Family resilience and health-related quality of life in children with malignant bone tumors: implications for pediatric oncology nursing

BackgroundPediatric malignant bone tumors impose substantial physical and psychosocial burdens that may compromise health-related quality of life (HRQOL) for both children and caregivers. Family resilience may be protective, yet dyadic evidence in pediatric bone tumor care remains limited.MethodsThis cross-sectional study was conducted at Shanghai General Hospital between May 2023 and July 2024. A total of 134 pediatric patients with malignant bone tumors and their primary caregivers were recruited. Family resilience was assessed using the Chinese version of the Family Resilience Assessment Scale (FRAS). Child health-related quality of life (HRQOL) was assessed using the Pediatric Quality of Life Inventory (PedsQL) 3.0 Cancer Module (child self-report and caregiver proxy-report). Demographic and clinical data were collected from medical records and caregiver reports. Statistical analyses included descriptive statistics, Pearson correlations, and multilevel linear modeling in an Actor, Partner Interdependence Model (APIM) framework, performed using IBM SPSS Statistics version 21.0.ResultsChild HRQOL self-reports were available for 95 children, and caregiver proxy-reports were available for all children (n = 134). Family resilience was positively correlated with child self-reported HRQOL (r = 0.661, p < 0.001) and caregiver proxy-reported child HRQOL (r = 0.615, p < 0.001), and child self-reported and caregiver proxy-reported HRQOL were highly correlated among paired cases (r = 0.899, p < 0.001; n = 95). In adjusted multilevel models, family resilience predicted higher child HRQOL in both the self-report model (B = 0.646, p < 0.001; n = 95) and the proxy-report model (B = 0.627, p < 0.001; n = 134).ConclusionFamily resilience was independently associated with HRQOL in pediatric malignant bone tumor dyads. Given the cross-sectional design, causality cannot be inferred; however, family resilience may represent a clinically relevant psychosocial correlate of HRQOL and a potential focus for supportive care. Longitudinal and interventional studies are warranted to clarify directionality and evaluate resilience-oriented supportive approaches.