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Hooke MC, Salisbury DL, Mathiason MA, Kunin-Batson AS, Blommer A, Hutter J, Mitby P, Moore I, Whitman S, Taylor O, Scheurer ME, Hockenberry MJ. Symptoms, Physical Activity, and Biomarkers in Children at the End of Leukemia Maintenance Therapy. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:386-399. [PMID: 37050865 DOI: 10.1177/27527530221148479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Background: Symptoms in children with acute lymphocytic leukemia (ALL) change over the trajectory of treatment but little is known about their symptoms as treatment ends. Physical activity may help decrease symptom distress and is vital for ongoing development. The role of biomarkers in symptom science is emerging. The purpose of the study was to explore relationships between self-report of symptoms and physical activity, actigraphy measures, and cerebrospinal fluid (CSF) biomarkers. Methods: Participants were children who were ages 3 to 18 years at the time of ALL diagnosis and were now in the last 12-week cycle of ALL maintenance. Self-reports of fatigue, sleep disturbance, depressive symptoms, and physical activity were completed by participants and parents of younger children. Participants wore a wrist actigraph continuously for the 7 days before other measurements. F2-isoprostanes and interleukin-8 were evaluated in CSF samples. Results: Among the 15 participants, self-report of symptoms and physical activity indicated levels similar to healthy peers. F2-isoprostane had a strong positive correlation with fatigue levels and with depressive symptoms. Fatigue, sleep disturbance, and depressive symptoms positively correlated with each other. Actigraph measures showed children met the CDC guidelines for 60 min of daily moderate to vigorous activity; sleep time was slightly less than healthy norms. Discussion: During maintenance therapy, most children return to healthy norms in symptom burden and physical activity. F2-isoprostane in the CSF is a biomarker for fatigue and depressive symptoms. Children who had persistent symptoms experienced them as a cluster, which confirms previous symptom cluster research.
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Affiliation(s)
- Mary C Hooke
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN, USA
| | | | | | | | - Audrey Blommer
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN, USA
| | - Jessica Hutter
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN, USA
| | - Pauline Mitby
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN, USA
| | - Ida Moore
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Susan Whitman
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Olga Taylor
- Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Michael E Scheurer
- Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Marilyn J Hockenberry
- Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
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Tucker P, Loew M, Russell K, Tynes BL, Mandrell BN, Witcraft SM, Schwartz LE, Crabtree VM. Sleep health behaviors in pediatric patients with newly diagnosed cancer. J Psychosom Res 2023; 172:111413. [PMID: 37354749 PMCID: PMC10751812 DOI: 10.1016/j.jpsychores.2023.111413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Disrupted sleep and fatigue are common symptoms in children with cancer, but little is known about this population's sleep health behaviors and how they may impact nighttime sleep. We aimed to describe the sleep health behaviors of children with newly diagnosed cancer and to determine if they changed over the next 8 weeks. METHODS Our sample included 169 children with cancer (86 males) who were aged 2-18 years (mean [SD] = 8.14 [4.4] y), with parent proxy report for 140 children (71 male) aged 2-12 years (mean [SD] = 6.67 [3.2] y) and self-report for 78 children (39 male) aged 8-18 years (mean [SD] = 12.0 [2.9] y). Parents and patients completed sleep hygiene questionnaires within 30 days of oncology diagnosis (T1); follow-up questionnaires were collected 8 weeks later (T2). Descriptive analyses characterized the sample by sociodemographic characteristics, cancer diagnosis, treatments received, and prescribed medications. RESULTS Age-related differences were found in sleep health behaviors, with adolescents reporting better overall sleep health behaviors than younger children at both time points. No differences in sleep health behaviors were found at T1 related to diagnosis, treatment, or medications. Some differences in sleep health behaviors were found at T2 related to gender, diagnosis, treatment, and medications. Sleep health behaviors and sleep problems remained relatively stable over 8 weeks. Fatigue was significantly associated with more pre-bedtime worries, insomnia, and lower rates of daytime sleepiness. CONCLUSIONS These findings offer novel descriptive characteristics of sleep health behaviors in a pediatric oncology sample and show relatively stable yet somewhat poor sleep health behaviors across 8 weeks. Better understanding of sleep health behaviors as modifiable factors will help inform targeted interventions.
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Affiliation(s)
- Pippa Tucker
- Graduate School of Professional Psychology, University of Denver, Denver, CO, United States of America.
| | - Megan Loew
- Behavioral Health, Housing, and Deaf & Hard of Hearing Services Administration, Minnesota Department of Human Services, St. Paul, MN, United States of America.
| | - Kathryn Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States of America.
| | - Brooklee L Tynes
- Psychiatric Services, Faith Regional Physician Services, Norfolk, NE, United States of America.
| | - Belinda N Mandrell
- Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, United States of America.
| | - Sara M Witcraft
- Department of Psychology, University of Mississippi, Oxford, MS, United States of America.
| | - Laura E Schwartz
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States of America.
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Akdeniz Kudubes A, Bektas M, Gerceker GÖ. The Predictive Power of Pain Characteristics and Sleep Quality on Fatigue in Adolescents With Cancer. J Pediatr Hematol Oncol 2023; 45:301-308. [PMID: 37494606 DOI: 10.1097/mph.0000000000002707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/15/2023] [Indexed: 07/28/2023]
Abstract
This study was conducted as descriptive, methodological, and cross-sectional research to determine the predictive power of pain characteristics and sleep quality on fatigue in adolescents with cancer. The study was conducted between November 2020 and April 2021 with 139 adolescents with cancer who reported pain. The study data were collected via an AdolescentInformation Form, the Adolescent Pediatric Pain Tool, the Scale For The Assessment Of Fatigue in Pediatric Oncology Patients Aged 13-18, and the Sleep Assessment Scale for Children with Cancer-Adolescent Form. Mean values, percentage calculations, Pearson correlation analysis, and linear regression analysis were used in the analysis of the data. There was a high level and negative correlation between pain characteristics (pain location, severity, and quality) of the adolescents participating in the study and their mean scores from the overall fatigue scale and its subdimensions and a high level and positive correlation with their mean scores from the overall sleep quality scale. Pain characteristics and sleep quality of adolescents with cancer explained 74% of fatigue. Pain, sleep quality, and fatigue are symptoms that should be closely addressed in adolescents with cancer.
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Affiliation(s)
- Asli Akdeniz Kudubes
- Department of Pediatric Nursing, Bilecik Şeyh Edebali University Faculty of Health, Bilecik
| | - Murat Bektas
- Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
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van Litsenburg R, Kamara D, Irestorm E, Partanen M, de Vries R, McLaughlin Crabtree V, Daniel LC. Sleep problems during and after paediatric brain tumours. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:280-287. [PMID: 36950977 DOI: 10.1016/s2352-4642(22)00380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 02/16/2023]
Abstract
Brain tumours are among the most common cancer diagnoses in paediatrics. Children with brain tumours are at risk of developing sleep problems because of direct and indirect effects of the tumour and its treatment, in addition to psychosocial and environmental factors. Sleep has an important role in physical and psychological wellbeing, and sleep problems are associated with many adverse outcomes. In this Review, we describe the state of the evidence regarding sleep in people with paediatric brain tumours, prevalence and types of sleep problems, risk factors, and effectiveness of interventions. Evidence shows that sleep problems, particularly excessive daytime sleepiness, are common in people with paediatric brain tumours, with high BMI emerging as a consistent predictor of sleep disruption. Further intervention studies are needed, and clinical evaluation of sleep is warranted for people with paediatric brain tumours.
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Affiliation(s)
| | - Dana Kamara
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Elin Irestorm
- Department of Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marita Partanen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Lauren C Daniel
- Department of Psychology, Rutgers University Camden, Camden, NJ, USA
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Fatigue trajectories during pediatric ALL therapy are associated with fatigue after treatment: a national longitudinal cohort study. Support Care Cancer 2023; 31:1. [PMID: 36512099 PMCID: PMC9747814 DOI: 10.1007/s00520-022-07456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Fatigue is one of the most prevalent and distressing symptoms reported by survivors of childhood cancer. There is currently a lack of longitudinal studies on cancer-related fatigue, and especially on the relationship between the course of fatigue during treatment and fatigue at follow-up. The purpose of the current study was therefore to investigate if the course of fatigue during treatment, treatment intensity, serious adverse events, sex, or age at diagnosis are associated with cancer-related fatigue after treatment. METHODS Participants were 92 children and adolescents diagnosed with acute lymphoblastic leukemia (mean age at diagnosis was 6.26 years). Fatigue was measured with PedsQL multidimensional fatigue scale proxy reports 5 months after diagnosis, 12 months after diagnosis, 24 months after diagnosis, and at follow-up 12 months after end of treatment. The effect of patient and treatment characteristics on fatigue reported at follow-up was tested through logistic regression analyses. RESULTS The course of fatigue during treatment significantly predicted fatigue reported at follow-up for general fatigue (p = .038, OR = 9.20), sleep/rest fatigue (p = .011, OR = 15.48), and cognitive fatigue (p < .001, OR = 10.78). None of the other variables were associated with fatigue at follow-up for any of the subscales. CONCLUSIONS The findings demonstrate that fatigue reported during treatment can predict fatigue at follow-up. These results stress the need for longitudinal assessments. Healthcare professionals need to be aware that pediatric patients who are fatigued during treatment need to receive additional attention and timely interventions since cancer-related fatigue will not resolve by itself in the first year after end of treatment.
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Associations Between Fatigue, Sleep Disturbance, Physical Activity, and Quality of Life for Children With Cancer: A Correlational Study. Cancer Nurs 2022; 45:421-429. [PMID: 34469358 DOI: 10.1097/ncc.0000000000001001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fatigue, sleep disturbance, and physical inactivity have been increasingly recognized as health issues that negatively affect quality of life (QoL) for children with cancer. Existing studies focus either on children receiving treatment or in survivorship, but not on both populations in a study. This causes difficulty in examining differences of these issues between treatment statuses and identifying associations of these issues with QoL. OBJECTIVE The aims of this study were to examine differences in fatigue, sleep disturbance, physical activity, and QoL between on- and off-treatment children and to identify their associations with QoL. METHODS The correlational study was conducted with 100 children with cancer 7 to 12 years old. Descriptive, bivariate, and multivariate regression analyses were used. RESULTS Participants undergoing treatment had higher degrees of fatigue ( P = .002), physical inactivity ( P = .004), and QoL distress ( P = .001) than those in survivorship. Mean sums (SDs) of sleep disturbance were 47.15 (8.23) and 48.48 (7.13) in the on- and off-treatment groups. Age ( P = .000), sex ( P = .023), fatigue ( P = .000), and sleep disturbance ( P = .004) were significantly associated with QoL distress. CONCLUSIONS This study is unique in that a frame of reference is addressed to gain insight into the distinct developmental issues of school-aged children undergoing cancer treatment and in survivorship. More studies are needed. IMPLICATIONS FOR PRACTICE Interventions to increase QoL should target children who are younger, male, and have higher levels of fatigue and sleep disturbance. Diagnosis and treatment of sleep disturbance should be considered as part of routine activities.
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Kaushik P, Sharma S, Shah N, Kutty PK, Ghildiyal R. Sleep disturbances and childhood cancer- A tertiary care experience. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Helligsoe ASL, Weile KS, Kenborg L, Henriksen LT, Lassen-Ramshad Y, Amidi A, Wu LM, Winther JF, Pickering L, Mathiasen R. Systematic Review: Sleep Disorders Based on Objective Data in Children and Adolescents Treated for a Brain Tumor. Front Neurosci 2022; 16:808398. [PMID: 35273474 PMCID: PMC8902496 DOI: 10.3389/fnins.2022.808398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Tumors of the central nervous system (CNS) are the most common solid childhood malignancy. Over the last decades, treatment developments have strongly contributed to the improved overall 5-year survival rate, which is now approaching 75%. However, children now face significant long-term morbidity with late-effects including sleep disorders that may have detrimental impact on everyday functioning and quality of life. The aims of this study were to (1) describe the symptoms that lead to polysomnographic evaluation; (2) describe the nature of sleep disorders diagnosed in survivors of childhood CNS tumor using polysomnography (PSG); and (3) explore the association between tumor location and diagnosed sleep disorder. Methods An extensive literature search following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA) was conducted. Inclusion criteria were children and adolescents diagnosed with a CNS tumor age <20 years having a PSG performed after end of tumor treatment. The primary outcome was sleep disorder confirmed by PSG. Results Of the 1,658 studies identified, 11 met the inclusion criteria. All the included articles were appraised for quality and included in the analysis. Analyses indicated that sleep disorders commonly occur among childhood CNS tumor survivors. Symptoms prior to referral for PSG were excessive daytime sleepiness (EDS), fatigue, irregular breathing during sleep and snoring. The most common sleep disorders diagnosed were sleep-related breathing disorders (i.e., obstructive sleep apnea) and central disorders of hypersomnolence (i.e., narcolepsy). Conclusion Our findings point to the potential benefit of systematically registering sleep disorder symptoms among CNS tumor patients together with tumor type and treatment information, so that at-risk patients can be identified early. Moreover, future rigorous and larger scale controlled observational studies that include possible modifiable confounders of sleep disorders such as fatigue and obesity are warranted. Clinical Trial Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021243866, identifier [CRD42021243866].
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Affiliation(s)
- Anne Sophie Lind Helligsoe
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kathrine Synne Weile
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise Tram Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lisa Maria Wu
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of AIAS, Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Jeanette Falck Winther
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Line Pickering
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
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LaRosa KN, MacArthur E, Wang F, Zhang H, Pan H, Brigden J, Pappo A, Wilson MW, Crabtree VM. Light Therapy for QoL/Depression in AYA With Cancer: A Randomized Trial. J Pediatr Psychol 2021; 47:306-317. [PMID: 34625800 DOI: 10.1093/jpepsy/jsab098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Secondary outcomes from a published feasibility and acceptability trial were examined to explore the effect of bright white light (BWL) on quality of life (QoL) and depressive symptoms compared to dim red light (DRL) control in adolescents and young adults (AYAs) receiving cancer-directed therapy. METHODS Fifty-one AYAs (12-22 years, 51% male) newly diagnosed with cancer were randomized to receive 8 weeks of BWL (n = 26) or DRL (n = 25). The CDI-2 (total score, negative mood/physical symptoms, interpersonal problems, ineffectiveness, and negative self-esteem) and parent- and self-report PedsQL (total score and subscales of physical, emotional, social, and school QoL) were completed at multiple timepoints. RESULTS BWL produced improvements in self-reported total depression (d = -.64; 95% confidence interval [CI] = -1.26, -0.01), negative self-esteem (d = -.80; 95% CI = -1.43, -.14), negative mood/physical symptoms (d = -.73; 95% CI = -1.36, -0.08), ineffectiveness (d = -.43; 95% CI = -1.04, .19), total self-reported QoL (d = .41; 95% CI = -.16, .96), emotional (d = .78; 95% CI = .19, 1.37), school functioning (d = .48; 95% CI = -.09, 1.04), and parent-reported school functioning (d = .66; 95% CI = 0.02, 1.33). BWL reported a greater rate of improvement than DRL for total depression (β = .49, p < .05) and self-esteem (β = .44, p < .05), and parent-reported school functioning (β = -1.68, p < .05). CONCLUSIONS BWL improved QoL and depressive symptoms for AYAs with cancer. These findings will inform larger randomized controlled trials.
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Affiliation(s)
- Kayla N LaRosa
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Erin MacArthur
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane Brigden
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alberto Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew W Wilson
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN, USA
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Crabtree VM, LaRosa KN, MacArthur E, Russell K, Wang F, Zhang H, Pan H, Brigden J, Schwartz LE, Wilson M, Pappo A. Feasibility and Acceptability of Light Therapy to Reduce Fatigue in Adolescents and Young Adults Receiving Cancer-Directed Therapy. Behav Sleep Med 2021; 19:492-504. [PMID: 32746639 DOI: 10.1080/15402002.2020.1797744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE/BACKGROUND Fatigue is one of the most consistent and distressing symptoms reported by adolescent/young adult (AYA) oncology patients. Bright white light (BWL) is used to treat fatigue in adult oncology but has not been explored in AYA oncology patients. The purpose of the current study was to determine the feasibility and acceptability of BWL for AYA who were receiving cancer-directed therapy. PARTICIPANTS 51 AYA patients with newly diagnosed solid tumors, including lymphoma. METHODS Participants were randomized to dim red light (DRL, n = 25) or BWL (n = 26) from devices retrofitted with adherence monitors for 30 minutes upon awakening daily for 8 weeks. Side effects were assessed via modified Systematic Assessment for Treatment-Emergent Effects (SAFTEE). Participants completed the PedsQL Multidimensional Fatigue Scale. RESULTS Of patients approached, 73% consented and participated. Mean adherence was 57% of days on study with 30.68 average daily minutes of usage. BWL did not cause more extreme treatment-emergent effects over DRL. Patients in the BWL group demonstrated significant improvement on all fatigue outcomes by both self-report and parent proxy report, which was not observed in the DRL group. CONCLUSIONS This is the first study to evaluate the feasibility and acceptability of light therapy to reduce fatigue in AYA patients receiving cancer-directed therapy. These findings demonstrate the feasibility and acceptability of the intervention and provide preliminary evidence of the potential benefits of BWL, which warrants further study in a confirmatory efficacy trial.ClinicalTrials.gov Identifier Number: NCT02429063.
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Affiliation(s)
| | - Kayla N LaRosa
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erin MacArthur
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kathryn Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jane Brigden
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Laura E Schwartz
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew Wilson
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Alberto Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Cheng L, Wang Y, Duan M, Wang J, Wang Y, Huang H, Yuan C. Self-Reported Fatigue in Chinese Children and Adolescents During Cancer Treatment. J Pediatr Oncol Nurs 2021; 38:262-270. [PMID: 33686896 DOI: 10.1177/1043454221992304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Fatigue is a prevalent and distressing symptom in children and adolescents with cancer. Objectives: This study aimed to (1) investigate the current fatigue status reported by Chinese children and adolescents with cancer during active cancer treatment and (2) examine whether sociodemographic information, disease and treatment information, co-occurring symptoms, function and related clinical data are significantly associated with fatigue according to the biopsychosocial model. Methods: Participants were children aged 8-17 years, who had undergone treatment for cancer at four hospitals in China. Children completed the Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System short forms. Results: In total, 187 children (33.16% female, mean age 10.28 years) participated. The mean T-score for child-reported fatigue was 48.52 (34-72). Multiple linear regression analysis showed that fatigue in pediatric active cancer treatment could be significantly predicted by greater child-reported pain interference (β = 0.391, p < .001), greater depressive symptoms (β = 0.443, p < .001), and reduced mobility (β = -0.226, p = .004) (adjusted R2 = 0.613, F = 16.476, p < .001). Conclusions: Children and adolescents with cancer experience multiple, intersecting troubling symptoms during their treatment. There is a need to attend to the biopsychosocial aspects of care for children and adolescents during active cancer treatment. To reduce pediatric oncology patients' fatigue level, clinicians could develop culturally sensitive interventions to alleviate children's pain interference, treat depressive symptoms, and maximize their physical mobility.
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Affiliation(s)
- Lei Cheng
- School of Nursing, 12478Fudan University, Shanghai, China
| | - Yingwen Wang
- Hemotology & Oncology Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Mingxia Duan
- Hemotology & Oncology Unit, Anhui Provincial Children's Hospital, Anhui, China
| | - Jiashu Wang
- School of Nursing, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yanqing Wang
- School of Medicine, Children's Hospital of Zhejiang University, Zhejiang, China
| | - Haiying Huang
- Hemotology & Oncology Unit, Guangzhou Women and Children's Medical Center, Guangdong, China
| | - Changrong Yuan
- School of Nursing, 12478Fudan University, Shanghai, China
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Daniel LC, Meltzer LJ, Gross JY, Flannery JL, Forrest CB, Barakat LP. Sleep practices in pediatric cancer patients: Indirect effects on sleep disturbances and symptom burden. Psychooncology 2021; 30:910-918. [PMID: 33686678 DOI: 10.1002/pon.5669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 02/18/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Sleep hygiene recommendations are commonly given to address patient-reported concerns about sleep, yet few studies have examined the relationship between sleep hygiene and sleep disturbances in the context of pediatric oncology. Because poor sleep may affect the patient's experience of cancer-related symptoms, understanding whether sleep hygiene practices influence sleep disturbances and symptoms may be important to improving symptom burden. METHODS One hundred and two caregivers of children ages 5-17 and 59 patients ages 8-17 receiving treatment for cancer completed parallel measures of child sleep, sleep hygiene, pain, fatigue, and nausea. Sleep hygiene practices were described, correlates between measures were examined, and the indirect relationship of sleep hygiene on symptom burden through sleep disturbances was tested using PROCESS. RESULTS Patients received adequate sleep for age but sleep timing was later than recommended for more than half of the sample and consistency in sleep times was poor. Sleep disturbances were moderately related to all symptoms, with the exception of patient-reported fatigue. Consistent sleep habits were indirectly related to fewer cancer-related symptoms of pain, fatigue, and nausea through sleep disturbances by caregiver report but not patient report. CONCLUSION Sleep disturbances are closely related to pain, fatigue, and nausea in pediatric cancer. Consistency in sleep/wake routines and schedules may be important to experiencing fewer sleep disturbances and lower symptom burden. Providing recommendations supporting consistent sleep habits broadly across pediatric oncology may be more effective than only presenting sleep hygiene recommendations to patients experiencing poor sleep.
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Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Rutgers University-Camden, Camden, New Jersey, USA
| | - Lisa J Meltzer
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - J Yael Gross
- Department of Psychology, Rutgers University-Camden, Camden, New Jersey, USA
| | - Jamie L Flannery
- Department of Psychology, Rutgers University-Camden, Camden, New Jersey, USA
| | - Christopher B Forrest
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lamia P Barakat
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Brown AL, Sok P, Taylor O, Woodhouse JP, Bernhardt MB, Raghubar KP, Kahalley LS, Lupo PJ, Hockenberry MJ, Scheurer ME. Cerebrospinal Fluid Metabolomic Profiles Associated With Fatigue During Treatment for Pediatric Acute Lymphoblastic Leukemia. J Pain Symptom Manage 2021; 61:464-473. [PMID: 32889041 PMCID: PMC7914130 DOI: 10.1016/j.jpainsymman.2020.08.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/22/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022]
Abstract
CONTEXT Cancer-related fatigue (CRF) is one of the most distressing and persistent symptoms reported during pediatric acute lymphoblastic leukemia (ALL) therapy; however, information on the pathways underlying CRF severity is limited. OBJECTIVES We conducted global metabolomics profiling of cerebrospinal fluid (CSF) samples to provide insight into the underlying mechanisms of CRF. METHODS Fatigue in pediatric ALL patients (2012-2017) was assessed during postinduction therapy approximately six months after diagnosis. Postinduction CSF was collected from 171 participants, comprising discovery (n = 86) and replication (n = 85) cohorts. We also conducted secondary validation using diagnostic CSF from 48 replication cohort participants. CSF metabolomic profiling was performed using gas chromatography-mass spectrometry (MS) and liquid chromatography-MS/MS. Kendall's rank correlation was used to evaluate associations between metabolite abundance and CRF. False discovery rate was used to account for multiple comparisons. RESULTS Participants were 56% males and 59% Hispanic with a mean age at diagnosis of 8.5 years. A total of 274 CSF-derived metabolites were common to the discovery and replication cohorts. Eight metabolites were significantly associated with fatigue in the discovery cohort (P < 0.05), of which three were significant in the replication cohort, including false discovery rate-corrected associations with gamma-glutamylglutamine (Pcombined = 6.2E-6) and asparagine (Pcombined = 3.5E-4). Notably, the abundance of gamma-glutamylglutamine in diagnostic CSF samples was also significantly associated with fatigue (P = 0.0062). CONCLUSION The metabolites identified in our assessment have been implicated in neurotransmitter transportation and glutathione recycling, suggesting that glutamatergic pathways or oxidative stress may contribute to ALL-associated CRF. This information could inform targeted therapies for reducing CRF in at-risk individuals.
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Affiliation(s)
- Austin L Brown
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
| | - Pagna Sok
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Olga Taylor
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - John P Woodhouse
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - M Brooke Bernhardt
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Lisa S Kahalley
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Michael E Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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14
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Montalvo RN, Doerr V, Nguyen BL, Kelley RC, Smuder AJ. Consideration of Sex as a Biological Variable in the Development of Doxorubicin Myotoxicity and the Efficacy of Exercise as a Therapeutic Intervention. Antioxidants (Basel) 2021; 10:antiox10030343. [PMID: 33669040 PMCID: PMC7996538 DOI: 10.3390/antiox10030343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
Doxorubicin (DOX) is an anthracycline antibiotic used to treat a wide variety of hematological and solid tumor cancers. While DOX is highly effective at reducing tumor burden, its clinical use is limited by the development of adverse effects to both cardiac and skeletal muscle. The detrimental effects of DOX to muscle tissue are associated with the increased incidence of heart failure, dyspnea, exercise intolerance, and reduced quality of life, which have been reported in both patients actively receiving chemotherapy and cancer survivors. A variety of factors elevate the probability of DOX-related morbidity in patients; however, the role of sex as a biological variable to calculate patient risk remains unclear. Uncertainty regarding sexual dimorphism in the presentation of DOX myotoxicity stems from inadequate study design to address this issue. Currently, the majority of clinical data on DOX myotoxicity come from studies where the ratio of males to females is unbalanced, one sex is omitted, and/or the patient cohort include a broad age range. Furthermore, lack of consensus on standard outcome measures, difficulties in long-term evaluation of patient outcomes, and other confounding factors (i.e., cancer type, drug combinations, adjuvant therapies, etc.) preclude a definitive answer as to whether differences exist in the incidence of DOX myotoxicity between sexes. This review summarizes the current clinical and preclinical literature relevant to sex differences in the incidence and severity of DOX myotoxicity, the proposed mechanisms for DOX sexual dimorphism, and the potential for exercise training to serve as an effective therapeutic countermeasure to preserve muscle strength and function in males and females.
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15
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Daniel LC, Gross JY, Meltzer LJ, Flannery JL, Forrest CB, Barakat LP. Clinical validity of the PROMIS pediatric sleep short forms in children receiving treatment for cancer. Pediatr Blood Cancer 2020; 67:e28535. [PMID: 32649043 DOI: 10.1002/pbc.28535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rates of sleep disturbances vary widely across pediatric cancer studies, partly due to differences in measurement tools. Patient-reported outcomes measurement information system (PROMIS) offers a rigorously developed, well-validated pair of pediatric sleep health instruments needed to advance sleep research and clinical practice in pediatric cancer. The current study evaluated the clinical validity of PROMIS pediatric sleep scales (sleep disturbances [SD] and sleep-related impairment [SRI]) among children in active cancer treatment. PROCEDURE Caregiver-patient dyads were enrolled during cancer treatment in 2-12 months after diagnosis: 45 children (ages 8-17 years) and 102 caregivers of children (ages 5-17 years) completed PROMIS SD and SRI 8-item short form self-report or caregiver-proxy scales, and caregivers reported the prior week's cancer treatments and blood counts. RESULTS Both scales demonstrated strong internal consistency reliability across reporters. SD and SRI were higher than the PROMIS general population calibration sample for caregivers and patients. Oncology caregivers reported lower SD and SRI than sleep clinic caregivers, but oncology patients were similar to sleep clinic patients. Convergent validity was evidenced through moderate correlations between scales by reporter and both scales being significantly higher in patients taking medications for sleep. There were no significant differences in SD or SRI by diagnostic group, receiving radiation, or having low blood counts. CONCLUSION The PROMIS SD and SRI short forms are promising measures for pediatric oncology, demonstrating strong internal consistency reliability and multiple indications of clinical validity. Although groups did not differ based on treatment variables, results suggest the need for universal screening for sleep problems during pediatric cancer treatment.
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Affiliation(s)
| | - J Yael Gross
- Department of Psychology, Rutgers University, Camden, NJ
| | | | | | - Christopher B Forrest
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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16
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Hooke MC, Linder LA. Symptoms in Children Receiving Treatment for Cancer-Part I: Fatigue, Sleep Disturbance, and Nausea/Vomiting. J Pediatr Oncol Nurs 2020; 36:244-261. [PMID: 31307321 PMCID: PMC7197223 DOI: 10.1177/1043454219849576] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Children and adolescents with cancer often undergo intensive chemotherapy treatment to obtain remission and long-term survival. The pursuit of successful treatment outcomes may lead to high levels of symptom distress related to treatment side effects and toxicities. The Children's Oncology Group Nursing Discipline held a State of the Science Symposium "Symptom Assessment During Childhood Cancer Treatment" in 2018 that included reviews of evidence regarding key symptoms. The purpose of this review is to summarize and synthesize the evidence presented about the prevalence, relationships, trajectories, and associated biomarkers of selected symptoms experienced by children and adolescents during cancer treatment. Five symptoms were selected, with the focus on fatigue, sleep disturbance, and nausea/vomiting and included in Part I of the review. Using Ovid-Medline, studies published between 2008 and 2018 that focused on these specific symptoms during active chemotherapy treatment were selected. Fatigue interferes with normal developmental activities and is associated with sleep disturbances, and its pattern changes within a cycle of chemotherapy as well as across the treatment trajectory. Sleep is disrupted by the hospital environment, treatment medications, and changes in normal childhood and schedules. Disturbances of sleep persist during treatment, preventing recovery from poor quality sleep. Although pharmacologic interventions have advanced for treatment of nausea and vomiting, children and adolescents continue to struggle with this symptom. Its trajectory changes with the intensity of treatment, and over half of the patients report that they experience nausea and/or vomiting. Future research is needed to advance identification of biologic risk factors for symptoms and test effectiveness of symptom-related interventions.
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Affiliation(s)
- Mary C Hooke
- 1 University of Minnesota School of Nursing, Minneapolis, MN, USA
- 2 Children's Minnesota, Minneapolis, MN, USA
| | - Lauri A Linder
- 3 University of Utah College of Nursing, Salt Lake City, UT, USA
- 4 Primary Children's Hospital, Salt Lake City, UT, USA
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17
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Reeve BB, McFatrich M, Mack JW, Pinheiro LC, Jacobs SS, Baker JN, Withycombe JS, Lin L, Mann CM, Villabroza KR, Hinds PS. Expanding construct validity of established and new PROMIS Pediatric measures for children and adolescents receiving cancer treatment. Pediatr Blood Cancer 2020; 67:e28160. [PMID: 31904157 PMCID: PMC7147933 DOI: 10.1002/pbc.28160] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/18/2019] [Accepted: 12/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures were designed to assess symptoms and functioning in children and adolescents. The study goal was to evaluate the validity and responsiveness of the PROMIS Pediatric measures in a diverse cohort of children with cancer. METHODS Children (7-18 years) from nine pediatric oncology hospitals completed surveys at 72 hours preceding treatment initiation (T1) and at follow-up (T2) approximately 7 to 17 days later for chemotherapy, and 4+ weeks later for radiation. Children completed PROMIS Pediatric measures (Mobility, Pain Interference, Fatigue, Depressive Symptoms, Anxiety, Psychological Stress), Memorial Symptom Assessment Scale (MSAS), and global impressions of change (GIC) questions on their symptoms and functioning at T2 reflecting on T1. Parents completed the Lansky Play-Performance Status (PPS) scale and medication list for their child. RESULTS The children (n = 482) were average age 12.9 years, 46% female, 60% Caucasian, and had diverse cancers and treatments. There were moderate to strong correlations between PROMIS Pediatric and MSAS, supporting convergent validity. In support for known-groups validity, the PROMIS Pediatric average scores were statistically different (P < 0.05) for most domains by PPS and if the child was on a medication (or not) for controlling a symptom. The PROMIS Pediatric measures were responsive over time in association with the GIC. CONCLUSIONS In a large, diverse sample of children and adolescents with cancer, there was strong evidence for the construct validity and responsiveness of the PROMIS Pediatric measures. This evidence supports PROMIS Pediatric measure use in pediatric oncology trials.
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Affiliation(s)
- Bryce B. Reeve
- Duke University School of Medicine, Durham, North Carolina
| | | | - Jennifer W. Mack
- Dana-Farber Cancer Institute/Boston Children’s Hospital, Boston, Massachusetts
| | | | - Shana S. Jacobs
- Children’s National Health System, Washington, District of Columbia
| | | | - Janice S. Withycombe
- Clemson University School of Nursing (formerly Emory University), Clemson, South Carolina
| | - Li Lin
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Pamela S. Hinds
- Children’s National Health System, Washington, District of Columbia
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18
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Swartz MC, Allen K, Deer RR, Lyons EJ, Swartz MD, Clifford T. A Narrative Review on the Potential of Red Beetroot as an Adjuvant Strategy to Counter Fatigue in Children with Cancer. Nutrients 2019; 11:E3003. [PMID: 31817919 PMCID: PMC6949985 DOI: 10.3390/nu11123003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 01/04/2023] Open
Abstract
Cancer-related fatigue (CRF) is a debilitating adverse effect among children with cancer and a significant barrier to physical activity (PA) participation. PA interventions are effective at reducing fatigue and improving both quality of life (QOL) and functional outcomes in children with cancer. However, 50-70% of children with cancer do not meet PA guidelines. Thus, adjuvant methods are needed to increase PA participation. Given the growing interest in the use of beetroot juice to reduce exercise-induced fatigue, our narrative review evaluated the potential use of beetroot to improve PA participation to counter CRF and improve QOL. Our review of 249 articles showed a lack of published clinical trials of beetroot in children and adults with cancer. Trials of beetroot use had been conducted in a noncancer population (n = 198), and anticancer studies were primarily in the preclinical phase (n = 40). Although results are promising, with beetroot juice shown to counter exercise-induced fatigue in a variety of athletic and patient populations, its use to counter CRF in children with cancer is inconclusive. Pilot and feasibility studies are needed to examine the potential benefits of beetroot to counter CRF, increase PA participation, and improve QOL in children with cancer.
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Affiliation(s)
- Maria C. Swartz
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA
| | - Kaitlyn Allen
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1124, USA; (K.A.); (E.J.L.)
| | - Rachel R. Deer
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1137, USA;
| | - Elizabeth J. Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1124, USA; (K.A.); (E.J.L.)
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center, School of Public Health, 1200 Pressler St., Houston, TX 77030, USA;
| | - Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK;
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle NE2 4HH, UK
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19
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Hockenberry MJ, Moore IMK, Scheurer ME, Hooke MC, Taylor OA, Koerner KM, Gundy PM, Pan W. Influence of Nitrosative Stress on Fatigue During Childhood Leukemia Treatment. Biol Res Nurs 2018; 20:403-409. [PMID: 29716390 DOI: 10.1177/1099800418772907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The focus on a cure for childhood leukemia over the last three decades has resulted in survival rates of more than 80%. However, efforts to manage leukemia-treatment symptoms have not kept pace with new therapies. Symptom toxicity during treatment can result in complications, treatment delays, and therapy dose reductions. Compromise in therapy can negatively influence the quality of life and, even more notably, jeopardize chances for long-term survival. This study examined biologic mechanisms that influence fatigue caused by increased reactive oxidative species (ROS) or actual failure of the antioxidant defense system due to genetic variation by investigating reactive nitrosative species, a "downstream" consequence of ROS. The specific aims of this study were to characterize the trajectory of nitrosative stress during acute lymphoblastic leukemia treatment and evaluate the influence of nitrosative stress on fatigue. A repeated measures design was used to evaluate the fatigue experienced by 186 children and adolescents, 3-18 years of age, with a diagnosis of leukemia during the most intense phase of treatment. An established biomarker of nitrosative stress, protein 3-nitrotyrosine (3NT) residues in the cerebral spinal fluid, was evaluated at diagnosis, postinduction, and consolidation phases of treatment. Higher fatigue was associated with higher 3NT levels at the beginning of treatment. Two distinct groups of children experienced either consistently high or consistently low 3NT levels across the treatment trajectory, from diagnosis to 12 months postinduction. Findings from this study support continued exploration into the phenotypic biochemical mechanisms that influence a reactive response to childhood cancer treatment.
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Affiliation(s)
| | - Ida M Ki Moore
- 2 Biobehavioral Health Science Division, College of Nursing, The University of Arizona, Tucson, AZ, USA
| | - Michael E Scheurer
- 3 Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX, USA.,4 Population Sciences Biorepository, Baylor College of Medicine, Houston, TX, USA
| | - Mary C Hooke
- 5 School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Olga A Taylor
- 3 Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX, USA
| | - Kari M Koerner
- 6 College of Nursing, The University of Arizona, Tucson, AZ, USA
| | - Patricia M Gundy
- 6 College of Nursing, The University of Arizona, Tucson, AZ, USA
| | - Wei Pan
- 1 School of Nursing, Duke University, Durham, NC, USA
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20
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Graef DM, Crabtree VM, Srivastava DK, Li C, Pritchard M, Hinds PS, Mandrell B. Sleep and mood during hospitalization for high-dose chemotherapy and hematopoietic rescue in pediatric medulloblastoma. Psychooncology 2018; 27:1847-1853. [PMID: 29663636 DOI: 10.1002/pon.4737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Disrupted sleep is common in pediatric cancer, which is associated with psychological distress and may impact neural recovery. Information regarding sleep during pediatric brain tumor treatment is limited. This study aimed to describe objective sleep-wake patterns and examine the sleep-mood relation in youth hospitalized for intensive chemotherapy and stem cell rescue. METHODS Participants included 37 patients (M age = 9.6 ± 4.2 years) enrolled on a medulloblastoma protocol (SJMB03) and their parents. Respondents completed a mood disturbance measure on 3 days, and patients wore an actigraph for 5 days as an objective estimate of sleep-wake patterns. General linear mixed models examined the relation between nocturnal sleep and next-day mood, as well as mood and that night's sleep. RESULTS Sleep duration was deficient, sleep efficiency was poor, and daytime napping was common, with large between-subjects variability. There were minimal mood concerns across all days. The sleep and next-day mood relationship was nonsignificant (P > .05). Greater parent-reported child mood disturbance on day 2 was associated with decreased same-night sleep (P < .001) and greater patient-reported mood disturbance was associated with greater same-night sleep latency (P = .036). CONCLUSIONS Patients with medulloblastoma are vulnerable to disturbed sleep during hospitalization, and mood may be an important correlate to consider. Sleep and mood are modifiable factors that may be targeted to maximize daytime functioning.
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Affiliation(s)
- Danielle M Graef
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michele Pritchard
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Memphis, TN, USA.,Department of Pediatrics, George Washington University Washington, District of Columbia, Washington, DC, USA
| | - Belinda Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
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21
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Bevans M, El-Jawahri A, Tierney DK, Wiener L, Wood WA, Hoodin F, Kent EE, Jacobsen PB, Lee SJ, Hsieh MM, Denzen EM, Syrjala KL. National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report. Biol Blood Marrow Transplant 2017; 23:538-551. [PMID: 27660168 PMCID: PMC5346334 DOI: 10.1016/j.bbmt.2016.09.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/20/2022]
Abstract
In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations. Patient-centered outcomes were summarized within physical, psychological, social, and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of patient-centered outcome measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included integration of annual screening of patient-centered outcomes, use of evidence-based practice guidelines, and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included the following: (1) design and test risk-targeted interventions with dose-intensity modulation matching the needs of HCT survivors with priority domains, including sexual dysfunction, fatigue, sleep disruption, nonadherence to medications and recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplantation centers; (2) design a consensus-based methodologic framework for outcomes evaluation; and (3) evaluate and compare existing practices for integrating patient-centered outcome screening and interventions across HCT survivorship programs.
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Affiliation(s)
- Margaret Bevans
- Nursing Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Areej El-Jawahri
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - D Kathryn Tierney
- Division of Primary, Preventive and Community Medicine, Stanford University, Stanford, California
| | - Lori Wiener
- Psychosocial Support and Research Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - William A Wood
- Division of Hematology and Oncology, University of North Carolina, Durham, North Carolina
| | - Flora Hoodin
- Department of Psychiatry, University of Michigan & Department of Psychology, Eastern Michigan University, Ann Arbor, Michigan
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Paul B Jacobsen
- Psychosocial and Palliative Care Program, Moffitt Cancer Center, Tampa, Florida
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthew M Hsieh
- Molecular and Clinical Hematology Branch, National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland
| | - Ellen M Denzen
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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22
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Rodgers C, Sanborn C, Taylor O, Gundy P, Pasvogel A, Moore IMK, Hockenberry MJ. Fatigue and Oxidative Stress in Children Undergoing Leukemia Treatment. Biol Res Nurs 2016; 18:515-20. [PMID: 27179013 DOI: 10.1177/1099800416647794] [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] [Indexed: 11/15/2022]
Abstract
Fatigue is a frequent and distressing symptom in children undergoing leukemia treatment; however, little is known about factors influencing this symptom. Antioxidants such as glutathione can decrease symptom severity in adult oncology patients, but no study has evaluated antioxidants' effects on symptoms in pediatric oncology patients. This study describes fatigue patterns and associations of fatigue with antioxidants represented by reduced glutathione (GSH) and the reduced/oxidized glutathione (GSH/GSSG) ratio among children receiving leukemia treatment. A repeated measures design assessed fatigue and antioxidants among 38 children from two large U.S. cancer centers. Fatigue was assessed among school-age children and by parent proxy among young children. Antioxidants (GSH and GSH/GSSG ratio) were assessed from cerebrospinal fluid at four phases during leukemia treatment. Young children had a steady decline of fatigue from the end of induction treatment through the continuation phase of treatment, but no significant changes were noted among the school-age children. Mean antioxidant scores varied slightly over time; however, the GSH/GSSG ratios in these children were significantly lower than the normal ratio. Mean GSH/GSSG ratios significantly correlated to fatigue scores of the school-age children during early phases of treatment. Children with low mean GSH/GSSG ratios demonstrated oxidative stress. The low ratios noted early in therapy were significantly correlated with higher fatigue scores during induction and postinduction treatment phases. This finding suggests that increased oxidative stress during the more intensive phases of therapy may explain the experience of fatigue children report.
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Affiliation(s)
| | - Chelse Sanborn
- Duke Children's Hospital & Health Center, Durham, NC, USA
| | | | - Patricia Gundy
- University of Arizona College of Nursing, Tucson, AZ, USA
| | - Alice Pasvogel
- University of Arizona College of Nursing, Tucson, AZ, USA
| | - Ida M Ki Moore
- University of Arizona College of Nursing, Tucson, AZ, USA
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