A Causal Model of Health-Related Quality of Life Among Thai Adolescent Survivors of Childhood Cancer: A Cross-Sectional Study

Improving health-related quality of life among adolescents who have survived childhood cancer is now a significant concern for healthcare professionals. To design effective interventions that elevate this health-related quality of life, understanding the relevant factors and how they work to influence their health-related quality of life is essential. This cross-sectional study aimed to develop and test a causal model of health-related quality of life among Thai adolescents who are survivors of childhood cancer. Data were collected at four tertiary hospitals in Thailand from 473 Thai adolescents who survived childhood cancer, utilizing nine instruments, including a Demographic Data Form, the Children Fatigue Scale, the Sleep Disturbance Scale for Children, the Children’s Depression Inventory, the Functional Status Questionnaire, the State Self-Esteem Scale, the Thai Family Functioning Scale, the Friend (Adaptability, Partnership, Growth, Affection, and Resolve) Questionnaire, and the Pediatric Quality of Life Inventory 4.0. Initial data analysis employed descriptive statistics, followed by structural equation modeling performed using the Mplus program. The final model fitted with the research data and accounted for 70.8% of the variation in health-related quality of life. Fatigue, sleep disturbance, depression, and functional status influenced health-related quality of life through both direct and indirect pathways. Family functioning and peer support were found to only indirectly influence health-related quality of life via self-esteem. Self-esteem was found to directly influence health-related quality of life, and its influence was the strongest. Therefore, nurses can design the interventions that emphasize promoting self-esteem, educating and encouraging adolescent survivors of childhood cancer to use effective symptom management strategies to reduce fatigue, sleep disturbances, and depression to improve functional status, along with fostering good family functioning and providing peer support groups, that can enhance self-esteem, leading to a higher HRQoL in this population.