Assessing the Impact of Biopsychosocial Factors on Adolescent Survivors of Extremity Tumors

PURPOSE: Adult and young adult survivors of extremity tumors (AYASET) experience lower health-related quality of life (QOL) compared with survivors of other pediatric cancers. By examining biopsychosocial factors in AYASET, it may become clearer why they are not thriving later in adulthood and where future interventions should be targeted. The purpose of the study was to investigate the feasibility of completing a biopsychosocial needs assessment on AYASET, to develop a biopsychosocial profile, and to examine correlations between biopsychosocial factors and QOL and participation.

METHOD: This study was cross-sectional in design. All data were collected from participants at one point in time. Participants were recruited using a sample identified by providers in the Pediatric Hematology/Oncology Program at St. Louis Children’s Hospital. Nine AYASET participants were administered 17 measures assessing biopsychosocial factors, including physical, psychological, and participation domains. Data analyses for the feasibility portion of the study were mainly descriptive and included patient acceptance rate, percentage of participants who successfully completed the assessment battery, and median and range of administration time for completion of the full assessment battery. We developed a profile of biopsychosocial factors by reporting descriptive statistics for each test. We computed and reported the T-scores to compare different domains. Finally, we examined the relationship between biopsychosocial factors and QOL and participation using Spearman rho.

RESULTS: The nine participants completed the entire battery in 1.5 hr or less. The biopsychosocial profile included deficits affecting cognitive function, endurance, dexterity in the dominant hand, grip strength, anxiety, peer relationships, body image, health-related QOL, and activity participation. Depression correlated with activity participation (r = .894, p = .041), endurance correlated with limb function (r = –.975, p = .005), inhibitory control and attention correlated with the General Health domain of health-related QOL (r = –.949, p = .014), and dexterity correlated with the Role Limitation domain of health-related QOL (r = –.894, p = .041).

CONCLUSION: Previous research suggested that AYASET have deficits in biopsychosocial factors related to low QOL and participation. This study found some deficits in biopsychosocial factors. The study also found some correlations between these factors and functional outcomes, although not in the expected direction. More research is needed to fully assess the biopsychosocial needs of AYASET and to investigate the correlations between these needs and functional outcomes. This research provides insight into ways to better provide occupational therapy evaluation and interventions for AYASET. By targeting the most important areas for AYASET, occupational therapy practitioners can help promote QOL and participation for this population.

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