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Corticosteroids, Behavior, and Quality of Life in Children Treated for Acute Lymphoblastic Leukemia; A Multicentered Trial

Pound, Catherine Maude MD; Clark, Camillia PhD, R. Psych; Ni, Andy MSc; Athale, Uma MD; Lewis, Victor MD; Halton, Jacqueline M. MD

Journal of Pediatric Hematology/Oncology: October 2012 - Volume 34 - Issue 7 - p 517–523
doi: 10.1097/MPH.0b013e318257fdac
Original Articles

The aim of this study was to investigate the effects of high-dose corticosteroids on behavior and quality of life of children with acute lymphoblastic leukemia (ALL) in maintenance therapy. Forty-three families (patient and/or parent) completed the Child Behavior Checklist (CBCL), the Pediatric Quality of Life Inventory (PedsQL) Cancer module questionnaires, a checklist of common complaints, and a descriptive intervention data questionnaire, on and off steroids, each child serving as his/her own control. Children 5 years and younger had higher CBCL scores in the somatic complaints, affective problems, internalizing, externalizing, and total problem scales, when comparing “on-steroid” to “off-steroid” periods (P<0.01). Children 6 years and above had higher CBCL scores in the externalizing, aggressive, and oppositional defiant problem scales on steroids compared with off steroids (P<0.05). Older children had larger changes on dexamethasone, compared with prednisone (P<0.05). On the PedsQL questionnaire, parents reported more pain and hurt (P<0.001), nausea (P=0.042), and procedural anxiety (P=0.013) when children were on steroids compared with off steroids. Corticosteroid treatment during ALL maintenance therapy is associated with behavior and emotional disturbances and adversely affects quality of life. Dexamethasone is associated with more significant behavioral changes in older children.

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*Department of Pediatrics, Division of Pediatric Medicine

Clinical Research Unit

Department of Pediatrics, Division of Pediatric Hematology and Oncology, Children’s Hospital of Eastern Ontario, Ottawa

§Department of Pediatrics, Division of Pediatric Hematology and Oncology, McMaster Children’s Hospital, Hamilton, ON

Department of Pediatrics, University of Calgary

Department of Pediatrics, Division of Pediatric Hematology and Oncology, Alberta Children’s Hospital, Calgary, AB, Canada

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Supported by the Pediatric Oncology Group of Ontario (POGO).

The authors declare no conflict of interest.

Reprints: Catherine Maude Pound, MD, 401 Smyth Road, Ottawa, ON, Canada K1S 2B7 (e-mail:

Received September 6, 2011

Accepted March 29, 2012

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.