COVID-19 Vaccine Uptake in Patients with Multiple Myeloma and AL Amyloidosis: A Cross-Sectional Observational Study from India.

COVID-19 vaccine uptake has been comparable, if not higher, in LMICs (Low- and Middle-Income Countries) than in developed nations. Patients with plasma cell disorders are at a higher risk for developing COVID-19 related morbidity and mortality due to impaired immune responses. We report the outcome of active counselling for COVID-19 vaccines in patients with multiple myeloma (MM) and AL amyloidosis and the reasons for hesitancy in those unvaccinated. This was a cross-sectional, single-centre, observational study enrolling patients who visited the hospital between January 1, 2021 and June 30, 2021. Patients with MM and AL amyloidosis at diagnosis or follow-up were actively counselled by treating oncologists regarding the available COVID-19 vaccines (Covishield and Covaxin) during clinic visits or hospital admission. In the subsequent hospital visits, vaccination details were collected and verified. A structured interview schedule was administered to unvaccinated patients to identify the reasons behind vaccine hesitancy. Association of vaccine acceptance with socio-economic parameters and other disease parameters was studied using Chi-square test. Out of 195 patients, 178 (91%) were included in the study; 17 were lost to follow-up. At least a single dose of vaccine was administered in 86%. 79% received Covishield, whereas 21% received Covaxin. 67% received both vaccine doses. Vaccine-related side effects were mild and no vaccine-related thrombotic events were seen. Three patients died due to COVID-19-related causes, of which two were unvaccinated. The reasons for hesitancy in the 24 unvaccinated patients included: 9-poor general health conditions, 8-lack of advice from doctors, 2-fear of side effects, and 2-unavailability of vaccine delivery centres nearby. In comparison to the other studies, we report a higher vaccine uptake which can be attributed to targeted counselling by the treating oncologist and the universal free vaccination programme that is familiar to all Indians.

Listening to Patient and Caregiver Voices to Anchor Global Cancer Control.

The experiences of those living with illness and those who care for them are central to disease control and prevention efforts. The history of public health is full of reminders of when consultations with patients and families helped develop meaningful interventions that were ultimately adopted by communities. Global cancer control, on the other hand, seems to increasingly take place in tertiary hospitals and centers where care is sought often at a late stage of cancer. This essay draws on personal experiences of the authors in working with cancer survivors in southern India and discusses how listening to patient and caregiver voices might guide global cancer control efforts.

Status of Palliative Care Services in Tamil Nadu - A Descriptive Report.

Objectives: Advanced cancer patients attending tertiary cancer centres from rural places are referred back to local physicians for symptom management. Due to lack of networking with palliative care centres (PCCs), the referred patients do not receive appropriate palliative care (PC) services. Hence, an attempt was made to map the PCCs in Tamil Nadu to make the referral system efficient. Material and Methods: PCCs in Tamil Nadu were identified from the National Health Mission directory, online sources and from morphine license annexure of drug control department. The details regarding nature of facility, PC model, service type, procedures, cost, morphine availability and type of personnel involved in their PCCs were collected from government and private centres. The data were analysed using descriptive statistics and geomapping of all the centres identified was created. Results: A total of 371 PCCs were identified, of which 32 were government headquarter hospitals (GHQH), 281 were government community centres and 58 were private. Eighty-three of the 90 centres (including GHQH and private) were active and 60 responded to the survey. More than half of the centres were hospital-based (61.7%) and 28.3% were community-based. The majority of the PCCs had in-patient (75%) and out-patient (63.3%) facilities and 63.3% had regular home visits. Forty-six centres provide PC service free of cost. Nearly 80% provide morphine for pain management, wherein 41 have obtained a license. In total, ten centres had a social worker and four had a psychologist. Conclusion: The number of PCCs is disproportionate, in which majority of the centres are clustered in urban areas. Integrating PC services into the existing health system is the way forward.

Perceived psychosexual dimensions of cervical cancer survivors in India-An exploratory study.

OBJECTIVE: Cervical cancer is the second most common cancer among women in India. Medical advancements have led to increased survival. However, sexuality and sexual concerns remain as major worries of patients after treatment. This study aims to understand the psychosexual experiences of cervical cancer survivors. METHODS: Cervical cancer survivors (n = 30) aged 35-55 years were interviewed using a semi-structured interview schedule, after obtaining consent. The audio-recorded in-depth interviews were transcribed and analysed using thematic analysis. RESULTS: Three major themes in each group namely sexually active and sexually inactive evolved on analysis. Three themes were derived under sexually active group namely (i) Enablers of active sexual functioning (ii) Impediments of active sexual functioning (iii) Sexual health communication. The three themes under sexually inactive include (i) Attributes of sexual abstinence (ii) Impact of sexual abstinence (iii) Barriers of sexual health communication. CONCLUSIONS: Both sexually active and inactive survivors in India experience various psychosexual concerns post cancer treatment indicating a strong need for psychosocial care and focused clinical interventions.

Body Image Scale: Evaluation of the Psychometric Properties in Three Indian Head and Neck Cancer Language Groups.

Background: Body image is a subjective concept encompassing a person's views and emotions about their body. Head and neck cancer (HNC) diagnosis and treatment affects several psychosocial concepts including body image. Large numbers of HNC patients are diagnosed each year in India but there are no suitable measures in regional languages to assess their body image. This study assessed the psychometric properties of the Body Image Scale (BIS), a measure suitable for clinical and research use in HNC populations, translated into Tamil, Telugu and Hindi and compared body image distress between language groups. Methods: Translated versions of BIS were completed by HNC patients recruited from three cancer centers across India one time only. Psychometric evaluation was conducted including factor analysis using principal component analysis and internal consistency reliability using Cronbach's alpha. Patients completed the EORTC Quality of Life Questionnaire (QLQ) C-30 and EORTC QLQ HN-35 measures to enable exploration of convergent and discriminant validity. ANOVA was used to calculate difference in mean values for body image. Results: Our sample included 621 HNC patients (Tamil = 205, Telugu = 216, Hindi = 200). Factor analysis revealed a one-factor solution and Cronbach's alpha coefficients ranged between 0.891 and 0.969 indicating good reliability. Hypothesized correlations between similar and different constructs were as expected, supporting construct validity. On the BIS, we found a statistically significant difference (F = 11.0954, P < 0.05) between means of Tamil, Telugu, and Hindi groups, with higher body image scores in Telugu (M = 12.86; SD = 7.65) and Hindi groups (M = 12.52; SD = 7.36) indicating more symptoms/body image distress, when compared to Tamil population (M = 9.28; SD = 10.04). Conclusion: The reliability and validity of the three translated Indian versions of the BIS were maintained, providing a method for assessing body image of HNC population worldwide speaking Tamil, Telugu, and Hindi across the illness trajectory.

Psychosocial issues and concerns of cancer patients due to COVID-19 pandemic lockdown.

BACKGROUND: The COVID-19 pandemic lockdown has posed numerous unique challenges for cancer patients, families and healthcare workers. However, the reports on psychosocial issues associated with such situations are scarce. This study aims to determine the psychosocial issues faced by cancer patients during COVID-19 pandemic lockdown. METHODS: Cancer patients irrespective of diagnosis and treatment status were assessed for fear of progression (FOP), distress and quality of life (QOL) using Fear of Progression- Short Form, Distress Thermometer and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) 30, respectively. The demographics, disease and treatment related details were obtained from case record form. Psychological issues and concerns were collected using a structured interview. Descriptive statistics, Mann Whitney U-test and Linear Regression were performed using SPSS ver 20.0. RESULTS: Among the 219 patients, 118 (52.5%) had either interruption in their on-going cancer treatment or the initiation of cancer treatment was delayed as a result of COVID-19 lockdown. Overall, 74% of the patients experienced distress, 55.3% experienced FOP and 58% had low global health status. Pain followed by fatigue remained as major issues among patients during lockdown. Interruption in treatment and logistical issues were strongly associated with increased distress (p = 0.026) and FOP (p = 0.004). Global health status (p = 0.037), emotional functioning (p = 0.000), social functioning (p = 0.000) and financial concerns (p = 0.046) differed significantly between patients with and without treatment interruption. Age (ß = -0.159), mode of transport (ß = -0.135), challenges in meeting daily needs (ß = -0.245) and being out-casted by the society (ß = -0.227) predicted distress. CONCLUSION: More than half of the patients had interruptions in their treatment as a result of COVID-19 lockdown. Cancer patients have had increased physical and psychological concerns as a result of the pandemic situation and its associated changes. Specific guidelines ought to be framed for providing continued and holistic cancer care for patients during such lockdown.

Does perceived social support, psychological problems, and fatigue impact quality of life of geriatric patients with cancer?

Background: Health-related comorbidities often increase due to cancer among the ageing population. However, thed omains of psychological functioning of geriatric patients remain undetected especially in the Indian scenario. This study aimed to evaluate psychological problems, perceived social support, fatigue, and quality of life among geriatric patients with cancer. Methods: A cross sectional study was conducted in a tertiary cancer center. Geriatric patients with cancer (n = 130) having solid malignancies categorized as older patients (>65 years) and younger geriatric patients (60-65 years) were included in the study. Depression, anxiety, perceived social support, fatigue, and quality of life was assessed using the Geriatric Depression Screening Scale, Geriatric Anxiety Scale, Multidimensional Scale of Perceived Social Support, Symbolic Assessment of Fatigue Extent, and the Old People Quality of life Scale, respectively. Descriptive and inferential statistics such as cross tab analysis, correlation and regression analysis. Results: A majority of patients 80 (61.5%) had low perceived social support, moderate-severe depression 61 (47.7%) and mild-moderate anxiety 55 (43.1%). Half of the patients were found to have poor quality of life. Further, psychological problems were higher among older geriatric patients (p = 0.000). Very few patients had a higher impact of fatigue on their daily functioning 17 (13.3%). There was a positive correlation between perceived social support, depression, anxiety, extent of fatigue, and quality of life (r = 0.256, P = 0.003). Conclusion: Psychological problems are higher among older geriatric patients with cancer undergoing treatment. Clinical implications could aim at regular screening to identify specific psychological issues and provide appropriate interventions. Future research warrants the efficacy of such therapeutic interventions for better quality of life outcomes.

Psychosocial Issues Among Primary Caregivers of Patients with Advanced Head and Neck Cancer - A Mixed-method Study.

OBJECTIVES: This study aims to explore the psychosocial issues faced by the primary caregivers of advanced head and neck cancer patients with the primary objective to understand their experiences within social context. MATERIALS AND METHODS: Burden and QOL of caregivers (n = 15) were quantified using Zarit Burden Interview schedule and caregiver quality of life index-cancer (CQOLC), respectively. Primary caregivers (n = 10) were interviewed using semi-structured interview schedule. Thematic analysis was employed to analyse the qualitative data. Descriptive statistics was used for quantitative data. RESULTS: Four major themes emerged: (1) Impacts of caregiving, (2) coping with caregiving, (3) caregiver's appraisal of caregiving and (4) caregiver's perception of illness. Majority (73.3%) of the caregivers had QOL below 100. The mean CQOLC score was 73.07 (SD 24.17) and most (46.7%) of the caregivers reported mild-to-moderate burden, while 27% had little to no burden. The mean ZBI score was 32.4 (SD 18.20). CONCLUSION: Caregiving impacts the physical, emotional, financial and social aspects of caregiver's life. Caregivers adopt active coping strategies to overcome the impacts of caregiving. Family acts as a major source of strength to manage the emotional constraints faced by Indian caregivers. Cultural beliefs and values of caregivers influence their appraisal of caregiving situation. Majority of the caregivers experienced mild-to-moderate burden while most of the caregivers scored low on QOL.

Patient-reported anxiety and depression measures for use in Indian head and neck cancer populations: a psychometric evaluation.

BACKGROUND: Head and neck cancers (HNC) are one of the most traumatic forms of cancer because they affect essential aspects of life such as speech, swallowing, eating and disfigurement. HNCs are common in India, with over 100,000 cases being registered each year. HNC and treatment are both associated with considerable anxiety and depression. With increasing multinational research, no suitable measures in Indian languages are available to assess anxiety and depression in Indian HNC patients. This study evaluated the psychometric properties of cross-culturally adapted versions of Zung's self-rating Anxiety Scale (SAS) and the Patient health questionnaire - 9 (PHQ-9) in Tamil, Telugu and Hindi speaking Indian HNC populations. METHODS: HNC patients were recruited from three tertiary cancer centres in India. Patients completed the cross-culturally adapted versions of SAS and PHQ-9. We assessed targeting, scaling assumptions, construct validity (exploratory and confirmatory factor analyses), convergent validity, and internal consistency reliability. RESULTS: The study sample included 205 Tamil, 216 Telugu and 200 Hindi speaking HNC patients. Exploratory and confirmatory factor analyses indicated a two-factor solution for PHQ-9 and four-factor solution for SAS in all three languages. Cronbach's alpha coefficients ranged between 0.717 and 0.890 for PHQ-9 and between 0.803 and 0.868 for SAS, indicating good reliability. Correlations between hypothesized scales were as expected providing evidence towards convergent validity. CONCLUSIONS: This first psychometric evaluation of the measurement properties of Tamil, Telugu and Hindi versions of the SAS and PHQ-9 in large, Indian HNC populations supported their use as severity and outcome measures across the disease and treatment continuum.

Psychosocial counseling of patients planned for hematopoietic stem-cell transplantation for malignant conditions-practical challenges and solutions from India.

Hematopoietic stem-cell transplantation (HSCT) is a life-saving procedure often performed to cure relapsed and difficult-to-treat malignancies. Only a handful of centers in India were initially involved in the delivery of these services. However, in the last decade, more than 100 centers in the private and public domain have started offering transplant services in the country. Moreover, there are funding options, which has opened up this expensive treatment options for economically backward patients. Costs apart, there are multiple social, familial, and emotional challenges faced by these patients. A multidisciplinary support team involving social workers, psychologists, and transplant nurses, besides the treating hematologist/oncologist, is required for the optimum care of these patients. These challenges, in the Indian context, are often unique. Unfortunately, there is limited information and resource available to guide counseling of patients planned for HSCT in India. We conducted a workshop at our center where a panel of experts with experience in dealing with patients undergoing HSCT discussed issues faced by them. These discussions constitute a valuable resource for counseling patients planned for HSCT. They were transcribed by a postgraduate doctor and are summarised here in a case-based format.

Quality of death: The unspoken experiences of patients with advanced cancers in India - An exploratory qualitative study.

OBJECTIVE: End-of-life (EOL) care is a developing concept in India, with well-established practices in certain states like Kerala, but not in all the states. As there is a substantial stigma associated with death discussion across the Indian population, the experiences of caregivers of people with advanced cancer have not been explored. Our aim in this study was to explore the experience and perceptions of caregivers of people diagnosed with advanced cancer regarding the quality of the individuals' death. METHODS: An exploratory study where the caregivers (n = 108) of advanced cancer patients, who died either during hospitalization or at home, were interviewed to assess quality of death (QOD), using an open-ended question to explore the sufferings of the patients in the final days and caregivers' coping mechanism. RESULTS: Majority of the patients died at home (n = 79, 73.1%). The thematic analysis of the transcripts resulted in seven sub-themes, which were categorized under four major themes, namely 'bodily discomfort', 'psychological experiences' with the sub-themes resilience and existential distress, 'awareness of prognoses' with the sub-themes aware, unaware and conjecture, and 'carers coping' with the sub-themes perceived strain and contentment. CONCLUSION: Patients under EOL care experience physical and psychological suffering, as reported by the caregivers. Efforts must be undertaken to reduce suffering by means of improving focus on and strengthening symptom management and enhancing psychosocial support, for optimally utilizing the available interventions to manage the physical symptoms and to address the psychosocial issues.

Quit attempts among tobacco users identified in the Tamil Nadu Tobacco Survey of 2015/2016: a 3 year follow-up mixed methods study.

OBJECTIVES: To determine current tobacco use in 2018/2019, quit attempts made and to explore the enablers and barriers in quitting tobacco among tobacco users identified in the Tamil Nadu Tobacco Survey (TNTS) in 2015/2016. SETTING: TNTS was conducted in 2015/2016 throughout the state of Tamil Nadu (TN) in India covering 111 363 individuals. Tobacco prevalence was found to be 5.2% (n=5208). PARTICIPANTS: All tobacco users in 11 districts of TN identified by TNTS (n=2909) were tracked after 3 years by telephone. In-depth interviews (n=26) were conducted in a subsample to understand the enablers and barriers in quitting. PRIMARY AND SECONDARY OUTCOMES: Current tobacco use status, any quit attempt and successful quit rate were the primary outcomes, while barriers and enablers in quitting were considered as secondary outcomes. RESULTS: Among the 2909 tobacco users identified in TNTS 2015/2016, only 724 (24.9%) could be contacted by telephone, of which 555 (76.7%) consented. Of those who consented, 210 (37.8%) were currently not using tobacco (ie, successfully quit) and 337 (60.7%) continued to use any form of tobacco. Of current tobacco users, 115 (34.1%) have never made any attempt to quit and 193 (57.3.8%) have made an attempt to quit. Those using smoking form of tobacco products (adjusted relative risk (aRR)=1.2, 95% CI: 1.1 to 1.4) and exposure to smoke at home (aRR=1.2, 95% CI: 1.1 to 1.3) were found to be positively associated with continued tobacco use (failed or no quit attempt). Support from family and perceived health benefits are key enablers, while peer influence, high dependence and lack of professional help are some of the barriers to quitting. CONCLUSION: Two-thirds of the tobacco users continue to use tobacco in the last 3 years. While tobacco users are well aware of the ill-effects of tobacco, various intrinsic and extrinsic factors play a major role as a facilitator and lack of the same act as a barrier to quit.

Long-Term Functional and Oncological Outcomes Following Intersphincteric Resection for Low Rectal Cancers.

Surgery for low rectal cancer often involves a permanent stoma. Intersphincteric resection (ISR) with colo-anal anastomosis is a valuable sphincter sparing surgical procedure that avoids the need for permanent stoma in patients with low rectal cancer. The aim of this study was to analyze the long-term functional and oncological outcomes following ISR. This was a retrospective analysis of patients with low rectal cancer who underwent ISR with colo-anal anastomosis in our institution between 2007 and 2015. All patients had a diversion stoma. Bowel function outcomes were assessed prospectively using Wexner incontinence score, low anterior resection syndrome score (LARS), and the Cancer Institute Quality of Life (QoL) questionnaire. The histological reports were reviewed to assess the oncological adequacy of the surgery. Patterns of recurrence and survival were analyzed in this group of patients. Thirty-three patients who underwent an ISR were eligible for this study. Laparoscopic resection was performed in five patients. All the patients received neoadjuvant chemoradiation except the two who received short course radiation and one who did not receive any neoadjuvant treatment. The median distance from the anal verge to the distal edge of the tumor was 3 cm (range 1.5-5 cm). Distal resection margins and circumferential resection margins were negative in all the patients. The 30-day post-operative mortality rate was 3.03%. In 20 patients with a median follow-up of 48 months, the 3-year overall survival was 95%. One patient had recurrence in the para-aortic nodes. No patient had a local recurrence. Bowel function was assessed in 18 patients who had a minimum stoma free period of 1 year. After a median of 43 months following stoma closure, the median Wexner score was 3.56 (range 0-19), median LARS score was 4.78 (range 0-33), and the mean Cancer Institute QoL score was 151.56 ± 15.741. The QoL was average to very high with an overall acceptable quality of life. In this study, ISR was associated with acceptable long-term functional and oncological outcomes. It can be considered as a safe alternative to a permanent stoma in selected patients with low rectal cancer.

Symptom Burden and Quality of Life Issues among Patients of Chronic Myeloid Leukemia on Long-term Imatinib Therapy.

BACKGROUND: Tyrosine kinase inhibitors such as imatinib have improved survival in chronic myeloid leukemia (CML). Imatinib can cause chronic side effects which are not considered serious but can impact the quality of life (QoL) of the patient. METHODS: The results of a detailed symptom burden analysis and its impact on QoL scores in a cohort of patients on long-term imatinib is presented in this study. Symptom burden was assessed using the M. D. Anderson Symptom Inventory specific for CML patients. An indigenously developed QoL questionnaire (Cancer Institute Quality of Life II) was administered simultaneously. RESULTS: Of 221 patients of CML (M:F = 133:88; median age: 39 years [18-65], median duration of imatinib: 4 years), QoL scores were high in 46%, average in 39%, and low in 14%. QoL scores were negatively correlated with general symptoms (r = -0.612, P < 0.001), CML-specific symptoms (r = -0.513, P < 0.001), and interference of symptoms (r = -0.596, P < 0.001). CONCLUSIONS: Significant impairment of QoL was noted among patients with CML primarily due to the burden of symptom related to side effects of imatinib. This issue must be addressed both in the clinic as well as in all studies of CML.

Validation of the symbolic assessment of fatigue extent (SAFE)-a cancer fatigue tool with visual response formats.

CONTEXT: Fatigue is the most common under-recognized symptom in cancer. Administering fatigue tools in multi-lingual and multi-literate populations may affect the quality and accuracy of the data collected as they rely on language to elicit responses. AIM: The aim of the study is to develop and validate a tool to assess fatigue in cancer patients using response formats that are not language-dependent. METHODS: The content validity of the tool was established using the Delphi procedure and was field tested with 102 cancer patients. Test-retest reliability of the tool was tested with 55 cancer patients and 47 healthy individuals. Convergent, concurrent, and discriminant validity and internal consistency were established with 374 cancer patients, 202 survivors, and 75 healthy controls. STATISTICAL ANALYSIS: Qualitative analyses, descriptive statistics, product-moment correlation, analysis of variance, Cronbach's α coefficient, and exploratory factor analysis were conducted. RESULTS: The Cronbach's alpha of the SAFE in cancer patients and healthy individuals was .86 and .92, and their test-retest reliability ranged from .44 to .83. SAFE correlated significantly with measures of quality of life (QOL) (r = -0.54, p < .01), anxiety (r = 0.54, p < .01), depression (r = 0.5, p < .01), and sleep (r = 0.52, p < .01). The tool was able to distinguish between cancer patients, survivors, and healthy controls (p < .05). Two factors emerged namely "Fatigue Extent and impact" and "General fatigue" contributing to 52% of the variance in fatigue. CONCLUSION: A symbolic tool using visual response formats to assess fatigue and its impact in cancer patients was developed and standardized with good reliability and construct, concurrent, and discriminant validity established.

Comprehensive Evaluation of Adherence to Therapy, Its Associations, and Its Implications in Patients With Chronic Myeloid Leukemia Receiving Imatinib.

BACKGROUND: Adherence to oral therapy over a long period is important for optimal outcomes in chronic myeloid leukemia (CML). METHODS: Patients in the chronic phase of CML (taking imatinib for ≥ 6 months) were assessed by the 8-item Morisky Medication Adherence Scale and European Organisation for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire (C30 and CML 24). Patients were classified as adherent (score 8) and nonadherent (score ≤ 7) as per the 8-item Morisky Medication Adherence Scale. RESULTS: Among 221 patients (male to female ratio = 133:88; median age, 39 (18-65) years; median duration of imatinib, 4 years), the nonadherence rate was 55% (N = 122/221). None of the demographic parameters, including occupation, education status, income, and availability of caregiver, were associated with nonadherence. QoL scores, especially the symptom scores associated with side effects of imatinib, significantly differed between adherent and nonadherent patients. Multivariate analysis revealed global health status as the sole predictor of adherent behavior (odds ratio, 0.978; 95% confidence interval, 0.963-0.994; P = .007). A higher proportion of adherent patients achieved deeper molecular responses. Low QoL was associated with nonadherence to imatinib in patients with CML. CONCLUSIONS: It is likely that increased long-term symptom burden due to side effects of imatinib could contribute to nonadherence. Interventions targeting individual components of QoL may improve adherence and outcomes in CML.

Late effects of treatment in survivors of childhood cancer from a tertiary cancer center in South India.

BACKGROUND: Improved survival after childhood cancer is attributed to intensive, aggressive therapy, adverse sequelae of which can manifest months to years after completion of treatment. There is little information about the late adverse effects of both childhood cancer and its therapy in survivors in India. AIM: To determine the long-term sequelae associated with therapy in childhood cancer survivors attending a tertiary cancer center in India. MATERIALS AND METHODS: We studied 155 consecutive survivors of childhood cancer who were ≤14 years at the time of diagnosis and had completed 3 years of follow-up. The study included a complete history and clinical examination, with specific investigations to detect organ toxicity. Quality of life (QOL) was assessed from responses to a standardized questionnaire. Neurocognitive assessment was carried out in 20 survivors with an adaptation of the revised Wechsler adult intelligence scale for adults and the Malins intelligence scale for children. RESULTS: The late effects included impaired fertility in 38 patients (24.5%), impaired growth pattern in 7 (4.5%), endocrine dysfunction in 7 (4.5%) and second malignancy in 2 (1.2%). Three of the 20 patients assessed had severe neurocognitive impairment. A high QOL was reported by 60% of survivors and an "average" QOL by 38%. CONCLUSION: Our study showed that most survivors had a good QOL and our results will help clinicians to better monitor childhood cancer survivors in countries with limited resources.