{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:37:55Z","timestamp":1792787875623,"version":"4.5.0"},"reference-count":64,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":47,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Semmelweis University","id":[{"id":"https:\/\/ror.org\/01g9ty582","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/objective<\/jats:title>\n                    <jats:p>Leukemia and its treatment can substantially impair children\u2019s health-related quality of life (HRQoL). This descriptive cross-sectional study aimed to evaluate HRQoL among Saudi children with leukemia and to identify the demographic, clinical, and functional factors associated with HRQoL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighty-six children aged 5\u201314 years with acute lymphoblastic or acute myeloid leukemia (AML) who were receiving active treatment at King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia. All participants had been diagnosed at least three months before enrolment and were receiving active treatment. HRQoL was assessed using the Arabic version of the Pediatric Quality of Life Inventory\u2122 (PedsQL\u2122) 3.0 Cancer Module, while physical function was evaluated using the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and the Lower Extremity Functional Scale (LEFS). Correlations and theory-driven multiple linear regression analyses were performed to identify factors associated with HRQoL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean overall HRQoL score was 62.7\u2009\u00b1\u200916.5, indicating a moderate level of HRQoL. The lowest scores were observed for procedural anxiety, whereas communication had the highest domain score. Girls demonstrated significantly higher HRQoL than boys.Multiple linear regression identified female gender (\u03b2\u2009=\u20090.270, 95% CI: 4.457\u201313.241,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), older age (\u03b2\u2009=\u20090.229, 95% CI: 1.951\u20137.986,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), higher educational level (\u03b2\u2009=\u20090.239, 95% CI: 1.933\u20137.437,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), and better lower-extremity function measured by the LEFS (\u03b2\u2009=\u20090.307, 95% CI: 0.142\u20130.434,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) as significant positive predictors of higher HRQoL, whereas more intensive cancer therapy was independently associated with lower HRQoL (\u03b2 = \u22120.211, 95% CI: \u22128.808 to \u2212\u20091.922,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). The model explained 70.1% of the variance in HRQoL (R\u00b2 = 0.701; adjusted R\u00b2 = 0.665; F(9,76)\u2009=\u200919.753,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HRQoL in children with leukemia was independently associated with physical function, cancer treatment, and several sociodemographic characteristics. These findings highlight the importance of incorporating functional assessment and multidisciplinary supportive care into the management of children with leukemia to optimize HRQoL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12887-026-07466-2","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T03:51:38Z","timestamp":1786161098000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors influencing health-related quality of life in children with leukemia in Saudi Arabia: a cross- sectional study"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2965-4916","authenticated-orcid":false,"given":"Mohammed T. A.","family":"Omar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatem Mosa","family":"Maeshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amani A.","family":"Alkofide","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6309-3484","authenticated-orcid":false,"given":"Zizi M.","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6586-2459","authenticated-orcid":false,"given":"Mohamed Abdelaziz","family":"Emam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2566-3380","authenticated-orcid":false,"given":"Maha F.","family":"Algabbani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahani H.","family":"Maashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4279-3662","authenticated-orcid":false,"given":"Olfat Ibrahim","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed A.","family":"Zalah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"7466_CR1","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1093\/jnci\/djp148","volume":"101","author":"GT Armstrong","year":"2009","unstructured":"Armstrong GT, Liu Q, Yasui Y, Huang S, Ness KK, Leisenring W, Hudson MM, Donaldson SS, King AA, Stovall M, et al. Long-term outcomes among adult survivors of childhood central nervous system malignancies in the childhood cancer survivor study. JNCI: J Natl Cancer Inst. 2009;101:946\u201358.","journal-title":"JNCI: J Natl Cancer Inst"},{"key":"7466_CR2","first-page":"2215","volume":"12","author":"S Wiangnon","year":"2011","unstructured":"Wiangnon S, Veerakul G, Nuchprayoon I, Seksarn P, Hongeng S, Krutvecho T, Sripaiboonkij N. Childhood cancer incidence and survival 2003\u20132005, Thailand: study from the Thai Pediatric Oncology Group. Asian Pac J Cancer Prev. 2011;12:2215\u201320.","journal-title":"Asian Pac J Cancer Prev"},{"key":"7466_CR3","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1002\/ijc.29708","volume":"138","author":"H-R Mitchell","year":"2016","unstructured":"Mitchell H-R, Lu X, Myers RM, Sung L, Balsamo LM, Carroll WL, Raetz E, Loh ML, Mattano LA Jr, Winick NJ, et al. Prospective, longitudinal assessment of quality of life in children from diagnosis to 3 months off treatment for standard risk acute lymphoblastic leukemia: results of children\u2019s oncology group study AALL0331. Int J Cancer. 2016;138:332\u20139.","journal-title":"Int J Cancer"},{"key":"7466_CR4","doi-asserted-by":"publisher","first-page":"e27684","DOI":"10.1002\/pbc.27684","volume":"66","author":"AF Belgaumi","year":"2019","unstructured":"Belgaumi AF, Pathan GQ, Siddiqui K, Ali AA, Al-Fawaz I, Al-Sweedan S, Ayas M, Al-Kofide AA. Incidence, clinical distribution, and patient characteristics of childhood cancer in Saudi Arabia: a population-based analysis. Pediatr Blood Cancer. 2019;66:e27684.","journal-title":"Pediatr Blood Cancer"},{"key":"7466_CR5","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1056\/NEJMsa060185","volume":"355","author":"KC Oeffinger","year":"2006","unstructured":"Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, Friedman DL, Marina N, Hobbie W, Kadan-Lottick NS, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355:1572\u201382.","journal-title":"N Engl J Med"},{"key":"7466_CR6","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1177\/1043454215609585","volume":"33","author":"TG Momani","year":"2016","unstructured":"Momani TG, Hathaway DK, Mandrell BN. Factors affecting health-related quality of life in children undergoing curative treatment for cancer: a review of the literature. J Pediatr Oncol Nurs. 2016;33:228\u201340.","journal-title":"J Pediatr Oncol Nurs"},{"key":"7466_CR7","first-page":"119","volume":"8","author":"BA Harris","year":"2010","unstructured":"Harris BA, Berger AM, Mitchell SA, Steinberg SM, Baker KL, Handel DL, Bolle JL, Bush EG, Avila D, Pavletic SZ. Spiritual well-being in long-term survivors with chronic graft versus host disease after Hematopoietic Stem Cell Transplant (HSCT). J Support Oncol. 2010;8:119.","journal-title":"J Support Oncol"},{"key":"7466_CR8","doi-asserted-by":"publisher","first-page":"2069","DOI":"10.3390\/ijerph16122069","volume":"16","author":"CC Choo","year":"2019","unstructured":"Choo CC, Chew PK, Tan P, Choo JQ, Choo AM, Ho RC, Quah TC. Health-related quality of life in pediatric patients with leukemia in Singapore: a cross-sectional pilot study. Int J Environ Res Public Health. 2019;16:2069.","journal-title":"Int J Environ Res Public Health"},{"key":"7466_CR9","doi-asserted-by":"publisher","first-page":"e2280","DOI":"10.1097\/MD.0000000000002280","volume":"94","author":"LM Sherief","year":"2015","unstructured":"Sherief LM, Kamal NM, Abdalrahman HM, Youssef DM, Abd Alhady MA, Ali AS, Abd Elbasset MA, Hashim HM. Psychological impact of chemotherapy for childhood acute lymphoblastic leukemia on patients and their parents. Medicine. 2015;94:e2280.","journal-title":"Medicine"},{"key":"7466_CR10","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.hemonc.2014.01.002","volume":"7","author":"AS Khalifa","year":"2014","unstructured":"Khalifa AS, Bishry Z, Tantawy AA, Ghanem MH, Effat SM, El Shahawy H, Ebeid FS. Psychiatric morbidity in Egyptian children with acute lymphoblastic leukemia and their care providers. Hematol Oncol Stem Cell Ther. 2014;7:76\u201384.","journal-title":"Hematol Oncol Stem Cell Ther"},{"key":"7466_CR11","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1016\/j.ejon.2013.09.004","volume":"17","author":"HA-S Huijer","year":"2013","unstructured":"Huijer HA-S, Sagherian K, Tamim H. Quality of life and symptom prevalence as reported by children with cancer in Lebanon. Eur J Oncol Nurs. 2013;17:704\u201310.","journal-title":"Eur J Oncol Nurs"},{"key":"7466_CR12","doi-asserted-by":"publisher","first-page":"119","DOI":"10.11648\/j.ajhr.20180605.12","volume":"6","author":"M Salah","year":"2018","unstructured":"Salah M. Quality of life among children with cancer in Gaza Strip. Am J Health Res. 2018;6:119\u201325.","journal-title":"Am J Health Res"},{"issue":"1","key":"7466_CR13","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.phoj.2022.12.008","volume":"8","author":"L Alnaim","year":"2023","unstructured":"Alnaim L, Alqub A, BinSalleeh R, Alsultan AS, Awwad SN. Health-related quality of life among patients with childhood acute lymphoblastic leukemia in Saudi Arabia: a cross-sectional study. Pediatr Hematol Oncol J. 2023;8(1):21\u20136. https:\/\/doi.org\/10.1016\/j.phoj.2022.12.008.","journal-title":"Pediatr Hematol Oncol J"},{"key":"7466_CR14","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1023\/A:1018779908502","volume":"21","author":"JW Varni","year":"1998","unstructured":"Varni JW, Katz ER, Seid M, Quiggins DJ, Friedman-Bender A, Castro CM. The Pediatric Cancer Quality of Life Inventory (PCQL). I. instrument development, descriptive statistics, and cross-informant variance. J Behav Med. 1998;21:179\u2013204.","journal-title":"J Behav Med"},{"key":"7466_CR15","unstructured":"Almomani T. Health-related quality of life in children with cancer. Theses and Dissertations (ETD), University of Tennessee Health Science Center. 2015."},{"key":"7466_CR16","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1002\/cncr.31066","volume":"124","author":"DJ Zheng","year":"2018","unstructured":"Zheng DJ, Lu X, Schore RJ, et al. Longitudinal analysis of quality-of-life outcomes in children during treatment for acute lymphoblastic leukemia: a report from the Children\u2019s Oncology Group AALL0932 trial. Cancer. 2018;124:571\u20139. https:\/\/doi.org\/10.1002\/cncr.31066.","journal-title":"Cancer"},{"key":"7466_CR17","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1038\/sj.bjc.6604826","volume":"100","author":"L Sung","year":"2009","unstructured":"Sung L, Klaassen R, Dix D, Pritchard S, Yanofsky R, Dzolganovski B, Almeida R, Klassen A. Identification of paediatric cancer patients with poor quality of life. Br J Cancer. 2009;100:82\u20138.","journal-title":"Br J Cancer"},{"key":"7466_CR18","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1002\/ijc.25737","volume":"129","author":"AF Klassen","year":"2011","unstructured":"Klassen AF, Raina P, McIntosh C, Sung L, Klaassen RJ, O\u2019Donnell M, Yanofsky R, Dix D. Parents of children with cancer: which factors explain differences in health-related quality of life. Int J Cancer. 2011;129:1190\u20138.","journal-title":"Int J Cancer"},{"key":"7466_CR19","doi-asserted-by":"publisher","unstructured":"Braam KI, van der Torre P, Takken T, Veening MA, Van Dulmen-den Broeder E, Kaspers GJ. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database Syst Rev. 2016;3(3):CD008796. https:\/\/doi.org\/10.1002\/14651858.CD008796.pub3. Published 31 Mar 2016.","DOI":"10.1002\/14651858.CD008796.pub3"},{"key":"7466_CR20","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.ctrv.2018.08.012","volume":"70","author":"JS Morales","year":"2018","unstructured":"Morales JS, Valenzuela PL, Rinc\u00f3n-Castanedo C, Takken T, Fiuza-Luces C, Santos-Lozano A, Lucia A. Exercise training in childhood cancer: a systematic review and meta-analysis of randomized controlled trials. Cancer Treat Rev. 2018;70:154\u201367.","journal-title":"Cancer Treat Rev"},{"key":"7466_CR21","doi-asserted-by":"publisher","first-page":"2090","DOI":"10.1002\/cncr.10428","volume":"94","author":"JW Varni","year":"2002","unstructured":"Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P. The PedsQL\u2122 in pediatric cancer: reliability and validity of the pediatric quality of life inventory\u2122 generic core scales, multidimensional fatigue scale, and cancer module. Cancer. 2002;94:2090\u2013106.","journal-title":"Cancer"},{"key":"7466_CR22","doi-asserted-by":"publisher","first-page":"301","DOI":"10.4236\/jdm.2012.23047","volume":"2","author":"M Abdul-Rasoul","year":"2012","unstructured":"Abdul-Rasoul M, AlOtaibi F, AlMahdi M, AlKandari H. Reliability and validity of the Arabic version of the PedsQLTM 4.0 generic core scales and PedsQLTM 3.0 diabetes module. J Diabetes Mellitus. 2012;2:301\u20137.","journal-title":"J Diabetes Mellitus"},{"key":"7466_CR23","doi-asserted-by":"publisher","first-page":"2776","DOI":"10.3390\/ijerph16152776","volume":"16","author":"A Kowaluk","year":"2019","unstructured":"Kowaluk A, Wo\u017aniewski M, Malicka I. Physical activity and quality of life of healthy children and patients with hematological cancers. Int J Environ Res Public Health. 2019;16:2776.","journal-title":"Int J Environ Res Public Health"},{"key":"7466_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.9734\/jammr\/2019\/v30i1030243","volume":"30","author":"A Hegazy","year":"2019","unstructured":"Hegazy A, Al Bar H, Alamri SH, Almahmoudi FA, Al Ghamdi WS, Abdulgader E. Quality of life in pediatric cancer patients. J Adv Med Med Res. 2019;30:1\u201311.","journal-title":"J Adv Med Med Res"},{"key":"7466_CR25","doi-asserted-by":"publisher","unstructured":"Hanna S, El-Ayadi M, Abdelazeim F. Identifying fine motor difficulties in children with acute lymphoblastic leukemia: a scoping review. Support Care Cancer. 2024;32. https:\/\/doi.org\/10.1007\/s00520-024-08667-0.","DOI":"10.1007\/s00520-024-08667-0"},{"key":"7466_CR26","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.jse.2009.11.006","volume":"19","author":"JE Hsu","year":"2010","unstructured":"Hsu JE, Nacke E, Park MJ, Sennett BJ, Huffman GR. The disabilities of the arm, shoulder, and hand questionnaire in intercollegiate athletes: validity limited by ceiling effect. J Shoulder Elbow Surg. 2010;19:349\u201354.","journal-title":"J Shoulder Elbow Surg"},{"key":"7466_CR27","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/1471-2474-7-44","volume":"7","author":"C Gummesson","year":"2006","unstructured":"Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (Quick DASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44.","journal-title":"BMC Musculoskelet Disord"},{"key":"7466_CR28","first-page":"2037","volume":"88","author":"F Salwa","year":"2020","unstructured":"Salwa F, Khattab AS, Mohammed MM, Naser MA. Validity and reliability of the Arabic version of the quick-dash questionnaire for upper extremity disorders. Med J Cairo Univ. 2020;88:2037\u201343.","journal-title":"Med J Cairo Univ"},{"key":"7466_CR29","doi-asserted-by":"publisher","first-page":"102372","DOI":"10.1016\/j.msksp.2021.102372","volume":"53","author":"A Alnahdi","year":"2021","unstructured":"Alnahdi A. Validity and reliability of the Arabic quick disabilities of the arm, Shoulder and Hand (QuickDASH-Arabic). Musculoskelet Sci Pract. 2021;53:102372. https:\/\/doi.org\/10.1016\/j.msksp.2021.102372.","journal-title":"Musculoskelet Sci Pract"},{"key":"7466_CR30","doi-asserted-by":"publisher","unstructured":"Aldaihan M, Alnahdi A. Responsiveness of the Arabic quick disabilities of the arm, shoulder and hand in patients with upper extremity musculoskeletal disorders. Healthcare. 2023;11. https:\/\/doi.org\/10.3390\/healthcare11182507.","DOI":"10.3390\/healthcare11182507"},{"key":"7466_CR31","doi-asserted-by":"publisher","first-page":"192","DOI":"10.2340\/17453674.2024.40181","volume":"95","author":"N K\u00e4mpp\u00e4","year":"2024","unstructured":"K\u00e4mpp\u00e4 N, Hulkkonen S, Grahn P, Laaksonen T, Repo J. The construct validity and internal consistency of QuickDASH in pediatric patients with upper extremity fractures. Acta Orthop. 2024;95:192\u20139. https:\/\/doi.org\/10.2340\/17453674.2024.40181.","journal-title":"Acta Orthop"},{"key":"7466_CR32","first-page":"371","volume":"79","author":"JM Binkley","year":"1999","unstructured":"Binkley JM, Stratford PW, Lott SA, Riddle DL, Network NA. O.R.R. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. Phys Ther. 1999;79:371\u201383.","journal-title":"Phys Ther"},{"key":"7466_CR33","doi-asserted-by":"publisher","first-page":"2965","DOI":"10.1080\/09638288.2018.1483435","volume":"41","author":"JP Repo","year":"2019","unstructured":"Repo JP, Tukiainen EJ, Roine RP, Sampo M, Sandelin H, H\u00e4kkinen AH. Rasch Analysis of the lower extremity functional scale for foot and ankle patients. Disabil Rehabil. 2019;41:2965\u201371.","journal-title":"Disabil Rehabil"},{"key":"7466_CR34","doi-asserted-by":"publisher","first-page":"98","DOI":"10.2522\/ptj.20100199","volume":"92","author":"CP Gabel","year":"2012","unstructured":"Gabel CP, Melloh M, Burkett B, Michener LA. Lower limb functional index: development and clinimetric properties. Phys Ther. 2012;92:98\u2013110.","journal-title":"Phys Ther"},{"key":"7466_CR35","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1097\/bpo.0000000000002647","volume":"44","author":"Y Chua","year":"2024","unstructured":"Chua Y, Sheri S, Yeo BS, Lee NK, Ng SH, Lim KBL. Can the lower extremity functional scale be used in children and adolescents? A validation study. J Pediatr Orthop. 2024;44:322\u20136. https:\/\/doi.org\/10.1097\/bpo.0000000000002647.","journal-title":"J Pediatr Orthop"},{"key":"7466_CR36","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1590\/S1413-35552012005000091","volume":"17","author":"LM Pereira","year":"2013","unstructured":"Pereira LM, Dias JM, Mazuquin BF, Castanhas LG, Menacho MO, Cardoso JR. Translation, cross-cultural adaptation and analysis of the psychometric properties of the Lower Extremity Functional Scale (LEFS): LEFS-BRAZIL. Braz J Phys Ther. 2013;17:272\u201380.","journal-title":"Braz J Phys Ther"},{"key":"7466_CR37","doi-asserted-by":"publisher","first-page":"3839","DOI":"10.1080\/09638288.2020.1754927","volume":"43","author":"A Alnahdi","year":"2020","unstructured":"Alnahdi A. Measurement properties of the 15-item Arabic lower extremity functional scale. Disabil Rehabil. 2020;43:3839\u201344. https:\/\/doi.org\/10.1080\/09638288.2020.1754927.","journal-title":"Disabil Rehabil"},{"key":"7466_CR38","doi-asserted-by":"crossref","unstructured":"Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE. Repeated measures and longitudinal data analysis. In Regression methods in biostatistics: linear, logistic, survival, and repeated measures models. Boston: Springer US; 2012. pp. 261\u2013308.","DOI":"10.1007\/978-1-4614-1353-0_7"},{"key":"7466_CR39","doi-asserted-by":"publisher","first-page":"117863292110293","DOI":"10.1177\/11786329211029351","volume":"14","author":"F Alabbas","year":"2021","unstructured":"Alabbas F, Elyamany G, Alkhayat N, AlShahrani M, Ibrahim W, Elborai Y, Binhassan A, Hamzi H, Al Thibani N, Alakel S, et al. Assessment of health-related quality of life in Saudi children with cancer. Health Serv Insights. 2021;14:11786329211029351. https:\/\/doi.org\/10.1177\/11786329211029351.","journal-title":"Health Serv Insights"},{"key":"7466_CR40","doi-asserted-by":"publisher","first-page":"2116","DOI":"10.1002\/cncr.20609","volume":"101","author":"K Meeske","year":"2004","unstructured":"Meeske K, Katz ER, Palmer SN, Burwinkle T, Varni JW. Parent proxy\u2013reported health-related quality of life and fatigue in pediatric patients diagnosed with brain tumors and acute lymphoblastic leukemia. Cancer. 2004;101:2116\u201325. https:\/\/doi.org\/10.1002\/cncr.20609.","journal-title":"Cancer"},{"key":"7466_CR41","unstructured":"Rodgers C, Hooke MC, Taylor O, Koerner KM, Mitby P, Moore I, Scheurer ME, Hockenberry MJ, Pan W. Childhood cancer symptom cluster: leukemia and health-related quality of Life. In: Proceedings of the Oncology nursing forum, vol. 46. 2019. p. 228."},{"key":"7466_CR42","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1186\/1477-7525-9-103","volume":"9","author":"Y Ji","year":"2011","unstructured":"Ji Y, Chen S, Li K, Xiao N, Yang X, Zheng S, Xiao X. Measuring health-related quality of life in children with cancer living in Mainland China: feasibility, reliability and validity of the Chinese Mandarin version of PedsQL 4.0 generic core scales and 3.0 cancer module. Health Qual Life Outcomes. 2011;9:103. https:\/\/doi.org\/10.1186\/1477-7525-9-103.","journal-title":"Health Qual Life Outcomes"},{"key":"7466_CR43","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s41687-018-0075-0","volume":"2","author":"E Stenmarker","year":"2018","unstructured":"Stenmarker E, Mellgren K, Matus M, Schroder Hakansson A, Stenmarker M. Health-related quality of life, culture and communication: a comparative study in children with cancer in Argentina and Sweden. J Patient-Reported Outcomes. 2018;2:49. https:\/\/doi.org\/10.1186\/s41687-018-0075-0.","journal-title":"J Patient-Reported Outcomes"},{"key":"7466_CR44","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/1477-7525-10-52","volume":"10","author":"Z Chaudhry","year":"2012","unstructured":"Chaudhry Z, Siddiqui S. Health related quality of life assessment in Pakistani paediatric cancer patients using PedsQLTM 4.0 generic core scale and PedsQL\u2122 cancer module. Health Qual Life Outcomes. 2012;10:52. https:\/\/doi.org\/10.1186\/1477-7525-10-52.","journal-title":"Health Qual Life Outcomes"},{"key":"7466_CR45","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/ped.13092","volume":"59","author":"K Kobayashi","year":"2017","unstructured":"Kobayashi K, Nakagami-Yamaguchi E, Hayakawa A, Adachi S, Hara J, Tokimasa S, Ohta H, Hashii Y, Rikiishi T, Sawada M, et al. Health-related quality of life in Japanese Children with acute lymphoblastic leukemia during and after chemotherapy. Pediatr Int. 2017;59:145\u201353. https:\/\/doi.org\/10.1111\/ped.13092.","journal-title":"Pediatr Int"},{"key":"7466_CR46","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.4236\/jct.2013.47148","volume":"4","author":"M Fawzy","year":"2013","unstructured":"Fawzy M, Saleh M, El-Wakil M, Monir Z, Eltahlawy E, et al. Quality of life in Egyptian children with cancer. J Cancer Therapy. 2013;4:1256. https:\/\/doi.org\/10.4236\/jct.2013.47148.","journal-title":"J Cancer Therapy"},{"key":"7466_CR47","doi-asserted-by":"publisher","first-page":"1502166","DOI":"10.3389\/frhem.2024.1502166","volume":"3","author":"S Salek","year":"2025","unstructured":"Salek S, Nier S, Pemberton-Whiteley Z, Ionova T, Ianni G, Tripepi G, York N, Schroeter N, Huntley K, Rynne M, Costello D, Pecova L, Oliva EN. Impact of leukemia subtype and demographics on patient quality of life in 76 countries: a cross-sectional study. Front Hematol. 2025;3:1502166. https:\/\/doi.org\/10.3389\/frhem.2024.1502166.","journal-title":"Front Hematol"},{"key":"7466_CR48","doi-asserted-by":"publisher","first-page":"1678","DOI":"10.6026\/9732063002001678","volume":"20","author":"K Kasinathan","year":"2024","unstructured":"Kasinathan K, Rajkumar R, Rajendran SS, Anbalagan M, Ramasamy R, Ramu B. Biopsychosocial needs of leukemic children \u2013 a systematic review. Bioinformation. 2024;20:1678\u201382. https:\/\/doi.org\/10.6026\/9732063002001678.","journal-title":"Bioinformation"},{"key":"7466_CR49","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1186\/s12887-024-05010-8","volume":"24","author":"KK Sudnawa","year":"2024","unstructured":"Sudnawa KK, Yeepae J, Photia A, Rujkijyanont P, Traivaree C, Monsereenusorn C. Health-related quality of life and its determinant factors in Thai children with cancer: parents vs. children perspectives. BMC Pediatr. 2024;24:531. https:\/\/doi.org\/10.1186\/s12887-024-05010-8.","journal-title":"BMC Pediatr"},{"key":"7466_CR50","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1002\/pon.4749","volume":"27","author":"M Nunns","year":"2018","unstructured":"Nunns M, Mayhew D, Ford T, Rogers M, Curle C, Logan S, Moore D. Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: a systematic review and meta-analysis. Psycho-oncology. 2018;27:1889\u201399. https:\/\/doi.org\/10.1002\/pon.4749.","journal-title":"Psycho-oncology"},{"key":"7466_CR51","doi-asserted-by":"publisher","first-page":"15","DOI":"10.21608\/ejcm.2017.5037","volume":"35","author":"ED El Desouky","year":"2017","unstructured":"El Desouky ED, Noaman MK, Shalaby LM, Shaaban SY, Elattar IA. Factors affecting quality of life in patients with pediatric leukemia during induction chemotherapy. Egypt J Community Med. 2017;35:15\u201323.","journal-title":"Egypt J Community Med"},{"key":"7466_CR52","doi-asserted-by":"publisher","unstructured":"Ernst M, Hinz A, Br\u00e4hler E, Merzenich H, Faber J, Wild PS, Beutel ME. Quality of life after pediatric cancer: comparison of long-term childhood cancer survivors\u2019 quality of life with a representative general population sample and associations with physical health and risk indicators. Health Qual Life Outcomes. 2023;21. https:\/\/doi.org\/10.1186\/s12955-023-02153-7.","DOI":"10.1186\/s12955-023-02153-7"},{"key":"7466_CR53","doi-asserted-by":"publisher","first-page":"e26489","DOI":"10.1002\/pbc.26489","volume":"64","author":"JE Fardell","year":"2017","unstructured":"Fardell JE, Vetsch J, Trahair T, Mateos MK, Grootenhuis MA, Touyz LM, et al. Health-related quality of life of children on treatment for acute lymphoblastic leukemia: a systematic review. Pediatr Blood Cancer. 2017;64:e26489. https:\/\/doi.org\/10.1002\/pbc.26489.","journal-title":"Pediatr Blood Cancer"},{"key":"7466_CR54","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1037\/0003-066X.56.6-7.497","volume":"56","author":"DB Downey","year":"2001","unstructured":"Downey DB. Number of siblings and intellectual development: the resource dilution explanation. Am Psychol. 2001;56:497\u2013504. https:\/\/doi.org\/10.1037\/0003-066X.56.6-7.497.","journal-title":"Am Psychol"},{"key":"7466_CR55","doi-asserted-by":"publisher","unstructured":"Ritter J, Allen S, D Cohen P, F Fajardo A, Marx K, Loggetto P, Auste C, Lewis H, E de S\u00e1 Rodrigues K, Hussain S, et al. Financial hardship in families of children or adolescents with cancer: a systematic literature review. Lancet Oncol. 2023;24(e364\u2013e375). https:\/\/doi.org\/10.1016\/S1470-2045(23)00320-0.","DOI":"10.1016\/S1470-2045(23)00320-0"},{"key":"7466_CR56","first-page":"219","volume":"82","author":"GM Mounir","year":"2007","unstructured":"Mounir GM, Abolfotouh MA. Assessment of health related quality of life among school children with cancer in Alexandria. J Egypt Public Health Assoc. 2007;82:219\u201338.","journal-title":"J Egypt Public Health Assoc"},{"key":"7466_CR57","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.jpeds.2019.10.068","volume":"218","author":"LN Cohn","year":"2020","unstructured":"Cohn LN, Pechlivanoglou P, Lee Y, Mahant S, Orkin J, Marson A, Cohen E. Health outcomes of parents of children with chronic illness: a systematic review and meta-analysis. J Pediatr. 2020;218:166\u2013e1772. https:\/\/doi.org\/10.1016\/j.jpeds.2019.10.068.","journal-title":"J Pediatr"},{"key":"7466_CR58","doi-asserted-by":"publisher","first-page":"2136","DOI":"10.1200\/JCO.2012.47.3173","volume":"31","author":"AW Smith","year":"2013","unstructured":"Smith AW, Bellizzi KM, Keegan TH, Zebrack B, Chen VW, Neale AV, Hamilton AS, Shnorhavorian M, Lynch CF. Health-related quality of life of adolescent and young adult patients with cancer in the United States: the adolescent and young adult health outcomes and patient experience study. J Clin Oncol. 2013;31:2136\u201345. https:\/\/doi.org\/10.1200\/JCO.2012.47.3173.","journal-title":"J Clin Oncol"},{"key":"7466_CR59","doi-asserted-by":"publisher","first-page":"3235","DOI":"10.1007\/s00520-014-2349-2","volume":"22","author":"RR Litsenburg","year":"2014","unstructured":"Litsenburg RR, van Huisman J, Pieters R, Verhaak C, Kaspers GJ, Gemke RJ. Determinants of quality of life during induction therapy in pediatric acute lymphoblastic leukemia. Support Care Cancer. 2014;22:3235\u201342. https:\/\/doi.org\/10.1007\/s00520-014-2349-2","journal-title":"Support Care Cancer"},{"key":"7466_CR60","doi-asserted-by":"publisher","first-page":"1616","DOI":"10.1002\/pbc.25514","volume":"62","author":"J Stokke","year":"2015","unstructured":"Stokke J, Sung L, Gupta A, Lindberg A, Rosenberg AR. Systematic review and meta-analysis of objective and subjective quality of life among pediatric, adolescent, and young adult bone tumor survivors. Pediatr Blood Cancer. 2015;62:1616\u201329. https:\/\/doi.org\/10.1002\/pbc.25514.","journal-title":"Pediatr Blood Cancer"},{"key":"7466_CR61","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1007\/s00520-024-08355-z","volume":"32","author":"H Liu","year":"2024","unstructured":"Liu H, Yin J, Wang K, Liu S, Yang Y, Song Z, Dong C, Zhang T, Luo J. Efficacy of physical exercise intervention on children with acute lymphoblastic leukemia during treatment and rehabilitation: a systematic review and meta-analysis. Support Care Cancer. 2024;32:177. https:\/\/doi.org\/10.1007\/s00520-024-08355-z.","journal-title":"Support Care Cancer"},{"key":"7466_CR62","doi-asserted-by":"publisher","first-page":"891650","DOI":"10.3389\/fped.2022.891650","volume":"10","author":"V Marchese","year":"2022","unstructured":"Marchese V, Rock K, York T, Ruble K, Gray VL. The efficacy of targeted exercise on gross motor and neuromuscular performance in survivors of childhood leukemia: a pilot study. Front Pead. 2022;10:891650. https:\/\/doi.org\/10.3389\/fped.2022.891650.","journal-title":"Front Pead"},{"key":"7466_CR63","doi-asserted-by":"publisher","first-page":"855","DOI":"10.3390\/cancers18050855","volume":"18","author":"L Ortiz-Comino","year":"2026","unstructured":"Ortiz-Comino L, Abril-Mera TM, Fern\u00e1ndez-Gualda M\u00c1, Lozano-Lozano M, Herbawi F, Fern\u00e1ndez-Lao C. Benefits of physiotherapy interventions in survivors of childhood cancer: a systematic review with meta-analysis. Cancers. 2026;18:855. https:\/\/doi.org\/10.3390\/cancers18050855.","journal-title":"Cancers"},{"key":"7466_CR64","doi-asserted-by":"publisher","first-page":"1807","DOI":"10.1016\/j.apmr.2022.01.142","volume":"103","author":"A Sleight","year":"2022","unstructured":"Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, et al. Systematic review of functional outcomes in cancer rehabilitation. Arch Phys Med Rehabil. 2022;103:1807\u201326. https:\/\/doi.org\/10.1016\/j.apmr.2022.01.142.","journal-title":"Arch Phys Med Rehabil"}],"container-title":["BMC Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12887-026-07466-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-026-07466-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-026-07466-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T15:02:19Z","timestamp":1790262139000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12887-026-07466-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,8]]},"references-count":64,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["7466"],"URL":"https:\/\/doi.org\/10.1186\/s12887-026-07466-2","relation":{},"ISSN":["1471-2431"],"issn-type":[{"value":"1471-2431","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,8]]},"assertion":[{"value":"13 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was obtained from the Institutional Review Board of King Faisal Specialist Hospital and Research Center in Riyadh (No. C380\/350\/42). The study objectives and data-collection procedures were explained verbally and in writing to the participants and their parents before written informed consent was obtained.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"903"}}