for Children's CANCER. 5-YEAR SURVIVAL RATE 2019 [Available from: https://curesearch.org/5-Year-Survival-Rate.
7. Han HR. Korean mothers’ psychosocial adjustment to their children's cancer. Journal of advanced nursing. 2003;44(5):499-506.
8. Al‐Gamal E, Long T, Shehadeh J. Health satisfaction and family impact of parents of children with cancer: a descriptive cross‐sectional study. Scandinavian journal of caring sciences. 2019.
9. Eiser C, Eiser JR, Stride CB. Quality of life in children newly diagnosed with cancer and their mothers. Health and quality of life outcomes. 2005;3(1):29.
10. Klassen AF, Dix D, Papsdorf M, Klaassen RJ, Yanofsky R, Sung L. Impact of caring for a child with cancer on single parents compared with parents from two‐parent families. Pediatric blood & cancer. 2012;58(1):74-9.
11. Karimi M, Brazier J. Health, health-related quality of life, and quality of life: what is the difference? Pharmacoeconomics. 2016;34(7):645-9.
12. Litzelman K, Catrine K, Gangnon R, Witt WP. Quality of life among parents of children with cancer or brain tumors: the impact of child characteristics and parental psychosocial factors. Quality of life Research. 2011;20(8):1261-9.
13. Quast LF, Turner EM, McCurdy MD, Hocking MC. Health-related quality of life in parents of pediatric brain tumor survivors at the end of tumor-directed therapy. Journal of psychosocial oncology. 2016;34(4):274-90.
14. Deatrick JA, Hobbie W, Ogle S, Fisher MJ, Barakat L, Hardie T, et al. Competence in caregivers of adolescent and young adult childhood brain tumor survivors. Health Psychology. 2014;33(10):1103.
15. Klassen AF, Klaassen R, Dix D, Pritchard S, Yanofsky R, O'Donnell M, et al. Impact of caring for a child with cancer on parents’ health-related quality of life. Journal of clinical oncology. 2008;26(36):5884-9.
16. Raina P, O'Donnell M, Schwellnus H, Rosenbaum P, King G, Brehaut J, et al. Caregiving process and caregiver burden: conceptual models to guide research and practice. BMC pediatrics. 2004;4(1):1-13.
17. Hovén E, Anclair M, Samuelsson U, Kogner P, Boman KK. The influence of pediatric cancer diagnosis and illness complication factors on parental distress. Journal of pediatric hematology/oncology. 2008;30(11):807-14.
18. Rensen N, Steur LM, Schepers SA, Merks JH, Moll AC, Kaspers GJ, et al. Gender‐specific differences in parental health‐related quality of life in childhood cancer. Pediatric blood & cancer. 2019;66(7):e27728.
19. Huang IC, Brinkman TM, Mullins L, Pui CH, Robison LL, Hudson MM, et al. Child symptoms, parent behaviors, and family strain in long‐term survivors of childhood acute lymphoblastic leukemia. Psycho‐oncology. 2018;27(8):2031-8.
20. Stenmarker E, Mellgren K, Matus M, Hakansson AS, Stenmarker M. Health-related quality of life, culture and communication: a comparative study in children with cancer in Argentina and Sweden. Journal of patient-reported outcomes. 2018;2(1):1-12.
21. Sawyer M, Antoniou G, Toogood I, Rice M, Baghurst P. Childhood cancer: A 4-year prospective study of the psychological adjustment of children and parents. Journal of pediatric hematology/oncology. 2000;22(3):214-20.
22. Yamazaki S, Sokejima S, Mizoue T, Eboshida A, Fukuhara S. Health-related quality of life of mothers of children with leukemia in Japan. Quality of life research. 2005;14(4):1079-85.
23. Wijnberg‐Williams BJ, Kamps WA, Klip EC, Hoekstra‐Weebers JE. Psychological adjustment of parents of pediatric cancer patients revisited: five years later. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer. 2006;15(1):1-8.
24. Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C, et al. Canadian normative data for the SF-36 health survey. Cmaj. 2000;163(3):265-71.
25. Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V, Stojanov A. Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19. The International journal of social psychiatry. 2021;67(2):175.
26. Gandek B, Ware J. SF-36 Health Survey: Manual and interpretation guide. Boston: the Health institute, new england Medical center. 1993.
27. Frank L, Kleinman L, Rentz A, Ciesla G, Kim JJ, Zacker C. Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. Clinical therapeutics. 2002;24(4):675-89.
28. Mingardi G, Cornalba L, Cortinovis E, Ruggiata R, Mosconi P, Apolone G. Health-related quality of life in dialysis patients. A report from an Italian study using the SF-36 Health Survey. DIA-QOL Group. Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association-European Renal Association. 1999;14(6):1503-10.
29. Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K. Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. Journal of clinical epidemiology. 1998;51(11):1037-44.
30. Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical care. 1992:473-83.
31. Wagner AK, Gandek B, Aaronson NK, Acquadro C, Alonso J, Apolone G, et al. Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA project. Journal of clinical epidemiology. 1998;51(11):925-32.
32. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Quality of life research. 2005;14(3):875-82.
33. Hays RD, Sherbourne CD, Mazel RM. User's manual for the Medical Outcomes Study (MOS) core measures of health-related quality of life: Rand Corporation Santa Monica; 1995.
34. Ware J, Kosinski M. Physical and mental health summary scales: A manual for users of Version 1. Lincoln, RI: Quality Metric. Inc; 2001.
35. Yakar HK, Pinar R. Reliability and validity of Turkish version of the caregiver quality of life index cancer scale. Asian Pacific Journal of Cancer Prevention. 2013;14(7):4415-9.
36. Gandek B, Sinclair SJ, Kosinski M, Ware Jr JE. Psychometric evaluation of the SF-36® health survey in medicare managed care. Health care financing review. 2004;25(4):5.
37. Muthén B, Muthén BO. Statistical analysis with latent variables: Wiley New York; 2009.
38. Luo J, Xiong C. DiagTest3Grp: an R package for analyzing diagnostic tests with three ordinal groups. Journal of Statistical Software. 2012;51(3):1.
39. Berlin KS, Williams NA, Parra GR. An introduction to latent variable mixture modeling (part 1): Overview and cross-sectional latent class and latent profile analyses. Journal of pediatric psychology. 2014;39(2):174-87.
40. Akaike H. Factor analysis and AIC. Selected papers of hirotugu akaike: Springer; 1987. p. 371-86.
41. Schwarz G. Estimating the dimension of a model. The annals of statistics. 1978:461-4.
42. Sclove SL. Application of model-selection criteria to some problems in multivariate analysis. Psychometrika. 1987;52(3):333-43.
43. Lo Y, Mendell NR, Rubin DB. Testing the number of components in a normal mixture. Biometrika. 2001;88(3):767-78.
44. Tein J-Y, Coxe S, Cham H. Statistical power to detect the correct number of classes in latent profile analysis. Structural equation modeling: a multidisciplinary journal. 2013;20(4):640-57.
45. Ferri C, Hernández-Orallo J, Salido MA, editors. Volume under the ROC surface for multi-class problems. European conference on machine learning; 2003: Springer.
46. Nakas CT, Alonzo TA, Yiannoutsos CT. Accuracy and cut‐off point selection in three‐class classification problems using a generalization of the Youden index. Statistics in medicine. 2010;29(28):2946-55.
47. Walsh TL, Homa K, Hanscom B, Lurie J, Sepulveda MG, Abdu W. Screening for depressive symptoms in patients with chronic spinal pain using the SF-36 Health Survey. The Spine Journal. 2006;6(3):316-20.
48. Matcham F, Norton S, Steer S, Hotopf M. Usefulness of the SF-36 Health Survey in screening for depressive and anxiety disorders in rheumatoid arthritis. BMC musculoskeletal disorders. 2016;17(1):1-10.
49. Bell JA, daCosta DiBonaventura M, Witt EA, Ben-Joseph R, Reeve BB. Use of the SF-36v2 health survey as a screen for risk of major depressive disorder in a US population-based sample and subgroup with chronic pain. Medical care. 2017;55(2):111-6.
50. Anagnostopoulos F, Niakas D, Pappa E. Construct validation of the Greek SF-36 health survey. Quality of Life Research. 2005;14(8):1959-65.
51. Schermer T, Malbon T, Morgan M, Briggs N, Holton C, Appleton S, et al. Lung function and health status in metropolitan fire-fighters compared to general population controls. International archives of occupational and environmental health. 2010;83(7):715-23.
52. Cross M, Lapsley H, Barcenilla A, Brooks P, March L. Association between measures of fatigue and health-related quality of life in rheumatoid arthritis and osteoarthritis. The Patient: Patient-Centered Outcomes Research. 2008;1(2):97-104.
53. Robinson Jr DW, Eisenberg DF, Cella D, Zhao N, de Boer C, DeWitte M. The prognostic significance of patient-reported outcomes in pancreatic cancer cachexia. The journal of supportive oncology. 2008;6(6):283-90.
54. Witt WP, Litzelman K, Wisk LE, Spear HA, Catrine K, Levin N, et al. Stress-mediated quality of life outcomes in parents of childhood cancer and brain tumor survivors: a case–control study. Quality of Life Research. 2010;19(7):995-1005.
55. Eiser C, Eiser JR, Stride CB. Quality of life in children newly diagnosed with cancer and their mothers. Health and quality of life outcomes. 2005;3(1):1-5.
56. Kearney JA, Salley CG, Muriel AC. Standards of psychosocial care for parents of children with cancer. Pediatric blood & cancer. 2015;62(S5):S632-S83.
57. Arora NK, McHorney CA. Patient preferences for medical decision making: who really wants to participate? Medical care. 2000:335-41.
58. Eshghi A, Haughton D, Legrand P, Skaletsky M, Woolford S. Identifying groups: A comparison of methodologies. Journal of Data Science. 2011;9(2):271-92.
1. World Health Organization. Cancer in children. [Available from: https://www.who.int/news-room/fact-sheets/detail/cancer-in-children.
2. Steliarova-Foucher E, Colombet M, Ries LA, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001–10: a population-based registry study. The Lancet Oncology. 2017;18(6):719-31.
3. World Health Organization. Global Health Observatory. Geneva: World Health Organization; [Available from: http://gco.iarc.fr.
4. Khazaei S, Khazaei S, Mansori K, Ayubi E. Childhood cancer patterns in Iran: Challenges and future directions. Iranian journal of public health. 2017;46(8):1145-6.
5. Morgan D. Caring for dying children: assessing the needs of the pediatric palliative care nurse. Pediatric nursing. 2009;35(2):86.
6. CURESEARCH for Children's CANCER. 5-YEAR SURVIVAL RATE 2019 [Available from: https://curesearch.org/5-Year-Survival-Rate.
7. Han HR. Korean mothers’ psychosocial adjustment to their children's cancer. Journal of advanced nursing. 2003;44(5):499-506.
8. Al‐Gamal E, Long T, Shehadeh J. Health satisfaction and family impact of parents of children with cancer: a descriptive cross‐sectional study. Scandinavian journal of caring sciences. 2019.
9. Eiser C, Eiser JR, Stride CB. Quality of life in children newly diagnosed with cancer and their mothers. Health and quality of life outcomes. 2005;3(1):29.
10. Klassen AF, Dix D, Papsdorf M, Klaassen RJ, Yanofsky R, Sung L. Impact of caring for a child with cancer on single parents compared with parents from two‐parent families. Pediatric blood & cancer. 2012;58(1):74-9.
11. Karimi M, Brazier J. Health, health-related quality of life, and quality of life: what is the difference? Pharmacoeconomics. 2016;34(7):645-9.
12. Litzelman K, Catrine K, Gangnon R, Witt WP. Quality of life among parents of children with cancer or brain tumors: the impact of child characteristics and parental psychosocial factors. Quality of life Research. 2011;20(8):1261-9.
13. Quast LF, Turner EM, McCurdy MD, Hocking MC. Health-related quality of life in parents of pediatric brain tumor survivors at the end of tumor-directed therapy. Journal of psychosocial oncology. 2016;34(4):274-90.
14. Deatrick JA, Hobbie W, Ogle S, Fisher MJ, Barakat L, Hardie T, et al. Competence in caregivers of adolescent and young adult childhood brain tumor survivors. Health Psychology. 2014;33(10):1103.
15. Klassen AF, Klaassen R, Dix D, Pritchard S, Yanofsky R, O'Donnell M, et al. Impact of caring for a child with cancer on parents’ health-related quality of life. Journal of clinical oncology. 2008;26(36):5884-9.
16. Raina P, O'Donnell M, Schwellnus H, Rosenbaum P, King G, Brehaut J, et al. Caregiving process and caregiver burden: conceptual models to guide research and practice. BMC pediatrics. 2004;4(1):1-13.
17. Hovén E, Anclair M, Samuelsson U, Kogner P, Boman KK. The influence of pediatric cancer diagnosis and illness complication factors on parental distress. Journal of pediatric hematology/oncology. 2008;30(11):807-14.
18. Rensen N, Steur LM, Schepers SA, Merks JH, Moll AC, Kaspers GJ, et al. Gender‐specific differences in parental health‐related quality of life in childhood cancer. Pediatric blood & cancer. 2019;66(7):e27728.
19. Huang IC, Brinkman TM, Mullins L, Pui CH, Robison LL, Hudson MM, et al. Child symptoms, parent behaviors, and family strain in long‐term survivors of childhood acute lymphoblastic leukemia. Psycho‐oncology. 2018;27(8):2031-8.
20. Stenmarker E, Mellgren K, Matus M, Hakansson AS, Stenmarker M. Health-related quality of life, culture and communication: a comparative study in children with cancer in Argentina and Sweden. Journal of patient-reported outcomes. 2018;2(1):1-12.
21. Sawyer M, Antoniou G, Toogood I, Rice M, Baghurst P. Childhood cancer: A 4-year prospective study of the psychological adjustment of children and parents. Journal of pediatric hematology/oncology. 2000;22(3):214-20.
22. Yamazaki S, Sokejima S, Mizoue T, Eboshida A, Fukuhara S. Health-related quality of life of mothers of children with leukemia in Japan. Quality of life research. 2005;14(4):1079-85.
23. Wijnberg‐Williams BJ, Kamps WA, Klip EC, Hoekstra‐Weebers JE. Psychological adjustment of parents of pediatric cancer patients revisited: five years later. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer. 2006;15(1):1-8.
24. Hopman WM, Towheed T, Anastassiades T, Tenenhouse A, Poliquin S, Berger C, et al. Canadian normative data for the SF-36 health survey. Cmaj. 2000;163(3):265-71.
25. Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V, Stojanov A. Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19. The International journal of social psychiatry. 2021;67(2):175.
26. Gandek B, Ware J. SF-36 Health Survey: Manual and interpretation guide. Boston: the Health institute, new england Medical center. 1993.
27. Frank L, Kleinman L, Rentz A, Ciesla G, Kim JJ, Zacker C. Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. Clinical therapeutics. 2002;24(4):675-89.
28. Mingardi G, Cornalba L, Cortinovis E, Ruggiata R, Mosconi P, Apolone G. Health-related quality of life in dialysis patients. A report from an Italian study using the SF-36 Health Survey. DIA-QOL Group. Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association-European Renal Association. 1999;14(6):1503-10.
29. Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K. Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. Journal of clinical epidemiology. 1998;51(11):1037-44.
30. Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical care. 1992:473-83.
31. Wagner AK, Gandek B, Aaronson NK, Acquadro C, Alonso J, Apolone G, et al. Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA project. Journal of clinical epidemiology. 1998;51(11):925-32.
32. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Quality of life research. 2005;14(3):875-82.
33. Hays RD, Sherbourne CD, Mazel RM. User's manual for the Medical Outcomes Study (MOS) core measures of health-related quality of life: Rand Corporation Santa Monica; 1995.
34. Ware J, Kosinski M. Physical and mental health summary scales: A manual for users of Version 1. Lincoln, RI: Quality Metric. Inc; 2001.
35. Yakar HK, Pinar R. Reliability and validity of Turkish version of the caregiver quality of life index cancer scale. Asian Pacific Journal of Cancer Prevention. 2013;14(7):4415-9.
36. Gandek B, Sinclair SJ, Kosinski M, Ware Jr JE. Psychometric evaluation of the SF-36® health survey in medicare managed care. Health care financing review. 2004;25(4):5.
37. Muthén B, Muthén BO. Statistical analysis with latent variables: Wiley New York; 2009.
38. Luo J, Xiong C. DiagTest3Grp: an R package for analyzing diagnostic tests with three ordinal groups. Journal of Statistical Software. 2012;51(3):1.
39. Berlin KS, Williams NA, Parra GR. An introduction to latent variable mixture modeling (part 1): Overview and cross-sectional latent class and latent profile analyses. Journal of pediatric psychology. 2014;39(2):174-87.
40. Akaike H. Factor analysis and AIC. Selected papers of hirotugu akaike: Springer; 1987. p. 371-86.
41. Schwarz G. Estimating the dimension of a model. The annals of statistics. 1978:461-4.
42. Sclove SL. Application of model-selection criteria to some problems in multivariate analysis. Psychometrika. 1987;52(3):333-43.
43. Lo Y, Mendell NR, Rubin DB. Testing the number of components in a normal mixture. Biometrika. 2001;88(3):767-78.
44. Tein J-Y, Coxe S, Cham H. Statistical power to detect the correct number of classes in latent profile analysis. Structural equation modeling: a multidisciplinary journal. 2013;20(4):640-57.
45. Ferri C, Hernández-Orallo J, Salido MA, editors. Volume under the ROC surface for multi-class problems. European conference on machine learning; 2003: Springer.
46. Nakas CT, Alonzo TA, Yiannoutsos CT. Accuracy and cut‐off point selection in three‐class classification problems using a generalization of the Youden index. Statistics in medicine. 2010;29(28):2946-55.
47. Walsh TL, Homa K, Hanscom B, Lurie J, Sepulveda MG, Abdu W. Screening for depressive symptoms in patients with chronic spinal pain using the SF-36 Health Survey. The Spine Journal. 2006;6(3):316-20.
48. Matcham F, Norton S, Steer S, Hotopf M. Usefulness of the SF-36 Health Survey in screening for depressive and anxiety disorders in rheumatoid arthritis. BMC musculoskeletal disorders. 2016;17(1):1-10.
49. Bell JA, daCosta DiBonaventura M, Witt EA, Ben-Joseph R, Reeve BB. Use of the SF-36v2 health survey as a screen for risk of major depressive disorder in a US population-based sample and subgroup with chronic pain. Medical care. 2017;55(2):111-6.
50. Anagnostopoulos F, Niakas D, Pappa E. Construct validation of the Greek SF-36 health survey. Quality of Life Research. 2005;14(8):1959-65.
51. Schermer T, Malbon T, Morgan M, Briggs N, Holton C, Appleton S, et al. Lung function and health status in metropolitan fire-fighters compared to general population controls. International archives of occupational and environmental health. 2010;83(7):715-23.
52. Cross M, Lapsley H, Barcenilla A, Brooks P, March L. Association between measures of fatigue and health-related quality of life in rheumatoid arthritis and osteoarthritis. The Patient: Patient-Centered Outcomes Research. 2008;1(2):97-104.
53. Robinson Jr DW, Eisenberg DF, Cella D, Zhao N, de Boer C, DeWitte M. The prognostic significance of patient-reported outcomes in pancreatic cancer cachexia. The journal of supportive oncology. 2008;6(6):283-90.
54. Witt WP, Litzelman K, Wisk LE, Spear HA, Catrine K, Levin N, et al. Stress-mediated quality of life outcomes in parents of childhood cancer and brain tumor survivors: a case–control study. Quality of Life Research. 2010;19(7):995-1005.
55. Eiser C, Eiser JR, Stride CB. Quality of life in children newly diagnosed with cancer and their mothers. Health and quality of life outcomes. 2005;3(1):1-5.
56. Kearney JA, Salley CG, Muriel AC. Standards of psychosocial care for parents of children with cancer. Pediatric blood & cancer. 2015;62(S5):S632-S83.
57. Arora NK, McHorney CA. Patient preferences for medical decision making: who really wants to participate? Medical care. 2000:335-41.
58. Eshghi A, Haughton D, Legrand P, Skaletsky M, Woolford S. Identifying groups: A comparison of methodologies. Journal of Data Science. 2011;9(2):271-92.