Background: Children with cancer experience decreased quality of life. The National Institutes of Health has recommended examination of quality of life factors to promote development of clinical interventions to reduce suffering. Measuring quality of life in children based on self-report instruments is limited by subjectivity, age, and developmental stage. Assessment of posture is a pioneering objective physical measure that may augment quality of life preceptions among individuals with cancer. Procedure: This systematic literature review synthesized published evidence regarding the relationship between posture and quality of life. A systematic search using PRISMA guidelines identified articles describing studies of human subjects that included the variables of a) posture measured by the standard thoracic kyphosis angle; and b) quality of life or depression/mood. A total of 14 eligible studies met inclusion criteria (published 2000-2018). Studies were graded for level of evidence and themes were identified. Results: No studies were found in children with cancer. The majority of the studies (8 of 14) were rated at the moderate level. Key review findings include evidence supporting: 1) a consistent bidirectional relationship between posture and quality of life; 2) that when posture improves, quality of life also increases; and when depression decreases, posture improves; and 3) emotion is expressed through posture. Conclusion: If posture is a sensitive and precise measure of quality of life, it could strengthen existing measurements and give a more complete picture to in turn identify children who may benefit from supportive care interventions during cancer treatment.

Symptom distress and decreased quality of life (QOL) among children with cancer are well documented. Research is emerging on the child’s voice in QOL-symptom reports, but existing QOL questionnaires are burdensome and objective biologic markers are lacking. We examined children’s symptoms and QOL from parent and child perspectives and compared the results to one biologic marker (body posture). A cross-sectional secondary analysis of prospective data from children receiving creative arts therapy explored potential associations among demographics with and between QOL measures (PedsQL, Faces Scale, posture). Children (n = 98) ranged in age from 3-17 years (M = 7.8) and were in the first year of cancer treatment. No significant associations were found among the child’s sex, race/ethnicity, socioeconomic status (SES), or distance from hospital and total PedsQL. Older age was associated with worse total PedsQL, pain, nausea, worry, and posture (all ps < .05). Greater worry (β = 0.51) and worse posture (β = 0.41) were the QOL variables most strongly correlated with older age. Poorer posture was associated with worse child PedsQL (total score, nausea, treatment anxiety, cognitive) and parent PedsQL (pain, nausea). Worse scores on the Faces Scale, PedsQL, and posture were all correlated (rs = .21 - .39, all ps < .05). Interventions to improve QOL could target nausea, worry, and older patients. Accuracy and interpretation of symptom distress in children is problematic. The Faces Scale and posture may be suitable, readily obtained measures of QOL in pediatric oncology that hold promise.