Fatigue in adolescents with and following a cancer diagnosis

Conducting focus groups with children and young people: strategies for success

Focus groups have become a popular and widely used method in qualitative research across the diversity of healthcare. Their use however has been applied mainly to research with adult participants. Only in the last 10 years have we witnessed an expansion in their use with children and young people. This paper describes briefly the characteristics of focus groups before focusing exclusively on the methodological and practical concerns when conducting focus groups with children and young people. Focus groups require considerable preparation and skill to run. Strategies are detailed in this paper to achieve two important outcomes, successful data collection and a positive experience for participants.

Fatigue and Sleep Experiences at Home in Children and Adolescents With Cancer

PURPOSE/OBJECTIVES

To (a) investigate fatigue and sleep patterns of children and adolescents at home and (b) examine factors associated with fatigue and sleep..

DESIGN

Descriptive with repeated measures
.

SETTING

Homes of study participants in Los Angeles and Orange, California
.

SAMPLE

35 children and adolescents with cancer.

METHODS

Data were collected using the PedsQL Multidimensional Fatigue Scale, which was completed once at home by each participant, and sleep actigraphs, which were worn for five days at home following discharge from hospitalization
.

MAIN RESEARCH VARIABLES

General fatigue, cognitive fatigue, sleep-rest fatigue, sleep duration, sleep quantity, sleep efficiency, and wake after sleep onset
.

FINDINGS

More than half of the participants had problems with fatigue at home. Significant correlations were found between sleep/rest fatigue and sleep duration. Factors that affected fatigue were age, gender, and cancer diagnosis. Adolescents had more problems with fatigue than children, and female patients had more problems with fatigue than male patients. Patients with sarcoma had more problems with fatigue than those with leukemia, lymphoma, and other cancer diagnoses. Adolescents slept less than children.

CONCLUSIONS

Children and adolescents with cancer have fatigue and sleep problems at home that vary by age, gender, and cancer diagnosis
.

IMPLICATIONS FOR NURSING

Data from the current study support the need for nurses to provide teaching about fatigue and sleep at home in children and adolescents with cancer. Future studies are needed to examine interventions that may alleviate fatigue and improve sleep at home
.

The relationships between fatigue, quality of life, and family impact among children with special health care needs

OBJECTIVE

To examine the relationships among pediatric fatigue, health-related quality of life (HRQOL), and family impact among children with special health care needs (CSHCNs), specifically whether HRQOL mediates the influence of fatigue on family impact.

METHODS

266 caregivers of CSHCNs were studied. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, Pediatric Quality of Life Inventory Generic Scale, and Impact on Family Scale were used to measure fatigue, HRQOL, and family impact, respectively. Linear regressions were used to analyze the designated relationships; path analyses were performed to quantify the mediating effects of HRQOL on fatigue-family impact relationship.

RESULTS

Although greater fatigue was associated with family impact (p < .05), the association was not significant after accounting for HRQOL. Path analyses indicated the direct effect of fatigue on family impact was not significant (p > .05), whereas physical and emotional functioning significantly mediated the fatigue-family impact relationship (p < .001).

CONCLUSION

Fatigue is related to family impact among CSHCNs, acting through the impairment in HRQOL.

Psychometric properties of instruments used to measure fatigue in children and adolescents with cancer: a systematic review

CONTEXT

Despite the recognized distressing symptom of fatigue in children with cancer, little information is available to assist in the selection of an instrument to be used to measure fatigue.

OBJECTIVES

The objectives of this study were to 1) describe the instruments that have been used to measure cancer-related fatigue in children and adolescents and 2) summarize the psychometric properties of the most commonly used instruments used to measure fatigue in children and adolescents with cancer.

METHODS

Five major electronic databases were systematically searched for studies using a fatigue measurement scale in a population of children or adolescents with cancer. Fatigue scales used in those studies were included in the review.

RESULTS

From a total of 1753 articles, 25 were included. We identified two main fatigue measurement instruments used in a pediatric oncology population: 1) the Fatigue Scale-Child/Fatigue Scale-Adolescent and the proxy report versions for parents and staff and 2) the PedsQL™ Multidimensional Fatigue Scale. These two scales show similar attributes with reasonably good internal consistency and responsiveness.

CONCLUSION

Either the Fatigue Scale or PedsQL Multidimensional Fatigue Scale can be incorporated into clinical research. Future research should focus on identifying specific fatigue measures more suited to different purposes such as comparative trials or identification of high-risk groups.

High fatigue scores before and after surgical treatment of bone and soft tissue tumors

The first objective of the present study was to investigate fatigue severity in patients diagnosed with bone and soft tissue tumors prior to the surgical treatment of the tumor and 6 months post-operatively. The second objective was to determine which variables are associated with severe fatigue. Patients diagnosed with benign or low-grade malignant bone and soft tissue tumors, undergoing surgical therapy for the tumor only, were included in this study. The control group contained patients scheduled for knee arthroscopy for suspected meniscus tears. Fatigue, pain, anxiety and self-efficacy were measured pre-operatively and after 6 months and each patient wore an actometer to quantify physical activity. In the tumor group of 43 patients, 35% were severely fatigued pre-operatively and 33% post-operatively. The tumor group reported a significantly higher level of anxiety. No differences were observed in pain, physical limitations, self-efficacy or actometer scores. Multiple regression analysis of the tumor group revealed that higher pain scores, higher state anxiety and lower self-efficacy were asssociated with fatigue severity. In the control group of 24 knee arthroscopy patients, the percentage of severely fatigued patients decreased from 38% (n=9) prior to treatment to 29% (n=7) 6 months later. A substantial number of patients were severely fatigued in both the tumor group and the knee arthroscopy group. Self-efficacy, pain and anxiety appear to be the most important variables associated with fatigue severity in tumor patients prior to surgery.

Review of symptom experiences in children and adolescents with cancer

BACKGROUND

Inadequate symptom relief in children and adolescents with cancer leads to unnecessary suffering. This review assesses research on children and adolescents with cancer that had been published from 2002 to 2010.

OBJECTIVES

The review identifies the symptom experiences of children and adolescents undergoing treatment and describes the progress that has been made since Docherty's 2003 systematic review of nurse researcher published studies from 1990 to 2002, which identified gaps in research on the symptoms of pediatric oncology patients.

METHOD

A computerized search of medical and nursing literature produced 50 published studies and 2 dissertations that addressed the symptom experiences of children and adolescents receiving treatment for cancer.

RESULTS

Pain from cancer-related procedures and fatigue were the most frequently identified symptoms, followed closely by nausea and vomiting. More preschool-aged subjects and nonwhite subjects need to be assessed, distinctions between age groups and gender should be explored, and instrumentation for the prereading group must be developed.

CONCLUSIONS

Research on symptoms experienced by children and adolescents has gained momentum within the last 10 years, and some of the gaps identified by Docherty have been addressed. Multicenter trials would increase sample sizes and decrease enrollment time.

IMPLICATIONS FOR PRACTICE

By synthesizing research completed from 2002 to 2010 on symptoms of children who had cancer, new ideas can be generated and shared with clinical nursing staff to improve patient care. Gaps to further direct research are also identified.

Psychometric and clinical assessment of the 13-item reduced version of the fatigue scale-adolescent instrument

Fatigue is one of the most common and distressing symptoms experienced by adolescents during and after treatment for cancer. The lack of reliable and valid instruments has prevented an accurate assessment of the trajectory of fatigue among adolescent oncology patients. The purposes of this study were to identify the items on the Fatigue Scale-Adolescent (FS-A) that distinguished adolescents with high fatigue and to identify the most sensitive and specific score ("cut score") in order to identify those in need of a fatigue intervention. Rasch methods were used to identify FS-A items that distinguished adolescents with high cancer-related fatigue, and results indicated that the 14-item FS-A could be reduced to 13 items. The 13-item FS-A was assessed for its psychometric properties, with application of the receiver operating characteristics curve analysis to the responses from 75 adolescents. The internal consistency coefficient was .87, and a 4-factor confirmatory analysis achieved good fit coefficients. The identified cut score was 31, with 66.6% sensitivity and 82.6% specificity; 16 (21.33%) of the patients scored 31 or higher. The 13-item FS-A has acceptable psychometric properties and is able to identify adolescent oncology patients with high fatigue.

Reliability and validity of the PedsQL™ Multidimensional Fatigue Scale in Japan

PURPOSE

To examine the reliability and validity of the Japanese-language version of the PedsQL™ Multidimensional Fatigue Scale and to investigate the agreement between child self-reported fatigue and parent proxy-reported fatigue.

METHODS

The Japanese-language version of the PedsQL™ Multidimensional Fatigue Scale was administered to 652 preschoolers and schoolchildren aged 5-12 and their parents, and to 91 parents of preschool children aged 1-4.

RESULTS

Internal consistency reliability was 0.62-0.87 for children and 0.81-0.93 for parents. Known-group validity was examined between a group of healthy samples (n = 530) and chronic condition sample (n = 102); the chronically ill group reported a significantly higher perceived fatigue problem. Correlations between child self- and parent proxy reports ranged from poor to fair. In subgroups identified by cluster analysis based on child self-reported scores, the greatest agreement between child and parent reports was seen in the good HRQOL group, while the least occurred in the poor HRQOL group. The parents overestimated their child's fatigue more when the child's HRQOL was low.

CONCLUSION

The Japanese-language version of the PedsQL™ Multidimensional Fatigue Scale demonstrated good reliability and validity and could be useful in evaluating Japanese children in school and health care settings.

Health Professionals’ Estimation of Cancer-Related Fatigue in Children

Many studies show that cancer-related fatigue is one of the most common symptoms experienced by children as a side effect of cancer therapy. This problem has grown considerably in recent years; the exact mechanisms underlying fatigue remain unclear. Therefore, assessing and managing this symptom can be problematic. This article describes the findings from a survey evaluating how health professionals (n = 56) at the Pediatric Oncology Centers in Izmir currently define and assess cancer-related fatigue. The results demonstrate that while the problems associated with fatigue are acknowledged, assessment tools are not widely used, and the majority of health professionals report that they would benefit from further education on the subject to assist in the care of patients.

Patterns of fatigue in adolescents receiving chemotherapy

PURPOSE/OBJECTIVES

To describe patterns of fatigue in adolescents and the impact of fatigue during one month of chemotherapy, to explore variables that affect fatigue, and to explore the feasibility of collecting daily self-report data in this population.

DESIGN

Longitudinal, descriptive.

SETTING

Two pediatric oncology centers in central Virginia.

SAMPLE

20 adolescents with a variety of cancer diagnoses receiving chemotherapy.

METHODS

Adolescents described daily fatigue for one month using rating scales and qualitative diaries.

MAIN RESEARCH VARIABLES

Fatigue severity.

FINDINGS

Adolescents commonly reported a peak in fatigue in the days immediately following chemotherapy administration. The most common pattern for adolescents who received chemotherapy on a schedule every three to four weeks was a "declining rollercoaster" pattern, with fatigue severity alternating on a daily basis but gradually declining until chemotherapy was scheduled again. Adolescents who received chemotherapy weekly showed more frequent peaks and troughs (the "yo-yo" pattern) that did not diminish in severity over the weeks of the study. Adolescents associated fatigue with other symptoms, particularly sleep-wake disturbances, pain, and nausea, and frequently reported that fatigue interfered with daily activities.

CONCLUSIONS

Fatigue commonly bothers adolescents receiving chemotherapy, particularly in the days following chemotherapy administration and when other symptoms are present. Although fatigue interfered with the adolescents' abilities to maintain their usual lifestyles, many still participated in the typical activities of adolescence.

IMPLICATIONS FOR NURSING

Fatigue is a complex and dynamic symptom. Oncology clinicians and researchers should frequently assess fatigue in adolescents receiving chemotherapy and apply timely and tailored interventions to match the factors that contribute to fatigue and influence fatigue severity. Management of fatigue during treatment will help adolescents stay involved in age-related activities and meet developmental milestones.

The complexity of symptoms and problems experienced in children with cancer: a review of the literature

To adequately help children with cancer, care providers need to understand the complexity of symptoms and problems associated with the illness that children are experiencing, which can enable them to better tailor patient care individually to each child. In this integrative literature review, we identified the types of symptoms and problems that children with cancer can experience during treatment and rehabilitation; the terms/expressions they use to describe their symptoms and problems; how children's symptoms and problems vary during the course of their illness; and how they vary and co-vary with age, gender or race. Of the 1175 titles identified, 110 articles met the inclusion criteria and were included in the review. Seventy-eight were research-based. A total of 219 distinct symptoms or problems were identified in the literature either as the main problem or a symptom of the main problem. There is significant evidence that children and adolescents experience numerous and complex symptoms, and problems during and after treatment for cancer. Children use many different expressions to talk about their symptom experiences. However, few articles looked at how children's symptoms and problems varied during the course of their illness or the variations in symptom severity and degree of bother, or examined the relationship between children's symptom experience and age, gender, or race. Most instruments that were used to measure symptoms were interviewer-administered questionnaires, often adaptations from adult versions, and in younger children, symptoms were often obtained from adult informants. The insights gained from this review can be helpful to researchers and clinicians who wish to better understand how symptoms and problems are experienced from the children's own perspective. However, more research is needed: to better understand differences in symptom experiences among different age groups; to identify differences among children from distinct cultural, ethnic, or socio-economic backgrounds; to clarify how symptoms and problems interfere with daily life; and to refine assessment methods that allow even younger children to communicate their symptom experiences in an age-adjusted manner.

Chemotherapy-Related Fatigue in Childhood Cancer: Correlates, Consequences, and Coping Strategies

The aim of this research is to examine the experience and impact of chemotherapy-related fatigue in recently diagnosed pediatric oncology patients. A repeated-measures, within-subjects, mixed (quantitative plus qualitative) design was used to prospectively assess fatigue during early chemotherapy cycles and to compare fatigue to depressive symptoms. Parental interviews collected concurrently were analyzed for descriptions of the child's fatigue and mood states and for strategies to cope with fatigue. Results indicated a significant correlation between fatigue and depression, but qualitative analyses suggested that the 2 phenomena may be unique and distinguishable. Qualitative analyses of parent interviews also identified specific strategies that were frequently used in response to high levels of fatigue. The findings illustrate the significant impact of chemotherapy-related fatigue in children being treated for cancer. The study also provides guidance for the assessment of fatigue and related symptoms and identifies specific strategies for coping with fatigue.

Prevalence of aspects of distress, coping, support and care among adolescents and young adults undergoing and being off cancer treatment

The overall aim is to describe the prevalence of physical and psychosocial distress, coping, support and care among adolescents and young adults who are both undergoing and off cancer treatment, and who find life satisfying or less satisfying. Prevalence of distress, coping, support and care were investigated using the Life Situation Scale for Adolescents (LSS-A) answered by 15 adolescents and young adults undergoing cancer treatment and 39 adolescents and young adults off cancer treatment. More adolescents and young adults receiving treatment reported problems with fatigue, eating, hair loss, taking medications/tablets and having to plan everything according to hospital visits than those adolescents and young adults off treatment. Fewer adolescents and young adults who reported finding life satisfying reported problems with fatigue, eating, not having any influence on their own life, often being sad and problems with school/work than those finding life less satisfying. Whether adolescents and young adults find life satisfying or not is not related to whether they are undergoing or off cancer treatment. The findings indicate the importance for those working with adolescent cancer victims to be alert of the fact that the treatment period is connected with more problems related to physical distress than the period after treatment, whereas aspects of psychosocial distress are as prevalent during the treatment period as they are after.

Experience of fatigue in adolescents living with cancer

This article reports on a small-scale exploratory study conducted with cohorts of adolescents during and after treatment of cancer to explore experiences of fatigue and perceptions of its impact on functioning. A concurrent mixed method design was used to enable detailed understanding of the phenomenon of fatigue in these groups of individuals through convergence of quantitative and qualitative data. Participants completed an investigator-designed Fatigue and Quality of Life Diary for a period of 1 week. Second, they took part in a semistructured interview to explore issues around fatigue and functioning in more detail. Eight adolescents undergoing treatment participated in the study, along with 6 in early remission (1-2 years off treatment) and 8 receiving follow-up (5 or more years off treatment). Data gained from these sources suggested that fatigue can be a considerable problem for adolescents during and after treatment, and that it may not necessarily abate quickly. Some individuals perceived that their quality of life remained compromised many years after treatment, and it seemed that fatigue might play an important part in this. These preliminary findings suggest that research into management of fatigue in this adolescent group is warranted, along with research and development to determine how best to provide supportive care once treatment finishes.

Researching chronic childhood illness: the example of childhood cancer

OBJECTIVES

To provide an overview of issues raised by conducting research in the area of chronic childhood illness, using the example of childhood cancer.

METHODS

This literature review used informal methods.

RESULTS

Children with cancer and their families may participate in a wide variety of studies in different research traditions, including social science studies, epidemiological, biological and genetic research, and clinical trials. Different concerns about research participation have been raised in these different contexts. Sociological debate has tended to characterize exclusion from research as a manifestation of assumptions of poor competence on the part of children, and to see inclusion in research as a means of restoring proper balance in power relations and giving children a voice. The ethical imperative within clinical research, on the other hand, has been in favour of protection of individuals from risk or direct harm. Lack of consensus on issues such as the status of children's consent for research participation persists, in part because debates have taken place within rather than across disciplinary boundaries, and in part because of a tendency to debate issues as ethical principles in an empirical vacuum. The lack of research on the experiences and views of those asked to take part in childhood cancer research is striking.

DISCUSSION

It is important that debates about the involvement of children in research are informed by high-quality social science research and by interdisciplinary dialogue.

A phenomenologic study of fatigue in adolescents receiving treatment for cancer

PURPOSE/OBJECTIVES

To generate a detailed description of how adolescents with cancer manage their daily lives and the way in which fatigue affects this.

DESIGN

Phenomenologic.

SETTING

A pediatric oncology unit at a regional cancer center in the United Kingdom.

SAMPLE

A convenience sample of adolescents (N = 8), aged 16-19 years and with hematologic or solid tumors, who currently were undergoing primary treatment.

METHODS

Semistructured interviews were conducted using 11 open-ended questions.

MAIN RESEARCH VARIABLES

Adolescents' perceptions of fatigue, well-being, and ability to maintain normal activities.

FINDINGS

Adolescents reported fatigue as overwhelming and embedded in a syndrome of symptoms and emotions associated with the illness itself and with treatment. Fatigue had a significant effect on physical, psychological, and social well-being, placing an extra burden on adolescents who were striving for normality.

CONCLUSIONS

Equipped with a rich description of fatigue, clinicians will be better prepared to initiate strategies congruent with their own work settings and particular patients.

IMPLICATIONS FOR NURSING

The findings should enable healthcare professionals to construct a more accurate and perceptive picture of the needs of particular individuals, highlighting those that may be amenable to intervention.