Quality of life assessment for patients with chronic conditions is very essential since they are prone to many changes in their lives after getting diagnosed. Children are a vulnerable group and significantly affected by their chronic conditions. The impact of the change in their lives affects not only the child, but the whole family. Our study included three groups of children with different chronic conditions. Initially, it was thought that children with cancer would have the lowest levels of quality of life, but after the completion of the study, it was found that thalassemic children were the lowest. Authors think that this could be explained as follow. Children with thalassemia had their siblings may also have the same disease, which may be a contributory factor to affect their quality of life. On the other hand, children with cancer are sometimes offered treatment outside Gaza Strip. This, in turn, may help them to live better. Children undergoing hemodialysis spent a lot of time connected to dialysis machine. This must be taken into account since this affects these children lives.
Results showed that parents think that their children had a lower level of quality of life than what child thinks. However, parents were very supportive to their children.
The assessment of quality of life among children included in this study could not be only explained in light of their diseases. Family economic situation was a strong factor to affect child’s assessment scores. Furthermore, the general status in Gaza Strip may also contribute to the low levels of quality of life, in general.
A study conducted in the same settings as ours by Salah M and his colleagues , but limited to pediatric with cancer only, found that most of the participants had a medium level of quality of life with the mean score was 52.53% using Pediatric Quality of Life Inventory (PedsQL 4.0 generic core scale). They recommended to raise awareness among health care professionals on the importance of communication skills. Another study conducted in Egypt, also among children with cancer, in which authors used PedsQL™ 3.0 Cancer Module . They identified long duration of hospital admission, similar to our results, is associated with poorer quality of life. Similar factors were identified to affect thalassemic children in Saudi Arabia . These factors were family income and family history of thalassemia, also similar to our study.
Most literature included only one group of children or compared children with chronic condition to a control group. Thalassemic children were included in many regional studies. In Qatar, 40 children aged 14–18 diagnosed with thalassemia major were assessed using PedsQL™ 4.0 generic core scale. Those children had significantly lower levels of quality of life compared to healthy matched children . A meta-analysis of 26 studies in which thalassemic children were targeted concluded that thalassemia adversely affects health-related quality of life of these children. Furthermore, quality of life should be considered as an essential part of overall health assessment of these patients .
Children with cancer were the main focus of most of studies worldwide. A cross-sectional study involved 150 children aged between 7–18 years without mental illness . The study found that children aged 16–18 reported lower school functioning but more sleep and fatigue. By contrast to our study, increasing years since diagnosis was associated with better quality of life. On the other side, some studies assessed the effect of caregivers’ distress on health-related quality of life of children with cancer. It was found that caregivers’ distress is an important factor in poor health-related quality of life among children with cancer .
Quality of life is an important aspect in any patient with chronic condition. This aspect is not well-addressed among children undergoing hemodialysis. However, it is assessed among some other chronic renal conditions and among children with renal transplant. Splinter et al. assessed health-related quality of life among three groups of children with different modalities of treatment (preemptive transplant, non-preemptive transplant, and dialysis) . Apart from treatment modality, all children had significantly lower mean scores and consequently higher proportions of impaired health-related quality of life on almost all domains compared to the healthy norm and other chronic health conditions. A new determinant was identified to affect quality of life was the presence of another comorbidity. Children with chronic kidney disease (CKD) suffer from poor quality of life as years pass. This was concluded by Dotis J et al.  following the assessment of 55 children with CKD. They used Greek version of the KIDSCREEN-52 multidimensional questionnaire in children with renal transplant, CKD and a control group. Children in the case group suffered mostly in the physical scale compared to control group.
Thus, to the best of our knowledge, this is the first study to compare quality of life among three different groups of children with chronic conditions.