Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing Science

Research Advisor

Belinda N. Mandrell, PhD, RN.


Patricia A. Cowan, PhD, RN. J. Carolyn Graff, PhD, RN. Donna K. Hathaway, PhD, RN, FAAN. I-Chan Huang, PhD. Sheila J. Santacroce. PhD, RN, FAANP.


Health-Related Quality of Life, Longitudinal Studies, Pediatric Oncology


Health-related quality of life is an important phenomenon to measure in children undergoing treatment for cancer. However, the effects of different treatment modalities and cancer related factors over the duration of treatment have not been explored. To assess the effects of different child-, cancer-, and treatment-related factors, we analyzed a large sample of children undergoing curative treatment for 5 different childhood cancer diagnoses. These diagnostic groups were Hodgkin Lymphoma (HL), Acute Lymphoblastic Leukemia (ALL), Acute Myeloid Leukemia (AML), Osteosarcoma (OS), and Melanoma. We analyzed a sample of 710 patients across the five diagnostic groups over four time-points in treatment. These time-points reflected significant clinical events that reflected change in the intensity or modality of treatments. Our analysis identified significant changes across different diagnostic groups and over time in HRQOL of children undergoing curative cancer treatments. Time in treatment was a significant predictor of change in HRQOL, with children reporting higher HRQOL scores at the end of treatment in comparison to the beginning of treatment. Demographic variables including age, gender, and race predicted significant changes over time in children. Other treatment related variables including risk group and surgery predicted change in HRQOL domains and cancerrelated symptoms in children undergoing curative cancer treatment. Multiple cancer-related symptoms have been identified to significantly predict HRQOL in children across the different diagnostic groups. These symptoms were also predicted by different demographic, treatment, and cancer related factors. Some of these symptoms including pain and hurt, and nausea did not regain the same level at the end of treatment in comparison to the beginning of treatment, indicating residual effects of treatment on children with cancer even at the end of treatment.