Parental Sleep, Distress, and Quality of Life in Childhood Acute Lymphoblastic Leukemia: A Longitudinal Report from Diagnosis up to Three Years Later

Niki Rensen, Lindsay Steur, Martha Grootenhuis, Jos Twisk, Natasha van Eijkelenburg, Inge van der Sluis, Natasja Dors, Cor van den Bos, Wim Tissing, Gertjan Kaspers, Raphaële van Litsenburg*

*Corresponding author for this work

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This study assessed sleep, distress and quality of life (QoL) in parents of children with acute lymphoblastic leukemia (ALL) from diagnosis to three years after, and the impact of sleep and distress on QoL. Additionally, this study explored determinants of sleep and distress. Parents completed the MOS Sleep, Distress Thermometer for Parents and SF-12 at four-five months (T0), one year (T1), two years (T2), and three years (T3) after diagnosis. The course of outcomes and longitudinal impact of clinically relevant sleep problems (>1SD above reference’s mean) and clinical distress (score ≥ 4) on QoL Z-scores were assessed with linear mixed-models. Determinants of sleep and distress were assessed with multinomial mixed-models. Parents (81% mothers) of 139 patients (60% males; 76% medium-risk (MR)) participated. Distress and QoL gradually restored from T0 to T3. Sleep problems improved, but were still elevated at T3: 33% reported clinically relevant sleep problems, of which 48% in concurrence with distress. Over time, presence of sleep problems or distress led to lower mental QoL Z-scores (SD-score −0.2 and −0.5, respectively). Presence of both led to a cumulatively lower Z-score (SD-score −1.3). Parents in the latter group were more likely to report insufficient social support, parenting problems, a chronic illness, pain for their child, having a child with MR-ALL, and being closer to diagnosis. In conclusion, parental well-being improves over time, yet sleep problems persist. In combination with ongoing distress, they cumulatively affect QoL. Special attention should be given to parents who are vulnerable to worse outcomes.

Original languageEnglish
Article number2779
Issue number11
Publication statusPublished - 3 Jun 2022

Bibliographical note

Funding Information:
Funding: This work was supported by the Dutch Cancer Society (VU 2014-6703). The funder had no involvement in the collection, analysis and interpretation of data, the writing of the report, and the decision to submit the article for publication.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


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