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von Sadovszky V, Christensen E, Jennings BM, Miller S, Hosley S, Drought L, Lenz ER. A systematic review of pediatric self-report symptom measures: Congruence with the theory of unpleasant symptoms. J SPEC PEDIATR NURS 2018; 23:e12215. [PMID: 29603611 DOI: 10.1111/jspn.12215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/15/2018] [Accepted: 02/24/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Many children and adolescents experience unpleasant symptoms due to acute and chronic illnesses. Several symptom measures specific to children and adolescents are available to assess unpleasant symptoms. What is unclear is how well these measures assess all dimensions of the symptom experience. Using the Theory of Unpleasant Symptoms (TOUS) as a guide, the purpose of this systematic review of self-report symptom measures was to examine the comprehensiveness of current symptom measures designed to assess children's and adolescents' symptom experiences. CONCLUSIONS The TOUS did not guide the development of any of the measures studied; hence, exact parallels were not expected. Currently, no pediatric self-report symptom measures were found that assessed all dimensions of the symptom experience. Four measures captured three dimensions: intensity, timing, and distress. Only two measures assessed quality. PRACTICE IMPLICATIONS Practitioners need to be aware of the dimensions reflected in commonly used symptom measures. Augmentation of these measures is needed in order to assess the entire symptom experience in children and adolescents.
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Affiliation(s)
| | | | | | - Susi Miller
- Nationwide Children's Hospital, Columbus, OH, USA
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102
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Johnston DL, Hyslop S, Tomlinson D, Baggott C, Gibson P, Orsey A, Dix D, Price V, Vanan M, Portwine C, Kuczynski S, Spiegler B, Tomlinson GA, Dupuis LL, Sung L. Describing symptoms using the Symptom Screening in Pediatrics Tool in hospitalized children with cancer and hematopoietic stem cell transplant recipients. Cancer Med 2018; 7:1750-1755. [PMID: 29573197 PMCID: PMC5943541 DOI: 10.1002/cam4.1433] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/05/2018] [Accepted: 02/17/2018] [Indexed: 01/26/2023] Open
Abstract
Objectives were to describe any bothersome symptom and severely bothersome symptoms in inpatient children with cancer and hematopoietic stem cell transplant (HSCT) recipients. We included children 8–18 years of age with cancer or HSCT recipients who were receiving active treatment for cancer, admitted to hospital, and expected to be in hospital 3 days later. We administered the self‐report Symptom Screening in Pediatrics Tool (SSPedi). We described those who identified any degree of symptom bother (at least “a little”) and those who rated the degree of bother as severe (“a lot” or “extremely”). Factors associated with severe symptoms and total SSPedi scores were examined using multiple logistic and linear regression. Among the 302 patients, 298 (98.7%) reported having any bothersome symptom and 181 (59.9%) had at least one severely bothersome symptom. In multiple regression, older children were significantly more likely to have at least one severely bothersome symptom (15–18 and 11–14 years vs. 8–10 years; P = 0.008) and to have higher total SSPedi scores (P = 0.0003). Those with relapsed disease were more likely to have at least one severely bothersome symptom (odds ratio 2.1, 95% confidence interval 1.1–4.3; P = 0.037) and HSCT recipients were more likely to have higher symptom scores (β = 3.48, standard error = 1.6; P = 0.030). Almost all children receiving cancer therapies experience bothersome symptoms and 60% have at least one severely bothersome symptom. Older children experienced more severely bothersome symptoms and higher symptom scores. Future studies should follow children longitudinally to better understand the symptom trajectory and should institute interventions to manage symptoms.
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Affiliation(s)
- Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Shannon Hyslop
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Christina Baggott
- Pediatric Hematology/Oncology, Stanford University Cancer Clinical Trials Office, 800 Welch Road, MC 5757, Palo Alto, California, 94305
| | - Paul Gibson
- Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Andrea Orsey
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, Connecticut, 06106
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, BC Children's Hospital, 4480 Oak Street Room B315, Vancouver, British Columbia, V6H 3V4, Canada
| | - Vicky Price
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Magimairajan Vanan
- Departments of Pediatrics & Child Health and Biochemistry & Medical Genetics, Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Research Institute in Oncology and Hematology, University of Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Carol Portwine
- Division of Haematology/Oncology, McMaster Children's Hospital, Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Laura Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.,Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
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103
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Management of fatigue in children and adolescents with cancer and in paediatric recipients of haemopoietic stem-cell transplants: a clinical practice guideline. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:371-378. [PMID: 30169270 DOI: 10.1016/s2352-4642(18)30059-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 12/29/2022]
Abstract
Fatigue is a prevalent and distressing symptom in children and adolescents with cancer and in those who have undergone haemopoietic stem-cell transplantation. A multidisciplinary and multinational group of experts in paediatric oncology and fatigue, together with patient advocates, developed a clinical practice guideline for management of fatigue on the basis of systematic reviews that included six paediatric and 456 adult randomised studies. We used the Grading of Recommendations Assessment, Development and Evaluation approach to generate recommendations, and made strong recommendations, supported by evidence of moderate quality, for use of physical activity, relaxation, and mindfulness to reduce fatigue. When these approaches are unsuccessful or not feasible, cognitive or cognitive behavioural therapies may be offered (weak recommendation supported by evidence of moderate quality). Maturity and cognitive ability of individual patients will affect the feasibility of interventions. Systemic pharmacological approaches should not be routinely used to manage fatigue in children. Apart from identification of optimal approaches to implement recommended interventions in clinical practice, future research should also address knowledge gaps, including establishment of minimum age thresholds for interventions and inclusion of paediatric patients in randomised trials of fatigue management.
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104
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105
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Rosenberg AR, Orellana L, Wolfe J, Dussel V. The Limitations of "How Are You Feeling?". J Pain Symptom Manage 2018; 55:e6-e8. [PMID: 29169994 PMCID: PMC6817576 DOI: 10.1016/j.jpainsymman.2017.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/12/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Abby R Rosenberg
- Seattle Children's Hospital Cancer and Blood Disorders Center, Seattle, Washington, USA; Center for Clinical and Translational Research and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA; Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Boston, Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Veronica Dussel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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106
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Nelson KE, Feinstein JA, Gerhardt CA, Rosenberg AR, Widger K, Faerber JA, Feudtner C. Emerging Methodologies in Pediatric Palliative Care Research: Six Case Studies. CHILDREN-BASEL 2018; 5:children5030032. [PMID: 29495384 PMCID: PMC5867491 DOI: 10.3390/children5030032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 12/17/2022]
Abstract
Given the broad focus of pediatric palliative care (PPC) on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery.
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Affiliation(s)
- Katherine E Nelson
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
| | - James A Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Children's Hospital Colorado, Aurora, CO 80045, USA.
- Division of General Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH 43210, USA.
| | - Abby R Rosenberg
- Department of Pediatrics, University of Washington School of Medicine; Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98101, USA.
| | - Kimberley Widger
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada.
| | - Jennifer A Faerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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107
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Oberoi S, Robinson PD, Cataudella D, Culos-Reed SN, Davis H, Duong N, Gibson F, Götte M, Hinds P, Nijhof SL, Tomlinson D, van der Torre P, Cabral S, Dupuis LL, Sung L. Physical activity reduces fatigue in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis of randomized trials. Crit Rev Oncol Hematol 2018; 122:52-59. [DOI: 10.1016/j.critrevonc.2017.12.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/02/2017] [Accepted: 12/14/2017] [Indexed: 11/25/2022] Open
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108
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Erdem E, Toruner EK. How Can We Use Symptom Clusters in Nursing Care of Children with Leukemia? Asia Pac J Oncol Nurs 2018; 5:51-56. [PMID: 29379835 PMCID: PMC5763441 DOI: 10.4103/apjon.apjon_57_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The incidence of childhood cancers has been gradually rising worldwide. The rate of leukemia, which is the most common cancer type in childhood, has been increasing as well. In recent years, multiple chemotherapeutic agents, radiotherapy and bone marrow transplantation have been using in leukemia treatment. Children receiving treatment for leukemia may experience many symptoms due to the disease and its treatment. These concurrent symptoms may have a complex relationship. The aim of this paper is to review and compile current literature data related to symptom clusters used to explain multiple symptoms that occur in a complex structure due to leukemia and its treatment. Symptom clustering is used in oncology nursing to explain the complex relationship among multiple symptoms and to find out the effects that symptoms have on each other and patient outcomes. There are generally two statistical approaches to modeling symptom clusters. One is to establish the symptom clusters by grounding on clinical experiences, while the other is to establish them according to the results of statistical analysis and then clinical experiences. With the latter method, symptom clusters can be established more objectively and more number of symptoms can be assessed. In the literature, there are four instruments available for the measurement of a large number of symptoms in children. It is important to increase use of symptom clusters in nursing care for a better understanding of the relationship among multiple symptoms experienced during leukemia treatment, a more effective symptom management, and a more holistic care.
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Affiliation(s)
- Esra Erdem
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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109
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Physical activity barriers, preferences, and beliefs in childhood cancer patients. Support Care Cancer 2018; 26:2177-2184. [DOI: 10.1007/s00520-017-4041-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/28/2017] [Indexed: 12/20/2022]
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110
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111
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Johnston K, Deliva R, Evans C. Mobilization patterns of children on a hematology/oncology inpatient ward. Pediatr Blood Cancer 2017; 64. [PMID: 28409889 DOI: 10.1002/pbc.26552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children being treated for cancer are admitted to the hospital for treatment of their disease or complications of therapy. Periods of bed rest during hospitalization can cause impairments detrimental to children with cancer who endure many side effects of therapy. Little is known about how these children mobilize while admitted to the hospital. The purpose of this study was to examine how children admitted to a hematology/oncology ward are mobilizing and analyze factors associated with delayed or infrequent mobility. PROCEDURE A retrospective chart review was conducted on 228 charts with data recorded on documented mobilization and referrals to physiotherapy. Primary outcome was related to mobility including timing, frequency, type, and nature of mobilization. RESULTS Almost half of children (43%) mobilized between 3 and 5 days per week, with median time to first mobilization being 2 days (interquartile range 1-3). Caregivers assisted with mobilization 91% of the time. Children isolated to their room and those reporting fever had a statistically significant decrease in the percent of admission days involving mobilization (mean difference 15 and 8%, respectively) than those not isolated and without fever. Children who were isolated also mobilized 1 day later (P = 0.016) than children who were not isolated. Percentage of time in isolation was positively correlated with timing (P = 0.04) and negatively correlated with frequency of mobilization (P < 0.001). CONCLUSION Most children admitted to the hospital for treatment of oncologic or hematologic conditions were noted to mobilize early, but frequency of mobilization could be improved. Periods of time in isolation appear to negatively affect mobilization.
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Affiliation(s)
- Krista Johnston
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robin Deliva
- Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cathy Evans
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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112
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Pinheiro LC, McFatrich M, Lucas N, Walker JS, Withycombe JS, Hinds PS, Sung L, Tomlinson D, Freyer DR, Mack JW, Baker JN, Reeve BB. Child and adolescent self-report symptom measurement in pediatric oncology research: a systematic literature review. Qual Life Res 2017; 27:291-319. [PMID: 28879501 DOI: 10.1007/s11136-017-1692-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Previous work in pediatric oncology has found that clinicians and parents tend to under-report the frequency and severity of treatment-related symptoms compared to child self-report. As such, there is a need to identify high-quality self-report instruments to be used in pediatric oncology research studies. This study's objective was to conduct a systematic literature review of existing English language instruments used to measure self-reported symptoms in children and adolescents undergoing cancer treatment. METHODS A comprehensive literature search was conducted in MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO to identify relevant articles published through November 10, 2016. Using pre-specified inclusion/exclusion criteria, six trained reviewers carefully screened abstracts and full-text articles for eligibility. RESULTS There were 7738 non-duplicate articles identified in the literature search. Forty articles met our eligibility criteria, and within these articles, there were 38 self-report English symptom instruments. Most studies evaluated only cross-sectional psychometric properties, such as reliability or validity. Ten studies assessed an instrument's responsiveness or ability to detect changes in symptoms over time. Eight instruments met our criteria for use in future longitudinal pediatric oncology studies. CONCLUSIONS This systematic review aids pediatric oncology researchers in identifying and selecting appropriate symptom measures with strong psychometric evidence for their studies. Enhancing the child's voice in pediatric oncology research studies allows us to better understand the impact of cancer and its treatment on the lives of children.
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Affiliation(s)
- Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10064, USA.
| | - Molly McFatrich
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nicole Lucas
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Walker
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Department of Pediatrics, George Washington University, Washington, DC, USA
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Deborah Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - David R Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Bryce B Reeve
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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113
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Nunes MDR, Jacob E, Bomfim EO, Lopes-Junior LC, de Lima RAG, Floria-Santos M, Nascimento LC. Fatigue and health related quality of life in children and adolescents with cancer. Eur J Oncol Nurs 2017; 29:39-46. [PMID: 28720264 PMCID: PMC5573875 DOI: 10.1016/j.ejon.2017.05.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 04/05/2017] [Accepted: 05/02/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The study examined the different dimensions of fatigue (general, sleep/rest, cognitive), health related quality of life (HRQL) (physical, emotional, cognitive, social), and the relationships between fatigue and HRQL in hospitalized children and adolescents with cancer in Brazil. METHOD Participants were recruited from a pediatric oncology inpatient unit in a comprehensive cancer care hospital in southeast Brazil. They completed the PedsQL Multidimensional Fatigue Scale and the PedsQL Inventory of Quality of Life (Generic and Cancer module) once during hospitalization. RESULTS The majority (66.7%) of the participants (n = 38; mean age 12.1 ± 2.9 years) had total fatigue scores < 75 on 0 to 100 scale; with the mean total fatigue score of 63.8 ± 18.5. The majority (72.2% generic; 83.3% cancer modules) had total PedsQL scores < 75 on 0 to 100 scale. The mean PedsQL score on generic module (61.1 ± 17.0) was similar to the mean PedsQL score cancer module (59.1 ± 16.7). Significant correlations were found between total fatigue and quality of life generic (r = 0.63, p = 0.000) and cancer module (r = 0.74, p = 0.000). CONCLUSIONS The study is the first to report fatigue and health related quality of life in hospitalized children and adolescents with cancer in Brazil. Similar to experiences of other children in the world, our findings indicate that children and adolescents with cancer had problems with fatigue that were associated with low HRQL. Future studies are recommended to examine interventions (exercise, leisurely activities) that may alleviate fatigue and improve HRQL in pediatric patients with cancer.
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Affiliation(s)
| | - Eufemia Jacob
- University of California Los Angeles, School of Nursing, 700 Tiverton Avenue, Factor Building, Rm 5-942 Los Angeles, CA, USA.
| | - Emiliana Omena Bomfim
- University of Saskatchewan at College of Medicine, 107 Wiggins Road, Saskatoon, SK, Canada.
| | - Luis Carlos Lopes-Junior
- University of São Paulo at Ribeirão Preto College of Nursing, Bandeirantes Avenue, 3900, Ribeirão Preto, 14040-902 SP, Brazil.
| | - Regina Aparecida Garcia de Lima
- University of São Paulo at Ribeirão Preto College of Nursing, Bandeirantes Avenue, 3900, Ribeirão Preto, 14040-902 SP, Brazil.
| | - Milena Floria-Santos
- University of São Paulo at Ribeirão Preto College of Nursing, Bandeirantes Avenue, 3900, Ribeirão Preto, 14040-902 SP, Brazil.
| | - Lucila Castanheira Nascimento
- University of São Paulo at Ribeirão Preto College of Nursing, Bandeirantes Avenue, 3900, Ribeirão Preto, 14040-902 SP, Brazil.
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114
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Bhardwaj T, Koffman J. Non-pharmacological interventions for management of fatigue among children with cancer: systematic review of existing practices and their effectiveness. BMJ Support Palliat Care 2017; 7:404-414. [PMID: 28760817 DOI: 10.1136/bmjspcare-2016-001132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/06/2017] [Accepted: 06/26/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Fatigue is common among children living with cancer, particularly in advance stages. Little is known about the effectiveness of non-pharmacological approaches to manage this complex and distressing symptom among children. Thus, the present paper aim to critically examine the effectiveness and setting for non-pharmacological interventions to manage fatigue among children with cancer. METHODS Six electronic databases were screened first in February 2013 and at second instance in March 2015. They include PsycINFO, Medline, EMBASE, CINAHL, Scopus and Cochrane library. All databases were systematically searched for literature on fatigue and cancer, limited to children (as age group) and English language. RESULTS 1498 articles were identified, of which six were reviewed. Three types of interventions for managing fatigue were identified including (1) complementary and alternative medicine (healing touch/massage therapy), (2) exercise-based interventions and (3) nursing-based interventions. Most interventions were delivered during active treatment and in hospital settings where parents were involved to optimise participation. Despite fatigue scores being lower among intervention groups, no study findings were observed as being statistically significant. CONCLUSION Fatigue is common among children treated for and living with cancer. The most appropriate setting to deliver non-pharmacological interventions to manage fatigue appears to be in hospital. However, in absence of any strong evidence, professionals need to be cautious about existing non-pharmacological interventions. Future research must adopt more rigorous research designs that are adequately powered using validated measures to identify potential benefits. In addition, researchers may wish to test psychosocial interventions shown to be of benefit in adults.
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Affiliation(s)
- Tushti Bhardwaj
- Department of Social Work, Dr B R Ambedkar College, University of Delhi, Yamuna Vihar, Delhi, India
| | - Jonathan Koffman
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
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115
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Linder LA, Erickson JM, Stegenga K, Macpherson CF, Wawrzynski S, Wilson C, Ameringer S. Symptom self-management strategies reported by adolescents and young adults with cancer receiving chemotherapy. Support Care Cancer 2017; 25:3793-3806. [PMID: 28718079 DOI: 10.1007/s00520-017-3811-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Adolescents and young adults (AYAs) with cancer experience multiple symptoms related to their cancer and its treatment which can negatively impact their development and quality of life. An understanding of the strategies AYAs use to self-manage their symptoms is limited. This study described symptom self-management strategies reported by AYAs with cancer using an iPad-based symptom heuristics tool, the Computerized Symptom Capture Tool. METHODS The study used a cross-sectional, descriptive design. AYAs' free text responses relating their symptom self-management strategies were explored using qualitative content analysis procedures. Strategies were examined overall and by individual symptoms. RESULTS Seventy-two AYAs 13-29 years of age (mean 18.4 years) reported a total of 772 symptom self-management codes for 585 individual symptoms. These codes were organized into 119 distinct categories. These categories were further organized into 16 subthemes and 3 overarching themes: "Things I Take … or Not" (n = 209 codes), "Physical Care Things I Do" (n = 367 codes), and "Psychosocial Care Things I Do" (n = 132 codes). AYAs frequently reported strategies from all three of the symptom self-management themes to manage individual symptoms; however, "medications" was the most frequently reported strategy. CONCLUSION AYAs receiving chemotherapy use multiple common, yet uniquely individual symptom self-management strategies. AYAs' reported strategies range from those that involve shared management with a healthcare provider to those that AYAs implement independently. The study provides a foundation for future research to empower AYAs to engage in symptom self-management and to guide healthcare providers as they discuss developmentally relevant and evidence-based symptom self-management strategies.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah and Cancer Transplant Center, Primary Children's Hospital, Salt Lake City, UT, USA.
| | - Jeanne M Erickson
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | | | - Sarah Wawrzynski
- College of Nursing, University of Utah and Pediatric Critical Care Services, Primary Children's Hospital, Salt Lake City, UT, USA
| | | | - Suzanne Ameringer
- College of Nursing, Virginia Commonwealth University, Richmond, VA, USA
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Sodergren SC, Husson O, Robinson J, Rohde GE, Tomaszewska IM, Vivat B, Dyar R, Darlington AS. Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer. Qual Life Res 2017; 26:1659-1672. [PMID: 28251543 PMCID: PMC5486886 DOI: 10.1007/s11136-017-1520-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment. METHODS MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted. RESULTS 166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life. CONCLUSION The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.
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Affiliation(s)
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jessica Robinson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Gudrun E Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Bella Vivat
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, UK
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Chokshi SK, Ladas EJ, Taromina K, McDaniel D, Rooney D, Jin Z, Hsu WC, Kelly KM. Predictors of acupuncture use among children and adolescents with cancer. Pediatr Blood Cancer 2017; 64. [PMID: 28176457 DOI: 10.1002/pbc.26424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/28/2016] [Accepted: 11/15/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Evidence for the application of acupuncture in pediatric oncology is limited. We investigated the acceptance of acupuncture and factors associated with its use among children and adolescents with cancer. METHODS Ninety acupuncture-naïve children receiving cancer treatment at Columbia University Medical Center (CUMC) provided consent/assent for participation. Participants could choose to receive or refuse integrative services offered at CUMC. Symptoms were collected for a 6-month period with the Memorial Symptom Assessment Scale (MSAS). Acute and delayed adverse events among participants who received acupuncture were recorded. RESULTS Fifty-four percent of the participants elected to receive acupuncture. In total, 252 acupuncture sessions were administered with a median of four sessions per patient (range 1-13 sessions). Pain (56%), nausea (51%), lack of energy (50%), and irritability (43%) were the most frequently reported symptoms in the whole cohort. Determinants of acupuncture use included older age and ethnicity. Acupuncture was more likely than other integrative modalities to be used for gastrointestinal and constitutional symptoms including drowsiness (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.98-5.66; P < 0.0001), lack of energy (OR, 3.23; 95% CI, 1.78-5.87; P = 0.0001), and pain (OR, 2.63; 95% CI, 1.46-4.72; P = 0.001). Adverse events were reported by 3% of the participants. There was no increased incidence of adverse events in children with thrombocytopenia (P = 0.189) or neutropenia (P = 0.497). CONCLUSION Our results highlight the potential use of acupuncture as a safe, adjunctive therapy for symptom management within existing supportive care regimens in pediatric oncology and potential areas to focus research initiatives.
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Affiliation(s)
- Sagar K Chokshi
- Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, New Jersey
| | - Elena J Ladas
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Columbia University Medical Center, New York, New York.,Institute of Human Nutrition, Columbia University Medical Center, New York, New York
| | - Katherine Taromina
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Columbia University Medical Center, New York, New York
| | - Douglas McDaniel
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Columbia University Medical Center, New York, New York
| | - Diane Rooney
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Columbia University Medical Center, New York, New York
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Wei-Chun Hsu
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York
| | - Kara M Kelly
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplant, Columbia University Medical Center, New York, New York
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Maple AM, Call T, Kimmel PC, Hammer RP. Effects of Repeated Ropinirole Treatment on Phencyclidine-Induced Hyperlocomotion, Prepulse Inhibition Deficits, and Social Avoidance in Rats. J Pharmacol Exp Ther 2017; 361:109-114. [PMID: 28167638 PMCID: PMC11047206 DOI: 10.1124/jpet.116.238634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/31/2017] [Indexed: 01/04/2023] Open
Abstract
Phencyclidine (PCP), a noncompetitive N-methyl d-aspartate (NMDA) receptor antagonist, provides the most complete pharmacologic model of schizophrenia in humans and animals. Acute PCP causes hyperlocomotion, disrupts prepulse inhibition (PPI), and increases social avoidance in rats. We have previously shown that repeated treatment with the dopamine (DA) D2-like receptor agonists, quinpirole or ropinirole, prevents agonist-induced PPI disruption. In the present study, we examined whether repeated ropinirole treatment similarly attenuates the effects of PCP in a more complete model of schizophrenia symptoms and examined the effect of repeated D2-like agonist treatment on locomotion, PPI, and social interaction after acute PCP challenge. The acute effect of PCP (3.0 or 6.0 mg/kg) on locomotor activity was examined to establish a minimum effective dose. Thereafter, the effect of PCP challenge (3.0 mg/kg) on locomotor activity, PPI, and social interaction was assessed in adult male rats before or 7-10 days after termination of repeated daily treatment with ropinirole (0.1 mg/kg) or saline vehicle (0.1 ml/kg) for 28 days. Repeated ropinirole treatment attenuates PCP-induced hyperlocomotion, PPI deficits, and social avoidance. These findings suggest that repeated ropinirole treatment might affect a final common pathway that is vulnerable to both PCP- and dopamine agonist-induced behavioral disruption, thereby providing an alternative approach to block the effects of PCP.
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Affiliation(s)
- Amanda M Maple
- Department of Basic Medical Sciences (A.M.M., P.C.K., R.P.H.), and Departments of Pharmacology and Psychiatry (R.P.H.), University of Arizona College of Medicine, Phoenix; and Department of Psychology (A.M.M., P.C.K., R.P.H.) and Interdisciplinary Graduate Program in Neuroscience (T.C., R.P.H.), Arizona State University, Tempe, Arizona
| | - Tanessa Call
- Department of Basic Medical Sciences (A.M.M., P.C.K., R.P.H.), and Departments of Pharmacology and Psychiatry (R.P.H.), University of Arizona College of Medicine, Phoenix; and Department of Psychology (A.M.M., P.C.K., R.P.H.) and Interdisciplinary Graduate Program in Neuroscience (T.C., R.P.H.), Arizona State University, Tempe, Arizona
| | - Phylicia C Kimmel
- Department of Basic Medical Sciences (A.M.M., P.C.K., R.P.H.), and Departments of Pharmacology and Psychiatry (R.P.H.), University of Arizona College of Medicine, Phoenix; and Department of Psychology (A.M.M., P.C.K., R.P.H.) and Interdisciplinary Graduate Program in Neuroscience (T.C., R.P.H.), Arizona State University, Tempe, Arizona
| | - Ronald P Hammer
- Department of Basic Medical Sciences (A.M.M., P.C.K., R.P.H.), and Departments of Pharmacology and Psychiatry (R.P.H.), University of Arizona College of Medicine, Phoenix; and Department of Psychology (A.M.M., P.C.K., R.P.H.) and Interdisciplinary Graduate Program in Neuroscience (T.C., R.P.H.), Arizona State University, Tempe, Arizona
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The Effects of Attention Problems on Psychosocial Functioning in Childhood Brain Tumor Survivors: A 2-Year Postcraniospinal Irradiation Follow-up. J Pediatr Hematol Oncol 2017; 39:e46-e53. [PMID: 28099397 DOI: 10.1097/mph.0000000000000766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the psychosocial outcomes and impact of attention problems in survivors of pediatric brain tumor. STUDY DESIGN The survivors' cognitive functioning was measured using the Wechsler Intelligence Scale for Children. The Child Behavior Checklist-Attention Problems scale was used to screen for attention problems, and participants were classified as having attention problems (n=15) or normal attention (n=36). Psychosocial functioning was examined with the Korean Personality Rating scale for Children (K-PRC) at precraniospinal radiation and at 2-year follow-up. RESULTS The attention problem group showed significantly higher depression and externalizing symptoms (delinquency, hyperactivity) and more significant impairment in family relationships than did the normal attention group at baseline. At follow-up, the attention problem group demonstrated significantly more delinquency and impaired family and social relationships. With the K-PRC scores, except for the somatization, social relationship subscale, there were significant differences between groups, but not in terms of treatment by time interaction or within time. At follow-up, multiple linear regressions showed that age at diagnosis significantly predicted K-PRC somatization (B=-1.7, P=0.004) and social relationships (B=-1.7, P=0.004), baseline full-scale intelligence quotient predicted K-PRC depression (B=-0.4, P=0.032) and somatization (B=-0.3, P=0.015), and attention problems at baseline predicted K-PRC depression (B=-15.2, P=0.036) and social relationships (B=-11.6, P=0.016). CONCLUSION Pediatric brain tumor survivors, in particular, patients with attention problems, had worse psychosocial functioning at baseline and follow-up. Attention problems at baseline need to be carefully evaluated in assessing psychosocial functioning of pediatric brain tumor survivors.
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Reeve BB, McFatrich M, Pinheiro LC, Weaver MS, Sung L, Withycombe JS, Baker JN, Mack JW, Waldron MK, Gibson D, Tomlinson D, Freyer DR, Mowbray C, Jacobs S, Palma D, Martens CE, Gold SH, Jackson KD, Hinds PS. Eliciting the child's voice in adverse event reporting in oncology trials: Cognitive interview findings from the Pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events initiative. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26261. [PMID: 27650708 PMCID: PMC5301979 DOI: 10.1002/pbc.26261] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/25/2016] [Accepted: 08/19/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adverse event (AE) reporting in oncology trials is required, but current practice does not directly integrate the child's voice. The Pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is being developed to assess symptomatic AEs via child/adolescent self-report or proxy-report. This qualitative study evaluates the child's/adolescent's understanding and ability to provide valid responses to the PRO-CTCAE to inform questionnaire refinements and confirm content validity. PROCEDURE From seven pediatric research hospitals, children/adolescents ages 7-15 years who were diagnosed with cancer and receiving treatment were eligible, along with their parent-proxies. The Pediatric PRO-CTCAE includes 130 questions that assess 62 symptomatic AEs capturing symptom frequency, severity, interference, or presence. Cognitive interviews with retrospective probing were completed with children in the age groups of 7-8, 9-12, and 13-15 years. The children/adolescents and proxies were interviewed independently. RESULTS Two rounds of interviews involved 81 children and adolescents and 74 parent-proxies. Fifteen of the 62 AE terms were revised after Round 1, including refinements to the questions assessing symptom severity. Most participants rated the PRO-CTCAE AE items as "very easy" or "somewhat easy" and were able to read, understand, and provide valid responses to questions. A few AE items assessing rare events were challenging to understand. CONCLUSIONS The Pediatric and Proxy PRO-CTCAE performed well among children and adolescents and their proxies, supporting its content validity. Data from PRO-CTCAE may improve symptomatic AE reporting in clinical trials and enhance the quality of care that children receive.
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Affiliation(s)
- Bryce B. Reeve
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Molly McFatrich
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Laura C. Pinheiro
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Meaghann S. Weaver
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | | | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Mia K. Waldron
- Department of Nursing Research and Quality Outcomes, Children’s National Health System, Washington, District of Columbia
| | - Deborah Gibson
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Deborah Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - David R. Freyer
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Catriona Mowbray
- Department of Oncology, Children’s National Health System, Washington, District of Columbia
| | - Shana Jacobs
- Department of Oncology, Children’s National Health System, Washington, District of Columbia
| | - Diana Palma
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Christa E. Martens
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Stuart H. Gold
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Kathryn D. Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Pamela S. Hinds
- Department of Nursing Research and Quality Outcomes, Children’s National Health System, Washington, District of Columbia,Department of Pediatrics, George Washington University, Washington, District of Columbia
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Hovén E, Grönqvist H, Pöder U, von Essen L, Lindahl Norberg A. Impact of a child's cancer disease on parents' everyday life: a longitudinal study from Sweden. Acta Oncol 2017; 56:93-100. [PMID: 27834555 DOI: 10.1080/0284186x.2016.1250945] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A child's cancer disease may disrupt the daily life of the affected family for a long period. The aim was to describe restrictions on parents' leisure activities and work/studies during and after the child's treatment. METHODS This study used data from a cohort of mothers and fathers (n = 246) of children diagnosed with cancer. Data was collected five times from two months after diagnosis to one year after end of treatment. Reports of restrictions were evaluated over time, between mothers and fathers, and in relation to parent-reported child symptom burden (The Memorial Symptom Assessment Scale) and partial post-traumatic stress disorder (PTSD) (The PTSD Checklist-Civilian Version). RESULTS Two (51%) and four (45%) months after diagnosis, about half reported that their leisure activities were restricted at least some of the time. Corresponding percentages for restrictions on work/studies were 84% and 77%. One year after end of treatment, the great majority reported that their leisure activities (91%) and/or work/studies (76%) were never/seldom restricted. During treatment, more mothers than fathers reported restrictions on work/studies all/most of the time. After end of treatment, gender was only related to reports of restrictions among parents not reporting partial PTSD. More parents who reported being restricted all/most of the time also reported partial PTSD and/or a greater symptom burden for the child. CONCLUSION Parents report frequent restrictions on everyday life during treatment. One year after end of treatment, parents report only a limited impact of the child's cancer on their leisure activities and work/studies. More parents who report restrictions also report partial PTSD and/or a greater child symptom burden. The effect of gender on restrictions varies depending on reports of partial PTSD. Future studies of gender differences regarding the impact of a child's cancer on parents' everyday life should thus consider mothers' and fathers' level of psychological distress.
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Affiliation(s)
- Emma Hovén
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Grönqvist
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Pöder
- Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Annika Lindahl Norberg
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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McNamara C, Johnson M, Read L, Vander Velden H, Thygeson M, Liu M, Gandrud L, McNamara J. Yoga Therapy in Children with Cystic Fibrosis Decreases Immediate Anxiety and Joint Pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:9429504. [PMID: 28077950 PMCID: PMC5204083 DOI: 10.1155/2016/9429504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/12/2016] [Accepted: 11/21/2016] [Indexed: 12/17/2022]
Abstract
This study was designed to determine whether yoga might alleviate symptoms of pain, sleep disturbance, anxiety, and depression in children with cystic fibrosis (CF). CF is the most common genetic, life-limiting chronic disease among Caucasian populations. It primarily affects the lungs but also many other secretory organs and consequently leads to significant morbidities. Research has shown that children with CF have significantly increased depression, anxiety, and pain compared to their healthy counterparts. Subjects participated in six one-on-one sessions over a 10-week period with a certified instructor who designed each yoga practice based on a preestablished list of 30 yoga asanas. Questionnaires evaluating pain, sleep disturbance, sustained anxiety, immediate anxiety, and depression were administered. Differences between premeasures and postmeasures were evaluated using a two-sided test. Twenty subjects were assessed (12 females/8 males), median age of 11 (7-20) years. Mean immediate anxiety scores decreased (before session to after session 29 to 23.6, respectively, p < 0.001). Joint pain improved (3.25 to 3.65, p = 0.028). CFQ-R emotion subscale improved from 79.2 to 85 (p = 0.073), and the respiratory subscale improved from 66.7 to 79.2 (p = 0.076). Other results were less notable. We conclude that yoga may reduce immediate anxiety and joint pain in patients with CF.
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Affiliation(s)
| | - Mahrya Johnson
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Lisa Read
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | - Megan Thygeson
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Meixia Liu
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Laura Gandrud
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - John McNamara
- Children's Respiratory and Critical Care Specialists, PA, Minneapolis, MN, USA
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Coombes LH, Wiseman T, Lucas G, Sangha A, Murtagh FE. Health-related quality-of-life outcome measures in paediatric palliative care: A systematic review of psychometric properties and feasibility of use. Palliat Med 2016; 30:935-949. [PMID: 27247087 PMCID: PMC5117129 DOI: 10.1177/0269216316649155] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The number of children worldwide requiring palliative care services is increasing due to advances in medical care and technology. The use of outcome measures is important to improve the quality and effectiveness of care. AIM To systematically identify health-related quality-of-life outcome measures that could be used in paediatric palliative care and examine their feasibility of use and psychometric properties. DESIGN A systematic literature review and analysis of psychometric properties. DATA SOURCES PsychInfo, Medline and EMBASE were searched from 1 January 1990 to 10 December 2014. Hand searches of the reference list of included studies and relevant reviews were also performed. RESULTS From 3460 articles, 125 papers were selected for full-text assessment. A total of 41 articles met the eligibility criteria and examined the psychometric properties of 22 health-related quality-of-life measures. Evidence was limited as at least half of the information on psychometric properties per instrument was missing. Measurement error was not analysed in any of the included articles and responsiveness was only analysed in one study. The methodological quality of included studies varied greatly. CONCLUSION There is currently no 'ideal' outcome assessment measure for use in paediatric palliative care. The domains of generic health-related quality-of-life measures are not relevant to all children receiving palliative care and some domains within disease-specific measures are only relevant for that specific population. Potential solutions include adapting an existing measure or developing more individualized patient-centred outcome and experience measures. Either way, it is important to continue work on outcome measurement in this field.
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Affiliation(s)
- Lucy H Coombes
- Caroline Menez Research Team, Oak Centre for Children and Young People, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Theresa Wiseman
- Applied Health Research Team, The Royal Marsden NHS Foundation Trust, London, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Grace Lucas
- Applied Health Research Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Amrit Sangha
- Applied Health Research Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Fliss Em Murtagh
- Department of Palliative Care, Policy & Rehabilitation, Faculty of Life Sciences and Medicine, Cicely Saunders Institute, King's College London, London, UK
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Rodgers C, Hooke MC, Ward J, Linder LA. Symptom Clusters in Children and Adolescents with Cancer. Semin Oncol Nurs 2016; 32:394-404. [DOI: 10.1016/j.soncn.2016.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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125
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Allen JM, Graef DM, Ehrentraut JH, Tynes BL, Crabtree VM. Sleep and Pain in Pediatric Illness: A Conceptual Review. CNS Neurosci Ther 2016; 22:880-893. [PMID: 27421251 PMCID: PMC6492850 DOI: 10.1111/cns.12583] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep disruption is a common comorbidity of pediatric pain. Consequences of pain and disrupted sleep, evidence for the pain-sleep relation, and how aspects of illness, treatment, and pharmacological pain management may contribute to or exacerbate these issues are presented. AIMS This conceptual review explored the relation between pain and sleep in children diagnosed with chronic medical or developmental conditions. The goal of this review is to expand upon the literature by examining common themes in sleep disturbances associated with painful conditions across multiple pediatric illnesses. Populations reviewed include youth with intellectual and developmental disabilities (IDD), migraines, cystic fibrosis (CF), sickle cell disease (SCD), cancer, juvenile idiopathic arthritis (JIA), juvenile fibromyalgia (JFM), and functional gastrointestinal disorders (FGIDs). RESULTS Consistent evidence demonstrates that children with medical or developmental conditions are more vulnerable to experiencing pain and subjective sleep complaints than healthy peers. Objective sleep concerns are common but often under-studied. Evidence of the pain-sleep relationship exists, particularly in pediatric SCD, IDD, and JIA, with a dearth of studies directly examining this relation in pediatric cancer, JFM, CF, and FGIDs. Findings suggest that assessing and treating pain and sleep disruption is important when optimizing functional outcomes. CONCLUSION It is essential that research further examine objective sleep, elucidate the pain-sleep relationship, consider physiological and psychosocial mechanisms of this relationship, and investigate nonpharmacological interventions aimed at improving pain and sleep in vulnerable pediatric populations.
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Affiliation(s)
- Jennifer M Allen
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Danielle M Graef
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Brooklee L Tynes
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Osenga K, Postier A, Dreyfus J, Foster L, Teeple W, Friedrichsdorf SJ. A Comparison of Circumstances at the End of Life in a Hospital Setting for Children With Palliative Care Involvement Versus Those Without. J Pain Symptom Manage 2016; 52:673-680. [PMID: 27693899 DOI: 10.1016/j.jpainsymman.2016.05.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/27/2016] [Accepted: 05/21/2016] [Indexed: 11/16/2022]
Abstract
CONTEXT Specialized pediatric palliative care (PPC) services have become more common in urban pediatric hospital settings, although little is known about palliative care specialist involvement. OBJECTIVES The objective of this study was to compare circumstances before death in children who spent their last days of life in an inpatient pediatric hospital setting, with or without PPC provider involvement during their inpatient stay. METHODS Retrospective chart review of medical records of children for the last inpatient stay that resulted in death at a children's hospital setting between January 2012 through June 2013. The setting was a free-standing, 385-bed tertiary care children's hospital. RESULTS Charts were reviewed for 114 children between 0 and 18 years of age, who were hospitalized for at least 24 hours before their death. Half of the children who died as inpatients were infants (median age five weeks). Children who received an inpatient PPC consult (25% of the sample) experienced 1) a higher rate of pain assessments, 2) better documentation around specific actions to manage pain, 3) greater odds of receiving integrative medicine services, 4) fewer diagnostic/monitoring procedures (e.g., blood gases, blood draws, placements of intravenous lines) in the last 48 hours of life, and 5) nearly eight times greater odds of having a do-not-resuscitate order in place at the time of death. CONCLUSION The integration of a PPC team was associated with fewer diagnostic/monitoring procedures and improved pain management documentation in this study of 114 children who died as inpatients.
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Affiliation(s)
- Kaci Osenga
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - Andrea Postier
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | | | - Laurie Foster
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Wrenda Teeple
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stefan J Friedrichsdorf
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Spathis A, Booth S, Grove S, Hatcher H, Kuhn I, Barclay S. Teenage and Young Adult Cancer-Related Fatigue Is Prevalent, Distressing, and Neglected: It Is Time to Intervene. A Systematic Literature Review and Narrative Synthesis. J Adolesc Young Adult Oncol 2016; 4:3-17. [PMID: 25852970 DOI: 10.1089/jayao.2014.0023] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Cancer-related fatigue in adults has been the subject of considerable recent research, confirming its importance as a common and debilitating symptom, and establishing a number of evidence-based interventions. There has, however, been limited focus on the fatigue suffered by teenagers and young adults with cancer, a group recognized as having unique experiences and developmental needs. We have undertaken a systematic review of the literature to provide a comprehensive overview of studies evaluating fatigue in this younger patient group in order to guide clinical practice and future research. METHOD We searched MEDLINE, EMBASE, PsycINFO, and CINAHL databases for literature containing data relating to any aspect of fatigue in patients aged 13-24 at cancer diagnosis or treatment. RESULTS Sixty articles were identified, of which five described interventional clinical trials. Cancer-related fatigue was consistently one of the most prevalent, severe, and distressing symptoms, and it persisted long-term in survivors. It was associated with a number of factors, including poor sleep, depression, and chemotherapy. There was little evidence for the effectiveness of any intervention, although exercise appears to be the most promising. Importantly, fatigue was itself a significant barrier to physical and social activities. CONCLUSION Cancer-related fatigue is a major and disabling problem in young cancer patients. Effective management strategies are needed to avoid compounding the dependence and social isolation of this vulnerable patient group. Future research should focus on providing evidence for the effectiveness of interventions, of which activity promotion and management of concurrent symptoms are the most promising.
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Affiliation(s)
- Anna Spathis
- Department of Palliative Care, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust Foundation , Cambridge, United Kingdom . ; Department of Public Health and Primary Care, University of Cambridge , Cambridge, United Kingdom
| | - Sara Booth
- Department of Palliative Care, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust Foundation , Cambridge, United Kingdom . ; University of Cambridge , Cambridge, United Kingdom
| | - Sarah Grove
- Department of Palliative Care, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust Foundation , Cambridge, United Kingdom
| | - Helen Hatcher
- TYA Cancer Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust Foundation , Cambridge, United Kingdom
| | - Isla Kuhn
- University of Cambridge Medical Library , Cambridge, United Kingdom
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge , Cambridge, United Kingdom
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Franck LS. Nursing management of children's pain: Current evidence and future directions for research. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/136140960300800503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This critical literature review discusses the research evidence underpinning each of the pain standards in the National Service Framework for Children: Standard for hospital services. Relevant evidence-based reviews and clinical practice guidelines are highlighted, and aspects of children's pain management where the research evidence is particularly strong or weak are identified. Priorities are suggested for nurse-led research aimed at generating new knowledge to improve pain management for children.
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Affiliation(s)
- Linda S. Franck
- Great Ormond Street, Hospital for Children NHS Trust and Institute of Child Health
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Pain buddy: A novel use of m-health in the management of children's cancer pain. Comput Biol Med 2016; 76:202-14. [PMID: 27479493 DOI: 10.1016/j.compbiomed.2016.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Over 12,000 children are diagnosed with cancer every year in the United States. In addition to symptoms associated with their disease, children undergoing chemotherapy frequently experience significant pain, which is unfortunately often undertreated. The field of m-Health offers an innovative avenue for pain assessment and intervention in the home setting. The current study describes the development and initial evaluation of a tablet-based program, Pain Buddy, aimed to enhance pain management and foster improved quality of life in children ages 8-18 years undergoing cancer treatment. METHODS An animated avatar-based tablet application was developed using state-of-the-art software. Key aspects of Pain Buddy include daily pain and symptom diaries completed by children, remote monitoring of symptoms by uploading patient's data through internet to a cloud server, cognitive and behavioral skills training, interactive three-dimensional avatars that guide children through the program, and an incentive system to motivate engagement. Twelve children between the ages of 8 and 18 participated in a pilot study of Pain Buddy. RESULTS Children were highly satisfied with the program. Pain and appetite disturbances were most frequently endorsed. Symptom trigger alerts to outside providers were largely related to clinically significant pain. Children infrequently used analgesics, and reported using some non-pharmacological pain management strategies. CONCLUSION Pain Buddy appears to be a promising tool to improve pain and symptom management in children undergoing cancer treatment. Results from the current study will inform future improvements to Pain Buddy, in preparation for a randomized controlled trial to assess the efficacy of this innovative treatment.
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Abstract
Interpretive phenomenological analysis methodology was used to explore coping strategies used by hospitalized Jordanian adolescents with cancer. In-depth face-to-face interviews were conducted with 10 Jordanian adolescents, aged 13 to18 years, who were receiving chemotherapy for cancer. During treatment, participants were confronted with physical, psychosocial, and emotional distresses resulting from the disease process, the treatment, and its associated side-effects. To cope with the impact of their illness, participants utilized 4 coping strategies: “Strengthening spiritual convictions,” “Being optimistic and rebuilding hope,” “Enhancing appearance,” and “Finding self again.” The findings of this study can assist health team members to promote positive psychological care to Arab Muslim adolescents with cancer in a supportive and therapeutic treatment environment.
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131
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Di Battista A, Dupuis LL, Cassidy M, Portwine C, Johnston DL, Pradier Silva M, Sung L, Barrera M. Parent Attributions About Child Symptoms Related to Cancer Therapy. J Pediatr Oncol Nurs 2016; 34:44-50. [DOI: 10.1177/1043454215628002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Symptom assessment is an emergent area of research in pediatric cancer. Our team previously reported on the development of a questionnaire to be completed by parents to determine symptom prevalence and bother. This exploratory study examined parental nonprobed, free-text comments about their child’s treatment-related symptoms reported on the questionnaire. Method: Participants were parents of children aged 4 to 18 years who had been diagnosed with cancer at least 2 months prior to enrolment and had received intravenous chemotherapy within the past month at 1 of 5 pediatric cancer centers. The questionnaire consisted of 69 or 71 items (based on child’s age) addressing physical and psychological sequelae. Each symptom query was accompanied by a blank space in which parents could comment on their response. Comments were analyzed guided by content analysis methodology. Results: Five major themes emerged: parental attributions for the symptoms experienced in their child; coping patterns and communication styles within the family; evidence of anticipatory, procedural, and other anxieties; interruption of daily life; and changes in the child’s physical appearance. Conclusions: These exploratory findings provide context to parental perception of their child’s treatment-related symptoms and may contribute to a better understanding of parental perception of child and the family coping and communicating style. These findings may assist in the development of psychoeducational interventions aimed at promoting open communication styles within the family and reducing child and parent burden during treatment procedures.
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Affiliation(s)
- Ashley Di Battista
- Community Head Injury Resource Services of Toronto, Toronto, Ontario, Canada
| | - Lee L. Dupuis
- University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marilyn Cassidy
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Carol Portwine
- McMaster University, Hamilton, Ontario, Canada
- McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Donna L. Johnston
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Mariana Pradier Silva
- Kingston General Hospital, Kingston, Ontario, Canada
- Queen’s University in Kingston, Ontario, Canada
| | - Lillian Sung
- University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maru Barrera
- University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
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132
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Linder LA, Seitz M. Through Their Words: Sources of Bother for Hospitalized Children and Adolescents With Cancer. J Pediatr Oncol Nurs 2016; 34:51-64. [PMID: 26902500 DOI: 10.1177/1043454216631308] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An increased intensity of inpatient treatment, hospital-based routines, and separation from the familiar home environment may collectively increase the burden of the pediatric cancer experience. This study explored children and adolescents' perceived sources of bother related to hospitalization using two questions: (1) What bothered you the most about the hospital or hospital environment? and (2) What do you think could improve the hospital or hospital environment? Fifty children and adolescents (mean age 12.6 years) responded to these questions during each shift of a 3-day/3-night data collection period. Responses were analyzed using content analysis and chi-square analyses. Themes related to sources of bother included (1) "nothing/don't know," (2) "treatment and its consequences," (3) "isolation and loneliness," (4) "imposed bother," (5) "negative environment," and (6) "staff behaviors." Themes related to improving the hospital environment included (1) "nothing/don't know," (2) "normalizing activities," (3) "quality of the hospital environment," (4) "decrease burden of cancer and its treatment," and (5) "patient care issues." Participants' responses to these questions provide a foundation for actionable change to alleviate the burden associated with hospitalization.
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Affiliation(s)
- Lauri A Linder
- 1 University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Marie Seitz
- 2 University of Utah College of Nursing, Salt Lake City, UT, USA
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Abstract
Fatigue is a complex phenomenon without a widely accepted definition, and is one of the least explained phenomena of advanced disease. A great deal of work and research has been done to explore the experience, incidence, and management of fatigue in children with cancer. Fatigue remains, however, a source of suffering for children with advanced disease and their families. The knowledge we have gained from the study of fatigue in children receiving antineoplastic therapy can be applied to children during this phase of their illness. The goal of this article is to address the incidence of fatigue in the advanced stage of illness, review the literature regarding fatigue in pediatric oncology, and propose how such findings may be applicable to children in the later stages of their illness.
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Affiliation(s)
- Kim Mooney-Doyle
- University of Pennsylvania School of Nursing, Philadelphia, 19104, USA.
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Ameringer S, Serlin RC, Hughes SH, Frierdich SA, Ward S. Concerns About Pain Management Among Adolescents With Cancer: Developing the Adolescent Barriers Questionnaire. J Pediatr Oncol Nurs 2016; 23:220-32. [PMID: 16766687 DOI: 10.1177/1043454206289736] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Investigators have examined barriers to pain management in adults with cancer, but these patient-related barriers have rarely been studied in adolescents. This article summarizes 2 studies used in the development and initial psychometric testing of the Adolescent Barriers Questionnaire (ABQ). Building on the Barriers Questionnaire-II, the ABQ is designed to measure the extent to which adolescents with cancer have concerns about reporting pain and using analgesics. Study 1 was a qualitative study investigating pain management concerns of 5 adolescents with cancer. Concerns emerged that could potentially impede pain management such as fear of addiction and worry about communicating pain to parents and providers. Each of the adolescents revealed at least 1 concern about pain management or held fatalistic beliefs that cancer pain cannot be relieved. In study 2, content validity of the preliminary ABQ (52 items assessing 13 barrier sub-scales) was assessed by 2 panels, adolescents with cancer and clinicians. Based on results, the ABQ was modified to contain 45 items that assess 11 barriers. Further examination of barriers in adolescents with cancer is warranted.
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Affiliation(s)
- Suzanne Ameringer
- School of Nursing, University of Wisconsin-Madison, Madison, WI 53792, USA.
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Abstract
Survival rates for childhood cancer have increased over the past 2 decades, due in large part to the increase in the intensity and complexity of the treatment modalities used. We can presume that this increase in intensity has produced increased distress or suffering (physical, psychological, social, and spiritual) in the child or adolescent undergoing these therapies for cancer. However, measurement of suffering is more than symptom occurrence, frequency, duration, and severity. An analysis of the concept of suffering is presented. Suffering needs to be defined and measured by self-report (as opposed to parent or staff report) to gain an accurate, complete holistic picture of the nature and scope of the child’s and adolescent’s suffering. Knowledge of how children and adolescents experience suffering would enable practitioners to design interventions to prevent or ameliorate this suffering.
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Affiliation(s)
- Dianne Fochtman
- Kapiolani Medical Center for Women and Children, Honolulu, HI 96826, USA.
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136
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Abstract
A review of the clinical research studies published within the past 5 years revealed that efforts to manage symptoms of cancer and its treatments have not kept pace with new advances in the cure for cancer. Children with cancer continue to experience distressing physical symptoms caused by the disease and treatment. The purpose of this article is to provide a concise overview of the most common symptoms experienced by children with cancer. These symptoms include pain, nausea and vomiting, nutritional concerns, mucositis, and fatigue experienced by the child with cancer. Recommendations for future research are addressed.
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Affiliation(s)
- Marilyn Hockenberry
- Department of Hematology/Oncology, Baylor College of Medicine, Houston TX, USA.
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137
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Bektas M, Akdeniz Kudubes A, Ugur O, Vergin C, Demirag B. Developing the Scale for Quality of Life in Pediatric Oncology Patients Aged 13–18: Adolescent Form and Parent Form. Asian Nurs Res (Korean Soc Nurs Sci) 2016; 10:106-15. [DOI: 10.1016/j.anr.2016.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 10/20/2015] [Accepted: 01/07/2016] [Indexed: 10/21/2022] Open
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La consommation de tabac, alcool et cannabis chez les adolescents et jeunes adultes atteints de cancer a-t-elle un impact sur l’utilisation hospitalière des traitements antalgiques pendant la période de traitement ? Arch Pediatr 2016; 23:353-9. [DOI: 10.1016/j.arcped.2015.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 11/17/2022]
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139
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A cross-sectional study of carnitine deficiency and fatigue in pediatric cancer patients. Childs Nerv Syst 2016; 32:475-83. [PMID: 26812488 PMCID: PMC5872812 DOI: 10.1007/s00381-015-2983-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Carnitine deficiency has been found in cancer patients and has been associated with fatigue. This study aimed to explore the prevalence of carnitine deficiency in pediatric cancer patients and its relationship with fatigue and other potential contributing factors. METHODS Children with cancer or Langerhans cell histiocytosis who were receiving treatment or had completed therapy were eligible. Patients completed the Pediatric Functional Assessment of Chronic Illness-Fatigue, the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, a numeric fatigue rating, and had carnitine levels obtained. Carnitine deficiency was defined as a total and/or free carnitine level less than normal for age or an acylcarnitine value higher than normal for age. RESULTS Data from 142 children aged 8-17 were analyzed. Twenty-eight of 142 (19.7 %) had decreased total and 42.8 % (12/28) had decreased free carnitine levels. No patients had elevated acylcarnitine levels or elevated ratios. Patients with versus without carnitine deficiency differed by age (p = 0.043), treatment (p = 0.037), duration since last chemotherapy (p = 0.020), and body mass index (p = 0.010), but not fatigue, when all data were analyzed together. Yet, a negative relationship between fatigue and carnitine levels was found on a subgroup (off-therapy; fatigue worse than the norm). CONCLUSION No significant association between fatigue and carnitine level was demonstrated when data from all patients were analyzed together; however, a significant yet unexpected relationship was found for patients who completed therapy and reported elevated fatigue. Given the small sample size, these results should be interpreted with caution. Future studies to explore impact upon excessive carnitine levels are warranted.
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140
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Widger K, Friedrichsdorf S, Wolfe J, Liben S, Pole JD, Bouffet E, Greenberg M, Husain A, Siden H, Whitlock JA, Rapoport A. Protocol: Evaluating the impact of a nation-wide train-the-trainer educational initiative to enhance the quality of palliative care for children with cancer. BMC Palliat Care 2016; 15:12. [PMID: 26818836 PMCID: PMC4729125 DOI: 10.1186/s12904-016-0085-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are identified gaps in the care provided to children with cancer based on the self-identified lack of education for health care professionals in pediatric palliative care and in the perceptions of bereaved parents who describe suboptimal care. In order to address these gaps, we will implement and evaluate a national roll-out of Education in Palliative and End-of-Life Care for Pediatrics (EPEC®-Pediatrics), using a 'Train-the-Trainer' model. METHODS/DESIGN In this study we are using a pre- post-test design and an integrated knowledge translation approach to assess the impact of the educational roll-out in four areas: 1) self-assessed knowledge of health professionals; 2) knowledge dissemination outcomes; 3) practice change outcomes; and 4) quality of palliative care. The quality of palliative care will be assessed using data from three sources: a) parent and child surveys about symptoms, quality of life and care provided; b) health record reviews of deceased patients; and c) bereaved parent surveys about end-of-life and bereavement care. After being trained in EPEC®-Pediatrics, 'Master Facilitators' will train 'Regional Teams' affiliated with 16 pediatric oncology programs in Canada. Each team will consist of three to five health professionals representing oncology, palliative care, and the community. Each team member will complete online modules and attend one of two face-to-face conferences, where they will receive training and materials to teach the EPEC®-Pediatrics curriculum to 'End-Users' in their region. Regional Teams will also choose a Tailored Implementation of Practice Standards (TIPS) Kit to guide implementation of a quality improvement project in their region; support will be provided via quarterly meetings with Co-Leads and via a listserv and webinars with other teams. DISCUSSION Through this study we aim to raise the level of pediatric palliative care education amongst health care professionals in Canada. Our study will be a significant step forward in evaluation of the impact of EPEC®-Pediatrics both on dissemination outcomes and on care quality at a national level. Based on the anticipated success of our project we hope to expand the EPEC®-Pediatrics roll-out to health professionals who care for children with non-oncological life-threatening conditions.
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Affiliation(s)
- Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130-155 College Street, Toronto, ON, M5T 1P8, Canada. .,Pediatric Advanced Care Team, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Stefan Friedrichsdorf
- Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA.
| | - Joanne Wolfe
- Pediatric Palliative Care Service, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Stephen Liben
- Pediatric Palliative Care Program, The Montreal Children's Hospital, 2300 Rue Tupper, Montréal, QC, H3H 1P3, Canada.
| | - Jason D Pole
- Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, M5G 1 V2, Canada.
| | - Eric Bouffet
- Brain Tumor Program, Division of Hematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Mark Greenberg
- Policy and Clinical Affairs, Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, M5G 1 V2, Canada.
| | - Amna Husain
- Department of Family and Community Medicine, University of Toronto, Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, 60 Murray Street, 4th Floor, Toronto, ON, M5T 3 L9, Canada.
| | - Harold Siden
- Canuck Place Children's Hospice, Clinical Professor, Department of Pediatrics, University of British Columbia, 1690 Matthews Avenue, Vancouver, BC, V6J 2 T2, Canada.
| | - James A Whitlock
- Department of Hematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Adam Rapoport
- Pediatric Advanced Care Team, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Gibson F, Hibbins S, Grew T, Morgan S, Pearce S, Stark D, Fern LA. How young people describe the impact of living with and beyond a cancer diagnosis: feasibility of using social media as a research method. Psychooncology 2016; 25:1317-1323. [PMID: 26748434 DOI: 10.1002/pon.4061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 11/20/2015] [Accepted: 12/06/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Young people with cancer exhibit unique needs. During a time of normal physical and psychological change, multiple disease and treatment-related symptoms cause short and long-term physical and psychosocial effects. Little is known about how young people cope with the impact of cancer and its treatment on daily routines and their strategies to manage the challenges of cancer and treatments. We aimed to determine how young people describe these challenges through a social media site. METHODS Using the principles of virtual ethnography and watching videos on a social media site we gathered data from young people describing their cancer experience. Qualitative content analysis was employed to analyse and interpret the narrative from longitudinal 'video diaries' by 18 young people equating to 156 films and 27 h and 49 min of recording. Themes were described then organized and clustered into typologies grouping commonalities across themes. RESULTS Four typologies emerged reflective of the cancer trajectory: treatment and relenting side effects, rehabilitation and getting on with life, relapse, facing more treatment and coming to terms with dying. CONCLUSIONS This study confirms the need for young people to strive towards normality and creating a new normal, even where uncertainty prevailed. Strategies young people used to gain mastery over their illness and the types of stories they choose to tell provide the focus of the main narrative. Social Media sites can be examined as a source of data, to supplement or instead of more traditional routes of data collection known to be practically challenging with this population. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- F Gibson
- London South Bank University, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S Hibbins
- London South Bank University, London, UK
| | - T Grew
- Oxford University Clinical Academic Graduate School, Oxford, UK
| | - S Morgan
- St James's University Hospital, Leeds, UK
| | - S Pearce
- University College London Hospitals NHS Foundation Trust, London, UK
| | - D Stark
- Section of Oncology and Clinical Research, Leeds Institute of Molecular Medicine, Leeds, UK
| | - L A Fern
- University College London Hospitals NHS Foundation Trust, London, UK.
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142
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Yoon HS, Kim KS, Choi SH, Choi SE, Kim KA, Kim KE. Physical, Psychological and Social Symptoms, Activity and Education of Children and Adolescents with Acute Lymphoblastic Leukemia Receiving Maintenance Chemotherapy. ASIAN ONCOLOGY NURSING 2016. [DOI: 10.5388/aon.2016.16.4.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hee Sung Yoon
- BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kwang Sung Kim
- BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sun Hee Choi
- BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - So Eun Choi
- Department of Nursing, Mokpo National University, Muan, Korea
| | - Kyoung A Kim
- BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Eon Kim
- BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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143
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Symptom assessment in pediatric oncology: how should concordance between children's and parents' reports be evaluated? Cancer Nurs 2015; 37:252-62. [PMID: 24936750 DOI: 10.1097/ncc.0000000000000111] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical evaluations in pediatric oncology are often triadic, involving children or adolescents, parents, and clinicians. However, few studies have evaluated the concordance between children's and parents' reports of symptom occurrence. OBJECTIVES The purposes of this study were to evaluate the concordance between children's and parents' symptom reports during the week of chemotherapy administration using 5 statistical approaches and determine which factors are associated with higher levels of dyadic concordance. METHODS Independent assessments of symptom occurrence were obtained from children and adolescents with cancer (n = 107) and their parents using the Memorial Symptom Assessment Scale 10-18. Concordance was assessed using (1) percentage of overall agreement, (2) Cohen κ coefficients, (3) McNemar tests, (4) positive percentage agreement, and (5) negative percentage agreement. RESULTS For each dyad, an average of 20 of the 31 symptom reports were concordant. Using children's reports as the "gold standard," parents rarely underestimated the children's symptoms. However, compared with children's reports, parents overestimated 7 symptoms. Advantages and disadvantages of each of the statistical approaches used to evaluate concordance are described in this article. CONCLUSIONS A variety of statistical approaches are needed to obtain a thorough evaluation of the concordance between symptom reports. Discordance was most common for symptoms that children refuted, particularly psychosocial symptoms. IMPLICATIONS FOR PRACTICE Clinicians need to interview children and adolescents along with their parents about the occurrence of symptoms and evaluate discrepant reports. Effective approaches are needed to improve communication between children and parents to improve symptom assessment and management.
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144
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Ameringer S, Erickson JM, Macpherson CF, Stegenga K, Linder LA. Symptoms and Symptom Clusters Identified by Adolescents and Young Adults With Cancer Using a Symptom Heuristics App. Res Nurs Health 2015; 38:436-48. [PMID: 26455729 DOI: 10.1002/nur.21697] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
Adolescents and young adults (AYAs) with cancer experience multiple distressing symptoms during treatment. Because the typical approach to symptom assessment does not easily reflect the symptom experience of individuals, alternative approaches to enhancing communication between the patient and provider are needed. We developed an iPad-based application that uses a heuristic approach to explore AYAs' cancer symptom experiences. In this mixed-methods descriptive study, 72 AYAs (13-29 years old) with cancer receiving myelosuppressive chemotherapy used the Computerized Symptom Capture Tool (C-SCAT) to create images of the symptoms and symptom clusters they experienced from a list of 30 symptoms. They answered open-ended questions within the C-SCAT about the causes of their symptoms and symptom clusters. The images generated through the C-SCAT and accompanying free-text data were analyzed using descriptive, content, and visual analyses. Most participants (n = 70) reported multiple symptoms (M = 8.14). The most frequently reported symptoms were nausea (65.3%), feeling drowsy (55.6%), lack of appetite (55.6%), and lack of energy (55.6%). Forty-six grouped their symptoms into one or more clusters. The most common symptom cluster was nausea/eating problems/appetite problems. Nausea was most frequently named as the priority symptom in a cluster and as a cause of other symptoms. Although common threads were present in the symptoms experienced by AYAs, the graphic images revealed unique perspectives and a range of complexity of symptom relationships, clusters, and causes. Results highlight the need for a tailored approach to symptom management based on how the AYA with cancer perceives his or her symptom experience.
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Affiliation(s)
- Suzanne Ameringer
- Associate Professor School of Nursing, Virginia Commonwealth University, 1100 East Leigh Street Richmond, VA, 23298
| | - Jeanne M Erickson
- Assistant Professor College of Nursing, University of Wisconsin-Milwaukee Milwaukee, WI
| | | | - Kristin Stegenga
- Nurse Researcher Children's Mercy Hospital, Kansas City, Missouri
| | - Lauri A Linder
- Assistant Professor College of Nursing, University of Utah, Clinical Nurse Specialist, Primary Children's Hospital, Salt Lake City, UT
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Shoshani A, Mifano K, Czamanski-Cohen J. The effects of the Make a Wish intervention on psychiatric symptoms and health-related quality of life of children with cancer: a randomised controlled trial. Qual Life Res 2015; 25:1209-18. [PMID: 26454450 DOI: 10.1007/s11136-015-1148-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Children with life-threatening medical conditions frequently undergo invasive medical procedures that may elicit anxiety and distress. However, there are few empirically validated interventions that reduce mental health symptoms and increase the resilience of children during the acute stages of illness. This study aimed to evaluate the efficacy of the Make a Wish intervention for children with life-threatening cancer. METHODS The design was a wait-list-controlled trial with two parallel groups. Sixty-six children aged 5-12 with an initial diagnosis of life-threatening cancer were identified and randomly assigned to the Make a Wish intervention (n = 32) or a wait-list control group (n = 34). Children completed measures of psychiatric and health-related symptoms, positive and negative affect, hope, and optimism pre-intervention and post-intervention. After baseline data collection, children were interviewed and made an authentic wish that they wanted to come true. These wishes were made possible 5-6 months after baseline data collection, to fuel anticipation and excitement over the wish-fulfillment event. The post-intervention assessment point was 5 weeks after wish fulfillment (approximately 7 months after baseline data collection). RESULTS Children in the intervention group exhibited a significant reduction in general distress (d = 0.54), depression (d = 0.70), and anxiety symptoms (d = 0.41), improved health-related quality of life (d = 0.59), hope (d = 0.71), and positive affect (d = 0.80) compared to decrease in positive affect and no significant changes in the other measures in the control group. CONCLUSIONS These findings emphasize the role of hope and positive emotions in fostering the well-being of children who suffer from serious illnesses.
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Affiliation(s)
- Anat Shoshani
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, P.O. Box 167, 46150, Herzliya, Israel.
| | - Keren Mifano
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, P.O. Box 167, 46150, Herzliya, Israel
| | - Johanna Czamanski-Cohen
- Cancer Center, University of Arizona, 1515 N. Campbell Ave., P.O. Box 245024, Tucson, AZ, USA
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146
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Abu-Saad Huijer H, Sagherian K, Tamim H. Validation of the Arabic Version of the Memorial Symptom Assessment Scale Among Lebanese Cancer Patients. J Pain Symptom Manage 2015; 50:559-65. [PMID: 25242019 DOI: 10.1016/j.jpainsymman.2014.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 07/24/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT To our knowledge, there have been no previous attempts to translate the Memorial Symptom Assessment Scale (MSAS) into the Arabic language and validate it among the Arab cancer population. OBJECTIVES The purpose of this study was to validate the MSAS in Arabic (MSAS-Leb) among 190 Lebanese oncology outpatients. METHODS The questionnaires were the MSAS-Leb and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Data were collected between 2009 and 2010 at a major teaching hospital in Lebanon. The psychometric indices used were reliability, convergent validity, principle component analysis, and confirmatory factor analysis (CFA). RESULTS The Cronbach's alpha coefficients for the MSAS and its subscales ranged from 0.71 to 0.83. On convergent validity testing, the psychological and global distress index subscales were moderately correlated (r > -0.50; P < 0.01) with the emotional functioning subscale of the EORTC QLQ-C30. Correlation coefficients between the MSAS items and selected subscales from the EORTC QLQ-C30 met the standards of convergent validity (r = -0.55 to 0.81; P < 0.01) except for the nausea/vomiting subscale. On principal component analysis (N = 95), four meaningful clusters were recovered. The clusters represented the psychological and physical components. CFA (N = 95) showed an acceptable model and a good fit (goodness-of-fit index = 0.59, adjusted goodness-of-fit index = 0.51, root mean square residual = 0.05, root mean square error of approximation = 0.2) with our data set. CONCLUSION The MSAS-Leb has acceptable psychometric properties of reliability and validity. We recommend its use in clinical practice and outpatient settings among health care professionals to assess and follow-up on symptom burden among patients diagnosed with cancer.
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Affiliation(s)
| | - Knar Sagherian
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Hani Tamim
- Biostatistics Unit, American University of Beirut, Beirut, Lebanon
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Weaver MS, Reeve BB, Baker JN, Martens CE, McFatrich M, Mowbray C, Palma D, Sung L, Tomlinson D, Withycombe J, Hinds P. Concept-elicitation phase for the development of the pediatric patient-reported outcome version of the Common Terminology Criteria for Adverse Events. Cancer 2015; 122:141-8. [PMID: 26421973 DOI: 10.1002/cncr.29702] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/11/2015] [Accepted: 08/26/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Symptoms arising from disease or treatment are subjective experiences. Insight into pediatric oncology treatment side effects or symptoms is ideally obtained from direct inquiry to the ill child. A concept-elicitation phase in a patient-reported outcome (PRO) instrument design provides an opportunity to elicit children's voices to shape cancer symptom selection and terminology. METHODS Through semistructured, one-on-one, voice-recorded interviews, symptom data were collected from 96 children with cancer between the ages of 7 and 20 years who were undergoing oncologic treatment at 7 pediatric oncology sites in the United States and Canada. RESULTS The mean number of symptoms reported per child over the prior 7 days was 1.49 (range, 0-7; median, 1; standard deviation, 1.56). The most common symptoms across all age groups were tiredness or fatigue, nausea or vomiting, aches or pains, and weakness. There was not a statistically significant correlation between self-reported wellness and the number of reported symptoms (r = -0.156, n = 65, P = .215) or the number of symptoms reported by age group or diagnosis type. Forty participants reported experiencing a change in their body in the past week, with one-third of these changes unanticipated. Only through direct questions about feelings were emotional symptoms revealed because 90.6% of interviewees who discussed feelings (48 of 53) did so only in the context of direct questioning on feelings. Adolescents were more likely than younger children to discuss feelings as part of the interview. CONCLUSIONS Concept elicitation from children and adolescents has the potential to enable researchers to develop age-appropriate, accurately representative PRO measures.
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Affiliation(s)
- Meaghann S Weaver
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, Children's National Health Systems, Washington, DC
| | - Bryce B Reeve
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.,Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Christa E Martens
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Molly McFatrich
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Catriona Mowbray
- Department of Oncology, Children's National Health Systems, Washington, DC
| | - Diana Palma
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
| | - Lillian Sung
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Deborah Tomlinson
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
| | - Janice Withycombe
- Palmetto Health Children's Hospital, Columbia, South Carolina.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Pamela Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health Systems, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
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148
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Lopes-Júnior LC, Bomfim EO, Nascimento LC, Nunes MDR, Pereira-da-Silva G, Lima RAG. Non-pharmacological interventions to manage fatigue and psychological stress in children and adolescents with cancer: an integrative review. Eur J Cancer Care (Engl) 2015; 25:921-935. [PMID: 26374619 DOI: 10.1111/ecc.12381] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Abstract
Cancer-related fatigue (CRF) is the most stressful and prevalent symptom in paediatric oncology patients. This integrative review aimed to identify, analyse and synthesise the evidence of non-pharmacological intervention studies to manage fatigue and psychological stress in a paediatric population with cancer. Eight electronic databases were used for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and the Cochrane Library. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts and the full articles, a final sample of nine articles was obtained. The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises. It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRF and psychological stress.
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Affiliation(s)
- L C Lopes-Júnior
- University of São Paulo at Ribeirão Preto College of Nursing - USP, WHO Collaborating Centre for the Development of Nursing Research, Ribeirão Preto, SP, Brazil.
| | - E O Bomfim
- University of Saskatchewan at College of Medicine - UOfS, Saskatoon, SK, Canada
| | - L C Nascimento
- Department Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing - USP, Ribeirão Preto, SP, Brazil
| | - M D R Nunes
- Rio de Janeiro State University, College of Nursing - UERJ, Rio de Janeiro, RJ, Brazil
| | - G Pereira-da-Silva
- Department Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing - USP, Ribeirão Preto, SP, Brazil
| | - R A G Lima
- Department Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing - USP, Ribeirão Preto, SP, Brazil
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150
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Zhukovsky DS, Rozmus CL, Robert RS, Bruera E, Wells RJ, Chisholm GB, Allo JA, Cohen MZ. Symptom profiles in children with advanced cancer: Patient, family caregiver, and oncologist ratings. Cancer 2015. [PMID: 26218240 DOI: 10.1002/cncr.29597] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Systematic symptom assessment is not routinely performed in pediatric oncology. The objectives of the current study were to characterize the symptoms of pediatric oncology outpatients and evaluate agreement between patient and proxy reports and the association between children's ratings and oncologists' treatment recommendations. METHODS Two versions of the pediatric Memorial Symptom Assessment Scale (pMSAS) were translated into Spanish. An age-appropriate and language-appropriate pMSAS was administered independently before visits to the oncologist to patients and family caregivers (caregivers) and after visits to consenting oncologists. Statistical analysis included Spearman correlation coefficients and weighted kappa values. RESULTS English and Spanish results were similar and were combined. A total of 60 children and their caregivers completed the pMSAS. The children had a median age of 10 years (range, 7-18 years); approximately 62% were male and 33% were Spanish-speaking. Fourteen oncologists completed the pMSAS for 25 patients. Nine patients (15%) had no symptoms and 38 patients (63%) reported ≥2 symptoms. The most common symptoms were fatigue (12 patients; 40%) and itch (9 patients; 30%) for the younger children and pain (15 patients; 50%) and lack of energy (13 patients; 45%) among the older children. Total and subscale score agreement varied by proxy type and subscale, ranging from fair to good for most comparisons. Agreement for individual symptoms between the patient and proxy ranged from a kappa of -0.30 (95% confidence interval, -0.43 to -0.01) to 0.91 (95% confidence interval, 0.75 to 1.00). Three of 51 symptomatic patients (6%) had treatment recommendations documented in the electronic health record. CONCLUSIONS Symptoms are common and cross several functional domains. Proxy and child reports are often not congruent, possibly explaining apparent undertreatment among this group of patients.
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Affiliation(s)
- Donna S Zhukovsky
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cathy L Rozmus
- School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Rhonda S Robert
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert J Wells
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary B Chisholm
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julio A Allo
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marlene Z Cohen
- College of Nursing, The University of Nebraska Medical Center, Omaha, Nebraska
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