Correspondence
Health Related Quality of Life among Children with Cancer in Hyderabad, India Sir, We read with great interest the study on ‘Health Related Quality of Life among children with Cancer in Hyderabad, India’, 1 which is a rare study of its kind covering the pediatric and young adolescent population. We congratulate authors for their work. Though the subject matter has been comprehensively explained, there are a few issues that we wish to raise in this regard. The study sample comprises children in the age range 5 - 15 yrs, which is a largely heterogeneous group in terms of differing age characteristics. Children aged 5 yr are too young and seem apparently unable to appropriately respond to domains like cognition and emotion. Authors have reported that children were excluded if they were unaware of their diagnosis. We find it hard to believe that a child aged 5 yr can understand his/her diagnosis of cancer, or authors just meant mere knowledge of the “medical term” without necessarily knowing its meaning and the possible impact on life, in the short and long run. Also, it is unclear how the awareness of a child about his/ her medical diagnosis was ascertained i.e., was it a Yes/ No response or assessed separately through a set of questions. Understanding of medical diagnosis by a child may vary with age, but this has not been reported. Further, the age group between 5-15 yrs includes children, as well as both early and middle adolescents, and cognition skills and understanding of illness is far higher in adolescents, but these have been reported as a combined group. Authors have also mentioned that the school functioning of child was inquired from parents. We do not find it convincing because children on active treatment are advised to stay away from school in our set-up. Thus, looking at the recall-time of last one wk, it seems unlikely that the child had been attending schools in last one wk while being on active treatment, which may not be same for those on palliative care. Further, the comparison and reporting the variations in HUI scores for children on active and palliative treatment may have made the picture clearer. We also could not comprehend that why the parent’s report was only utilized for ‘school functioning’ rather than obtaining complete proxy report from them instead from physicians. The level and duration of
Indian Journal of Pediatrics, Volume 77—July, 2010
interaction between subjects and their physicians is not reported, which raises serious questions against the fact that whether physicians had enough knowledge of patient’s emotional, cognition and dexterity domains of life to become their proxy respondent. This also seems to be linked to the reporting of ‘perfect health’ by physicians in patients suffering from osteosarcoma, rhabdomyosarcoma, ALL etc. We are questioning the validity of these results. There is an overlap between emotion, cognition, and pain domains that are common to both HUI2 and HUI3 instruments. It would have been clearer if the questionnaire items were included in the paper. In the study proxy-report was obtained from physicians and the instrument was intervieweradministered. Self-reporting is considered to be the ideal method if responder, in this case physicians, is literate and ‘in senses’ to respond as the proxy’s rating may be influenced by their own feelings and the extent to which patient talks to the proxy about their own feelings. 2 Authors have also not discussed the possible biases of interviewer-administered methods and the means adopted to minimize these in the study. Also, were some physicians excluded due to the inclusion criteria of knowing and understanding English? This has not been reported or discussed anywhere. The authors have also not clarified if written informed consent was obtained from parents for their child’s participation, and if yes, then in which language? Shally Awasthi and Kasturi Agnihotri Department of Pediatrics, Chhatrapati Shahuji Maharaj Medical University, Lucknow-226003 (UP), India. E-mail:
[email protected] [DOI-10.1007/s12098-010-0113-2]
REFERENCES 1. Chirivella S, Rajappa S, Sinha S, Eden T, Barr RD. HealthRelated Quality of Life among children with Cancer in Hyderabad, India. Indian J Pediatr 2009; 76: 1231-1235. 2. Addington-Hall J, Kalra L. Measuring quality of life: Who should measure quality of life? BMJ 2001; 322: 1417-1420.
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