An Evaluation of Quality of Life During Participation in Early-Phase Clinical Trials in Paediatric Oncology

Background: Given the poor prognoses and potential treatment toxicities faced by paediatric patients in early-phase oncology trials, evaluating quality of life (QoL) is crucial for both families and physicians when considering patient recruitment. This prospective, longitudinal study evaluates the impact of trial participation on QoL in children, agreement between self-reports, proxy-reports and physician assessments, and associations with demographic and clinical factors. Procedure: Patients aged 5–18 years enrolled in Phase I/II clinical trials at Hospital Niño Jesus from 2019 to 2023, and their caregiver proxies were eligible. PedsQL 3.0 Cancer Module was independently completed by children and proxies at baseline, Day +30, and Day +90 of Cycle 1 Day 1. Stratified analyses by gender, age, tumour type, outcome, reason for end of treatment, trial characteristics and treatment setting were performed. Agreement between child, proxy and investigator responses was measured. Results: Ninety-three paediatric patients with cancer and their proxies were included. 38.71% of patients and 33.33% of proxies experienced a clinically relevant change in QoL scores after 30 days. Patients in Phase II trials demonstrated greater QoL improvements compared to Phase I (p = 0.0061). No significant associations were found between improvement of QoL and demographic or clinical factors. Proxies consistently reported lower QoL scores than patients, while physicians underestimated symptom severity compared to patient-reported outcomes. Conclusions: Trial participation aligns with maintaining or improving QoL, particularly in later phase trials. Discrepancies among patient, proxy and investigator perspectives underscore the necessity of multi-informant tools to capture comprehensive insights.