An assessment of global health status in survivors of acute lymphoblastic leukemia in childhood.

PURPOSE: Progressive improvement in survival rates of children with cancer demands an appraisal of the "cost of cure." Much information is available on the frequency and severity of individual late effects in long-term survivors, but there are few data on multiple sequelae in individual patients or on global morbidity burdens. PATIENTS AND METHODS: To address this issue, we developed a multiattribute health status classification system. This consists of three to five levels of function within each of seven attributes: sensation, mobility, emotion, cognition, self-care, pain, and fertility. The system was applied to survivors of acute lymphoblastic leukemia (ALL). RESULTS: Overall burdens of morbidity were greater in those who had had "high-risk" disease than in children treated less intensively for "standard-risk" ALL. Deficits in emotional and cognitive status were especially common (alone and in combination). These were more prevalent in younger patients and exhibited a dose relationship to cranial irradiation. CONCLUSIONS: Such appraisals of morbidity must be compared with prevalence rates in the general population.