1
|
Montgomery KE, Basha M, Nyholm L, Smith C, Ananiev G, Fedorov A, Kapoor A, Brown R, Capitini C, Kwekkeboom K. Exploring Inflammation and Stress as Biological Correlates of Symptoms in Children With Advanced Cancer: A Longitudinal Feasibility Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:157-171. [PMID: 38588659 DOI: 10.1177/27527530231214544] [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: 04/10/2024]
Abstract
Background: Few studies have examined biomarkers of stress and inflammation as underlying mechanisms of symptoms in adolescents and young adults with cancer. This study determined the feasibility of collecting blood and saliva samples across time, described the range and distribution of biomarkers, and explored the association of biomarkers with symptom adverse events (AEs). Method: This longitudinal, prospective repeated-measures single-site feasibility study recruited N = 10 children (M = 12.5 years) receiving treatment for advanced cancer. Symptom AE data and inflammation (cytokines and C-reactive protein) and physiologic response to stress (salivary cortisol and salivary alpha-amylase) biomarker levels were collected at three time points. Descriptive statistics were used to examine feasibility and acceptability and to summarize symptom AE, stress, and inflammatory biomarker data. A linear regression model was used to determine cortisol diurnal slopes. The relationship between symptom and inflammatory biomarker data was explored and Hedges's g statistic was used to determine its effect size. Results: Participants provided 83% of saliva samples (n = 199/240) and 185 samples were sufficient to be analyzed. Nurses collected 97% (n = 29/30) of blood samples. Participants reported the saliva collection instructions, kits, and reminders were clear and helpful. Insomnia, pain, fatigue, and anxiety demonstrated the most medium and large negative effects with inflammatory markers. Symptom AEs demonstrated the highest number of medium and large negative effects with interleukin-8 and tumor necrosis factor-alpha (-0.53 to -2.00). Discussion: The results indicate longitudinal concurrent collection of symptom and biomarker data is feasible and inflammatory and stress biomarkers merit consideration for inclusion in future studies.
Collapse
Affiliation(s)
| | - Mays Basha
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Leah Nyholm
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Corey Smith
- Department of Medicine - Pulmonary/Critical Care, UW Health, Madison, WI, USA
| | - Gene Ananiev
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alexander Fedorov
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amita Kapoor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Roger Brown
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Christian Capitini
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | |
Collapse
|
2
|
Al-Saadi LS, Chan MF, Al Sabahi A, Alkendi J, Al-Mashaikhi N, Sumri HA, Al-Fahdi A, Al-Azri M. Prevalence of anxiety, depression, and post-traumatic stress disorder among Omani children and adolescents diagnosed with cancer: a prospective cross-sectional study. BMC Cancer 2024; 24:518. [PMID: 38654218 DOI: 10.1186/s12885-024-12272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Children and adolescents diagnosed with cancer often experience psychological distress, encompassing anxiety, depression, and post-traumatic stress disorder (PTSD). This study aimed to evaluate the prevalence of these conditions among Omani children and adolescents diagnosed with cancer, alongside identifying contributing factors. METHODS A prospective cross-sectional study was conducted from October 2021 to June 2023 among a cohort of Omani children and adolescents (6-18 years old) diagnosed with cancer at three primary cancer referral centres in Oman. Validated Arabic-language versions of the Screen for Child Anxiety Related Disorders, the Center for Epidemiologic Studies Depression Scale for Children, and the Impact of Event Scale-Revised instruments were used to assess symptoms of anxiety, depression, and PTSD, respectively. An initial assessment (T1) was undertaken within the first 3 months of diagnosis, followed by a second assessment (T2) 3-6 months later. RESULTS Of 113 eligible participants, 101 agreed to participate in the study (response rate: 95.6%), with 92 (91.0%) completing both assessments and included in the final analysis. Prevalence rates of anxiety, depression, and PTSD decreased from 43.5%, 56.5%, and 32.6%, respectively, at T1, to 38.0%, 35.9%, and 23.9% at T2. All average scores were below diagnostic cut-off points, except for the depression score at T1. Anxiety and depression scores decreased significantly (p = 0.043 and 0.001, respectively) between T1 and T2, as did the overall prevalence of depression (p = 0.004). At T1, linear regression analysis showed significant correlations between anxiety scores and the child's age and PTSD score (p < 0.05); these variables were also correlated with depression scores (p ≤ 0.001). At T2, significant correlations were observed between anxiety scores and the child's age and PTSD scores (p < 0.001). At both T1 and T2, anxiety, depression, and PTSD scores remained significantly correlated (p < 0.001). CONCLUSIONS Omani children and adolescents recently diagnosed with cancer exhibit a high prevalence of anxiety, depression, and PTSD over time. Age-appropriate communication, ongoing support, and mental health services are recommended to help this patient group cope with their diagnosis and manage their emotional wellbeing. There is a need for future research to determine the effectiveness of specific psychological interventions in reducing the frequency of these disorders.
Collapse
Affiliation(s)
- Laila S Al-Saadi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Postal Code 123, Al Khoud, Al Khoud, Muscat, PO Box 38, Oman
| | - Moon Fai Chan
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Postal Code 123, Al Khoud, Al Khoud, Muscat, PO Box 38, Oman
| | - Amal Al Sabahi
- National Oncology Centre, Royal Hospital, Bawshar, Muscat, Oman
| | - Jalila Alkendi
- National Oncology Centre, Royal Hospital, Bawshar, Muscat, Oman
| | - Nawal Al-Mashaikhi
- Department of Child Health, Sultan Qaboos University Hospital, Al Khoud, Muscat, Oman
| | - Hana Al Sumri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Postal Code 123, Al Khoud, Al Khoud, Muscat, PO Box 38, Oman
| | - Amal Al-Fahdi
- Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Al Khoud, Muscat, Oman
| | - Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Postal Code 123, Al Khoud, Al Khoud, Muscat, PO Box 38, Oman.
| |
Collapse
|
3
|
Walsh S, Mulraney M, McCarthy MC, De Luca CR. Fatigue in children who have recently completed treatment for acute lymphoblastic leukemia: a longitudinal study. Health Qual Life Outcomes 2024; 22:27. [PMID: 38519964 PMCID: PMC10960388 DOI: 10.1186/s12955-024-02241-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND This study examined fatigue in patients treated for childhood acute lymphoblastic leukemia (ALL) over a 2-year period (3- to 27-months post-treatment completion), from the perspective of children and parent caregivers, compared to a healthy comparison group. METHODS Eighty-three patients (4-16 years at enrolment) and their parents, reported on the child's fatigue using the Pediatric Quality of Life Inventory- Multidimensional Fatigue Scale (PedsQL-MFS), at 3- 15- and 27-months post-treatment completion, and 53 healthy children and their parents reported on fatigue across the same timepoints. RESULTS Parent proxy-reporting showed that parents of ALL patients reported more total fatigue than parents of the comparison group at all time points, with all subscales elevated (general, cognitive, and sleep/rest fatigue). In contrast, patient self-report of fatigue over this period differed from the comparison children for the general fatigue subscale only. Self-reported total fatigue was worse than the comparison group at the 27-month timepoint, with cognitive and sleep/rest fatigue symptoms contributing to this difference. Expected improvements in fatigue over time were not evident in either patient or parent report and no demographic risk factors were identified. Parents and children from both groups reported significantly more fatigue at all time points compared to commonly utilised normative population data. CONCLUSIONS Patients treated for childhood ALL are impacted by fatigue symptoms in the post-treatment and early survivorship period. These findings highlight that patients in the 2-years following treatment require increased symptom surveillance and may benefit particularly from interventions that target cognitive and sleep/rest fatigue.
Collapse
Affiliation(s)
- S Walsh
- Institute for Social Neuroscience, ISN Psychology, Heidelberg, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - M Mulraney
- Institute for Social Neuroscience, ISN Psychology, Heidelberg, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - M C McCarthy
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Children's Cancer Centre, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Cinzia R De Luca
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
- Children's Cancer Centre, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
| |
Collapse
|
4
|
Zhang Q. Coping styles and the developmental trajectories of anxiety symptoms in children during transition into early adolescence. Br J Psychol 2024. [PMID: 38502134 DOI: 10.1111/bjop.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
The study investigated how active and avoidant coping styles predicted the trajectory membership of anxiety symptoms during the transition into early adolescence. A total of 321 Chinese children aged 9 to 10 years were recruited from a primary school in mainland China. Self-reported trait anxiety, coping styles and anxiety symptoms were assessed at baseline. After 6 months, self-reported anxiety symptoms were measured at three follow-up assessments with an interval of 6 months. Latent class growth modelling revealed high (18.7%) and low (81.3%) trajectories of anxiety symptoms in children during the transition into early adolescence. After controlling for trait anxiety, depression and sex, high active coping style predicted the trajectory of high anxiety symptoms, which was not moderated by trait anxiety. Before controlling for these covariates, the relation between active coping style and anxiety symptoms was in the opposite direction. A high avoidant coping style showed a trend to predict the trajectory of high anxiety symptoms only for children with low trait anxiety. These findings add a developmental context to the relationships of active and avoidant coping styles to anxiety symptoms and suggest that trait anxiety may moderate these relationships.
Collapse
Affiliation(s)
- Qiaochu Zhang
- Department of Social and Behavioural Sciences, College of Humanities and Social Sciences, City University of Hong Kong, Kowloon, Hong Kong
| |
Collapse
|
5
|
Wang M, Fang J, Hu X, Cai T, Wu F, Lin Y. Chemotherapy-related symptoms in children with leukemia: application of latent profile analysis and network analysis. Support Care Cancer 2024; 32:207. [PMID: 38436749 DOI: 10.1007/s00520-024-08410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Children with leukemia may experience a range of chemotherapy-related symptoms. Identifying subgroups and their distinct characteristics of symptoms may improve symptom management. We aimed to identify subgroups and their distinct characteristics of chemotherapy-related symptoms in children with leukemia. METHODS A cross-sectional survey was conducted among 500 children with leukemia, who completed questionnaires that assessed their demographic and clinical characteristics, as well as the Memorial Symptom Assessment Scale. Latent profile analysis was conducted to identify subgroups of symptoms. Additionally, multiple regression analysis and network analysis were utilized to reveal the characteristics of each subgroup. RESULTS Four subgroups were identified: "Profile 1: low symptom burden subgroup" (26.2%), "Profile 2: moderate symptom burden subgroup in transitional period" (14.8%), "Profile 3: moderate psychological symptom burden subgroup" (35.6%), and "Profile 4: high symptom burden subgroup" (23.4%). Multiple logistic regression analysis indicated that lower primary caregiver's education level, lower family monthly income, self-paid medical expenses, induction remission period, and consolidation enhancement period were associated with more severe symptoms of subgroups. Network analysis further revealed that nausea was the core symptom in Profiles 1 and 2, while the core symptom in Profile 3 was "I don't look like myself." Additionally, worrying was the core symptom in Profile 4. CONCLUSION There exists heterogeneity in chemotherapy-related symptoms. Four subgroups and their corresponding characteristics of children with varying symptom severity were identified. Identifying these subgroups will facilitate personalized care, maximize intervention effectiveness, and alleviate symptom burden.
Collapse
Affiliation(s)
- Meixiang Wang
- Department of Nursing, Guangzhou Women and Children's Medical Center, No.9 Huasui Road, Guangzhou, 510620, China
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jia Fang
- School of Nursing, Guangzhou Medical University, Guangzhou, China.
| | - Xiaoyan Hu
- Department of Nursing, Guangzhou Women and Children's Medical Center, No.9 Huasui Road, Guangzhou, 510620, China
| | - Tingting Cai
- School of Nursing, Fudan University, Shanghai, China
| | - Fulei Wu
- School of Nursing, Fudan University, Shanghai, China
| | - Yan Lin
- Department of Nursing, Guangzhou Women and Children's Medical Center, No.9 Huasui Road, Guangzhou, 510620, China.
| |
Collapse
|
6
|
Ruan H, Sun J, Zhao K, He M, Yuan C, Fu L, Shen N. Subjective Toxicity Profiles of Children With Cancer During Treatment: A Latent Class Analysis. Cancer Nurs 2024; 47:E1-E9. [PMID: 36881644 DOI: 10.1097/ncc.0000000000001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Children and adolescents may experience a variety of subjective adverse events (AEs) caused by cancer treatment. The identification of distinct groups of patients is crucial for guiding symptomatic AE management interventions to prevent AEs from worsening. OBJECTIVE The aim of this study was to identify subgroups of children with cancer experiencing similar patterns of subjective toxicities and evaluate differences among these subgroups in demographic and clinical characteristics. METHODS A cross-sectional survey was conducted of 356 children in China with malignancies who received chemotherapy within the past 7 days using the pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. A latent class analysis (LCA) was conducted to identify subgroups of patients with distinct profiles of symptomatic AE occurrence. RESULTS Nausea (54.5%), anorexia (53.4%), and headache (39.3%) were the top 3 AEs children experienced. Nearly all participants (97.8%) experienced ≥1 core AEs, and 30.3% experienced ≥5 AEs. The LCA results identified 3 subgroups ("high gastrotoxicity and low neurotoxicity" [53.2%], "moderate gastrotoxicity and high neurotoxicity" [23.6%], and "high gastrotoxicity and high neurotoxicity" [22.8%]). The subgroups were differentiated by monthly family per-capita income, time since diagnosis, and Karnofsky Performance Status score. CONCLUSIONS Children experienced multiple subjective toxicities during chemotherapy, especially gastrotoxicity and neurotoxicity. Heterogeneity was found in the LCA in the patients' toxicities. The prevalence of toxicities could be distinguished by the children's characteristics. IMPLICATIONS FOR PRACTICE The results showing different subgroups in our study may assist clinical staff in focusing on patients with higher toxicities to provide effective interventions.
Collapse
Affiliation(s)
- Haishan Ruan
- Author Affiliations: Department of Hematology and Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Ms Ruan and Ms He); School of Nursing, Shanghai Jiao Tong University, Shanghai, China (Ms Zhao); Department of Nursing, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Ms Sun and Ms Shen); School of Nursing, Fudan University, Shanghai, China (Dr Yuan); Fujian Children's Hospital, Fujian, China (Ms Fu)
| | | | | | | | | | | | | |
Collapse
|
7
|
Lan X, Wu J, Liao Z, Wu Y, Hu R. Prevalence of symptoms in children with acute lymphoblastic leukaemia: a systematic review and meta-analysis. BMC Cancer 2023; 23:1113. [PMID: 37968600 PMCID: PMC10648628 DOI: 10.1186/s12885-023-11581-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/28/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Children with acute lymphoblastic leukaemia (ALL) experience multiple symptoms that occur in complicated patterns and negatively affect patient outcomes. To date, no systematic review has been performed on the prevalence of symptoms in children with ALL. OBJECTIVE The study aimed to report and analyse the prevalence of symptoms in children with ALL during treatment. METHODS A systematic search was conducted in eight databases (PubMed, Ovid Embase, Web of Science, CINAHL, PsycINFO, China WanFang Database, China Science and Technology Journal Database, and China National Knowledge Infrastructure) for studies published between January 1, 2000, and August 12, 2023. The methodological quality of the included studies was evaluated and a meta-analysis was performed to pool the prevalence of symptoms. RESULTS In total, 17 studies were included, from which 34 symptoms were identified. The symptom prevalence ranged between 1.5 and 91.0% and the most frequent symptoms observed were fatigue, lack of energy, dry mouth, lack of appetite, sweating, and feeling irritable, which occurred in at least 60% of the patients. CONCLUSIONS Symptoms remain highly prevalent in paediatric patients with ALL, which provides support for the need for symptom assessment in the clinical setting. Specific intervention is urgently needed to mitigate the symptoms in children with ALL and help them cope with the symptom burden.
Collapse
Affiliation(s)
- Xiaoyan Lan
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou, 350108, Fujian Province, China
| | - Junjun Wu
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou, 350108, Fujian Province, China
| | - Zhenling Liao
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou, 350108, Fujian Province, China
| | - Yong Wu
- Department of Haematology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
| | - Rong Hu
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou, 350108, Fujian Province, China.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Fang J, Wong CL, Liu CQ, Huang HY, Qi YS, Xu LL, Wang MX, Lin Y. Identifying central symptom clusters and correlates in children with acute leukemia undergoing chemotherapy: a network analysis. Front Oncol 2023; 13:1236129. [PMID: 37671049 PMCID: PMC10475730 DOI: 10.3389/fonc.2023.1236129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
Background Previous studies have examined symptom clusters in children with acute leukemia, yet a knowledge gap persists regarding central symptom clusters and their influencing factors. By identifying these central clusters and associated factors, healthcare providers can enhance their understanding and effective management of symptoms. Our study seeks to address this gap by identifying symptom clusters, exploring central clusters, and investigating the demographic and health-related factors associated with these clusters in children with acute leukemia undergoing chemotherapy. Methods A total of 586 children with acute leukemia from January 2021 to April 2023 were recruited from China. They were investigated using Memorial Symptom Assessment Scale 10-18 during chemotherapy. The principal component analysis was used to identify the symptom clusters. An association network was conducted to describe the relationships among symptoms and clusters. A multiple linear model was used to investigate the associated factors for the severity of overall symptoms and each symptom cluster. Results Five clusters were identified, including oral and skin cluster, somatic cluster, self-image disorder cluster, gastrointestinal cluster and psychological cluster. Gastrointestinal cluster was the most central symptom cluster. Age, sex, clinical classification, number of having chemotherapy and education degree and marital status of the primary caregiver are associated with the severity of these five symptom clusters. Conclusion Our study highlights the importance of evaluating symptom clusters in children with acute leukemia during chemotherapy. Specifically, addressing gastrointestinal symptoms is crucial for effective symptom management and overall care.
Collapse
Affiliation(s)
- Jia Fang
- Department of Nursing, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Cho-Lee Wong
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chun-Qin Liu
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Hai-Ying Huang
- Department of Nursing, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Yi-Shu Qi
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Li-Ling Xu
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Mei-Xiang Wang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yan Lin
- Department of Nursing, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| |
Collapse
|
10
|
Kozioł A, Pupek M. Application of Metabolomics in Childhood Leukemia Diagnostics. Arch Immunol Ther Exp (Warsz) 2022; 70:28. [DOI: 10.1007/s00005-022-00665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022]
Abstract
AbstractMetabolomics is a new field of science dealing with the study and analysis of metabolites formed in living cells. The biological fluids used in this test method are: blood, blood plasma, serum, cerebrospinal fluid, saliva and urine. The most popular methods of assessing the composition of metabolites include nuclear magnetic resonance spectroscopy and mass spectrometry (MS) in combination with gas chromatography–MS or liquid chromatography–MS. Metabolomics is used in many areas of medicine. The variability of biochemical processes in neoplastic cells in relation to healthy cells is the starting point for this type of research. The aim of the research currently being carried out is primarily to find biomarkers for quick diagnosis of the disease, assessment of its advancement and treatment effectiveness. The development of metabolomics may also contribute to the individualization of treatment of patients, adjusting drugs depending on the metabolic profile, and thus may improve the effectiveness of therapy, reduce side effects and help to improve the quality of life of patients. Here, we review the current and potential applications of metabolomics, focusing on its use as a biomarker method for childhood leukemia.
Graphic abstract
Collapse
|
11
|
Jacobs SS, Withycombe JS, Castellino SM, Lin L, Mack JW, McFatrich M, Baker JN, Freyer DR, Maurer SH, Mowbray C, Hinds PS, Reeve BB. Longitudinal use of patient reported outcomes in pediatric leukemia and lymphoma reveals clinically relevant symptomatic adverse events. Pediatr Blood Cancer 2022; 69:e29986. [PMID: 36151978 DOI: 10.1002/pbc.29986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Leukemia and lymphoma (LL) are the most common cancer diagnoses of childhood with high survival rates, but not without impact on the child's functioning and quality of life. This study aimed to use patient-reported data to describe the symptomatic adverse event (AE) experiences among children with LL diagnoses. METHODS Two hundred and fifty seven children and adolescents aged 7-18 years with a first LL diagnosis completed the Pediatric Patient-Reported version of the Common Terminology Criteria for Adverse Events (Ped-PRO-CTCAE) and Patient-Reported Outcome Measurement Information System (PROMIS) Pediatric measures before starting a treatment course (T1) and after the treatment (T2). RESULTS Fatigue was the most severe AE (68.1% at T1; 67% at T2) and caused the most interference over time. Gastrointestinal AEs were also quite common (e.g., nausea 46.3% at T1 and 48.9% at T2; abdominal pain 42.4% at T1; 46.5% at T2). In general, symptoms were present both at T1 and T2 and did not change significantly in severity or interference. The prevalence of AEs varied by LL disease group (e.g., nausea was most common in acute lymphoblastic leukemia (ALL), fatigue was most severe in ALL and Hodgkin Lymphoma (HL), acute myeloid leukemia had the fewest AEs). CONCLUSION Despite current supportive care regimens, many children with LL continue to report fatigue, pain, insomnia, and gastrointestinal symptoms as the most frequent or severe symptoms during therapy.
Collapse
Affiliation(s)
- Shana S Jacobs
- Children's National Health System, Washington, District of Columbia, USA
| | | | - Sharon M Castellino
- Emory University Department of Pediatrics, Aflac Cancer and Blood Disorders center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Li Lin
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer W Mack
- Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts, USA
| | - Molly McFatrich
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Justin N Baker
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David R Freyer
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Scott H Maurer
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Catriona Mowbray
- Children's National Health System, Washington, District of Columbia, USA
| | - Pamela S Hinds
- Children's National Health System, Washington, District of Columbia, USA
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
12
|
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.
Collapse
|
13
|
Gandy K, Chambers T, Raghubar KP, Fatih Okcu M, Chintagumpala M, Taylor O, Mahajan A, Kahalley LS, Chan W, Grosshans DR, Brown AL, Douglas Ris M. A Prospective Evaluation of Fatigue in Pediatric Brain Tumor Patients Treated With Radiation Therapy. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:358-365. [PMID: 36285825 DOI: 10.1177/275275302110560011068754] [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: 06/16/2023]
Abstract
Background: Fatigue is a well-established consequence of cranial radiotherapy in survivors of pediatric brain tumor, but less is known about acute fatigue during radiotherapy treatment. This study aimed to longitudinally evaluate fatigue in newly diagnosed pediatric patients with brain tumors during treatment. Methods: Primary caregivers of pediatric patients with brain tumors completed the proxy-reported Parent Fatigue Scale assessments prior to radiotherapy and weekly during radiotherapy treatment. The association between clinical factors and fatigue at each assessment was evaluated with multiple linear regressions. A comparison of fatigue between radiation modalities was also analyzed. Results: A total of 33 caregivers completed pre-radiation fatigue assessments, with 29 reporting fatigue during radiotherapy. Patients were aged 3 to 16 years (M = 8.32) at diagnosis and diagnosed with medulloblastoma (n = 23), primitive neuroectodermal tumor (n = 2), ependymoma (n = 1), germ cell tumor (n = 1), pineoblastoma (n = 1), atypical teratoid rhabdoid (n = 1), and other unspecific tumors (n = 3). Moderate-to-severe fatigue was reported for the majority of patients (31/33; 94%) during treatment. Craniospinal irradiation dose was the only significant predictor of fatigue (p < .05), but this association was restricted to the first week of therapy and was attenuated by therapy completion. Discussion: Although fatigue is often considered a long-term consequence of cranial radiotherapy, this pilot study demonstrates that moderate-to-severe fatigue is pervasive prior to radiotherapy and persists throughout treatment in pediatric patients with brain tumors, regardless of radiation modality or clinical factors. Additional research is warranted to establish a link between acute and long-term fatigue and develop interventions to mitigate this adverse outcome.
Collapse
Affiliation(s)
- Kellen Gandy
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Tiffany Chambers
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Kimberly P Raghubar
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mehmet Fatih Okcu
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Murali Chintagumpala
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Olga Taylor
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Anita Mahajan
- Department of Radiation Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisa S Kahalley
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics, School of Public Health, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David R Grosshans
- Department of Radiation Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Austin L Brown
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Martin Douglas Ris
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
14
|
Raghubar KP, Chambers T, Hill RM, Taylor O, Hockenberry M, Casey Hooke M, Mitby P, Moore IK, Brown AL, Scheurer ME. Longitudinal investigation of suicidal ideation and associated factors during pediatric acute lymphoblastic leukemia chemotherapy. Psychooncology 2022; 31:1782-1789. [PMID: 35986586 PMCID: PMC10754031 DOI: 10.1002/pon.6014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/28/2022] [Accepted: 08/07/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study describes the prevalence of suicidal ideation (SI) during acute lymphoblastic leukemia (ALL) therapy and investigates the influence of clinical factors and physical symptoms on SI. METHODS The Children's Depressive Inventory (CDI-2) was administered to ALL patients (diagnosed 2012-2017) at start of consolidation, delayed intensification (DI), maintenance cycle 1 (MC1), and maintenance cycle 2 (MC2) in a multi-site study. SI was present if patients endorsed the item "I want to kill myself." Logistic regression models evaluated associations between SI and sociodemographic factors; depressive symptoms; and below average, average, and above average symptom clusters identified using latent class analysis of pain, nausea, fatigue, and sleep. RESULTS Participants (n = 175) were 51% male, 75% high-/very high-risk disease, with a median age of 11.2 years at diagnosis (range: 7-18 years). Overall, 14.9% of patients (75% under age 12 years) endorsed SI during treatment, including 4% at start of consolidation, 9% at DI, 8% at MC1, and 4% at MC2. Non-Hispanic Other patients were 10.9-times (95% CI: 2.30-53.40) more likely than non-Hispanic Whites to endorse SI (p = 0.003). The frequency of SI was higher in patients experiencing above average (53.3%) compared to below average (4.1%, p = 0.003) symptoms. Depressive symptoms were consistently associated with SI. CONCLUSIONS SI during the initial year of childhood ALL was more prevalent in children under the age of 12 years, from ethnic groups not typically associated with increased risk, and who endorsed increased physical and depressive symptoms. Findings highlight the need for improved screening of mental health problems to mitigate symptoms of distress.
Collapse
Affiliation(s)
- Kimberly P. Raghubar
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, Texas, USA
| | - Tiffany Chambers
- Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Ryan M. Hill
- Department of Psychology, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Olga Taylor
- Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Marilyn Hockenberry
- Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - M. Casey Hooke
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
- Children’s Minnesota Cancer and Blood Disorders Program, Minneapolis, Minnesota, USA
| | - Pauline Mitby
- Children’s Minnesota Cancer and Blood Disorders Program, Minneapolis, Minnesota, USA
| | - Ida Ki Moore
- Department of Nursing, University of Arizona, Tuscan, Arizona, USA
| | - Austin L. Brown
- Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E. Scheurer
- Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
15
|
Targeting Redox Regulation as a Therapeutic Opportunity against Acute Leukemia: Pro-Oxidant Strategy or Antioxidant Approach? Antioxidants (Basel) 2022; 11:antiox11091696. [PMID: 36139768 PMCID: PMC9495346 DOI: 10.3390/antiox11091696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/07/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Redox adaptation is essential for human health, as the physiological quantities of non-radical reactive oxygen species operate as the main second messengers to regulate normal redox reactions by controlling several sensors. An abnormal increase reactive oxygen species, called oxidative stress, induces biological injury. For this reason, variations in oxidative stress continue to receive consideration as a possible approach to treat leukemic diseases. However, the intricacy of redox reactions and their effects might be a relevant obstacle; consequently, and alongside approaches aimed at increasing oxidative stress in neoplastic cells, antioxidant strategies have also been suggested for the same purpose. The present review focuses on the molecular processes of anomalous oxidative stress in acute myeloid and acute lymphoblastic leukemias as well as on the oxidative stress-determined pathways implicated in leukemogenic development. Furthermore, we review the effect of chemotherapies on oxidative stress and the possibility that their pharmacological effects might be increased by modifying the intracellular redox equilibrium through a pro-oxidant approach or an antioxidant strategy. Finally, we evaluated the prospect of varying oxidative stress as an efficacious modality to destroy chemoresistant cells using new methodologies. Altering redox conditions may be advantageous for inhibiting genomic variability and the eradication of leukemic clones will promote the treatment of leukemic disease.
Collapse
|
16
|
Linder LA, Newman A, Bernier Carney KM, Wawrzynski S, Stegenga K, Chiu YS, Jung SH, Iacob E, Lewis M, Linder C, Fox K, Altizer R. Symptoms and daily experiences reported by children with cancer using a game-based app. J Pediatr Nurs 2022; 65:33-43. [PMID: 35490550 PMCID: PMC10405915 DOI: 10.1016/j.pedn.2022.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/18/2022] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Mobile health (mHealth) resources, including apps, are emerging as resources to support children in tracking symptoms and other health-related data. The purpose of this study was to describe symptoms and daily experiences reported by elementary school-age children receiving treatment for cancer using the newly developed Color Me Healthy app. DESIGN AND METHODS Participants in this descriptive study were children 6-12 years of age, who were receiving cancer treatment at a free-standing children's hospital in the Intermountain West of the United States. Children were requested to use the app for at least five days between clinical visits. Children's app-reported data were extracted from individual user accounts for analysis. Quantitative data were summarized descriptively. Qualitative data were summarized using qualitative content analysis. RESULTS Nineteen children (6-12 years; median 8 years; 7 females) completed 107 days of app use. All children reported symptoms at least once, and 14 reported at least one day with a symptom of moderate or greater severity. Daily experiences reported through the app reflected children's engagement in usual childhood experiences while also describing life with cancer, including symptoms. CONCLUSIONS Elementary school-age children are capable of self-reporting symptoms using a symptom reporting app, providing preliminary evidence for the potential benefits and clinical relevance of mHealth resources to support health outcomes within this population. PRACTICE IMPLICATIONS Clinicians should anticipate and support ongoing symptom management needs between clinical visits. Children's self-reported data can promote a person-centered approach to symptom assessment and management.
Collapse
Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
| | - Amy Newman
- College of Nursing, Marquette University, 530 N 16(th) St., Milwaukee, WI 53233, USA
| | - Katherine M Bernier Carney
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; University of Connecticut School of Nursing, 231 Glenbrook Rd., Unit 4026, Storrs, CT 06269-4026, USA
| | - Sarah Wawrzynski
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Kristin Stegenga
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Yin-Shun Chiu
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Se-Hee Jung
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Eli Iacob
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Melina Lewis
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Huntsman Cancer Hospital, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Caitlin Linder
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA
| | - Kaitlyn Fox
- College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112, USA; Primary Children's Hospital, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA; Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd, SN-ADM, Portland, OR 97239-2941, USA
| | - Roger Altizer
- Population Health Science, Entertainment Arts and Engineering, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| |
Collapse
|
17
|
Bernier Carney KM, Stegenga K, Linder LA. Informing Parents as Caregivers With a Symptom Assessment App Developed for Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:264-272. [PMID: 35791850 PMCID: PMC9527534 DOI: 10.1177/27527530211073307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Mobile health technologies can assist children to communicate their symptom experiences in a developmentally appropriate format. However, few investigations have examined how mHealth resources may also assist parents in their caregiver role. The purpose of this study was to explore how a symptom assessment app designed for school-age children with cancer could further inform parents as caregivers. Methods: Nineteen parents (18 mothers; median 35 years old, range 26-48 years) of children (6-12 years of age) receiving cancer treatment participated in the feasibility/acceptability trial of a game-based symptom assessment app. Acceptability interviews with parents were completed after each child's trial with the app. We completed a secondary analysis of the parent interviews using thematic analysis to examine how the app could support parents in their caregiving role. Results: Parents perceived the app to (1) elicit the child's voice about his/her symptom experience; (2) provide a supportive and safe environment for the child to report symptoms; and (3) create an opportunity to facilitate communication between the child, parent, and clinical team. Parents expressed a willingness for their child to represent his/her experience with the app so that they could make informed decisions regarding symptom care. Discussion: Perceived benefits of the app extended to parents as they described developing further insight into their child's cancer experience. The knowledge gained allowed parents the potential to enhance symptom communication and supportive care strategies. Future research should further evaluate how mHealth tools facilitate shared symptom management between children receiving treatment for cancer and their caregivers.
Collapse
Affiliation(s)
| | - Kristin Stegenga
- Division of Hematology/Oncology, Children’s Mercy Hospital, Kansas City, MO,
USA
| | - Lauri A. Linder
- University of Utah, College of Nursing, Salt Lake City, UT, USA
- Clinical Nurse Specialist, Primary Children’s Hospital, Center for Cancer
and Blood Disorders, Salt Lake City, UT, USA
| |
Collapse
|
18
|
Alelayan H, Huang H, Yang Y, Chen Y, Liao X. Psychometric validation of the simplified Chinese version of the therapy-related symptom checklist in children with cancer. J Pediatr Nurs 2022; 64:e32-e39. [PMID: 35101353 DOI: 10.1016/j.pedn.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To validate a simplified Chinese version of the therapy-related symptom checklist for children (TRSC-C) in children with cancer. METHODS Reliability was assessed by internal consistency and test-retest coefficients. Dimensionality and construct validity were clarified using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Pearson's correlation coefficient was calculated between the TRSC-C and the PedsQL 3.0 cancer model (PedsQL 3.0) and the Lansky Play Performance Scale (LPPS) to test concurrent validity. A Student's t-test was used to compare the scores of the simplified Chinese version of the TRSC-C subscales by gender, age groups, and functional status to test sensitivity of the TRSC-C. RESULTS A sample of 170 children with cancer was recruited (11.27 ± 2.31 years). Cronbach's alpha (0.89) and interclass correlation coefficient (0.98) were acceptable. Seven factors with eigenvalues >1 explained 56.86% of the total variances. CFA demonstrated an acceptable model (CFI = 0.93, RMSE = 0.04). Concurrent validity was supported by moderate to high correlations between the TRSC-C and both the PedsQL 3.0 (r = -0.71) and LPPS (r = -0.43). The TRSC-C scores significantly differed by age groups and functional status (effect size 0.40-0.93), indicating adequate sensitivity. CONCLUSION The simplified Chinese version of the TRSC-C demonstrated acceptable reliability, validity, and sensitivity to support its use in clinical practice and future studies.
Collapse
Affiliation(s)
- Hasan Alelayan
- Southern Medical University, Nanfang Hospital, Nursing Department of Zengcheng Branch, China; Southern Medical University, School of Nursing, China
| | - Haiying Huang
- Guangzhou Women and Children's Medical Center, Nursing Department, China
| | - Yiling Yang
- Southern Medical University, School of Nursing, China
| | - Yingying Chen
- Southern Medical University, Nanfang Hospital, Pediatric Department, China
| | - Xiaoyan Liao
- Southern Medical University, Nanfang Hospital, Nursing Department of Zengcheng Branch, China.
| |
Collapse
|
19
|
Vasquez P, Escalante J, Raghubar KP, Kahalley LS, Taylor OA, Moore IK, Hockenberry MJ, Scheurer ME, Brown AL. Association between fatigue and sleep disturbances during treatment for pediatric acute lymphoblastic leukemia and posttreatment neurocognitive performance. Pediatr Blood Cancer 2022; 69:e29507. [PMID: 34889514 PMCID: PMC8957586 DOI: 10.1002/pbc.29507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Survivors of pediatric acute lymphoblastic leukemia (ALL) are at increased risk of neurocognitive weakness in the areas of attention, executive function, and processing speed. Although fatigue and sleep disturbances are frequent complications of ALL therapy and associated with cognitive functions, the impact of fatigue and sleep profiles during active ALL treatment on posttreatment neurocognitive performance has received limited attention. METHODS Pediatric patients (n = 120) with ALL (diagnosed 2011-2016) who completed fatigue and sleep questionnaires at four time points during active treatment were enrolled in a study of neurocognitive performance. Latent class growth analysis identified subgroups of patients with similar sleep and fatigue profiles during treatment. Neurocognitive performance collected >6 months post treatment on 40 participants was compared between latent classes using multivariable linear regression models. RESULTS Participants (57.5% male and 79.1% Hispanic or non-Hispanic White) were classified into one of two fatigue and sleep profiles: Class 1 characterized by mild fatigue and sleep disturbances during treatment (50.8%), and Class 2 characterized by higher levels of fatigue and sleep disturbances (49.2%). Posttreatment cognitive performance was in the normal range for most measures, but significantly below normative means for executive function, verbal short-term memory, attention, and distractability measures. Compared to Class 1, Class 2 demonstrated significantly (p < .05) poorer posttreatment neurocognitive performance, particularly in measures of attention. CONCLUSIONS Our findings indicate that fatigue and sleep disturbances during the first year of pediatric ALL therapy may impact long-term neurocognitive performance. Sleep and fatigue may be targets for intervention to preserve cognitive functioning in survivors.
Collapse
Affiliation(s)
- Priscilla Vasquez
- Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston TX
| | - Johanna Escalante
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston TX
| | - Kimberly P. Raghubar
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston TX
| | - Lisa S. Kahalley
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston TX
| | - Olga A. Taylor
- Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston TX
| | - Ida Ki Moore
- College of Nursing, University of Arizona, Tuscan AZ
| | | | - Michael E. Scheurer
- Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston TX
| | - Austin L. Brown
- Department of Pediatrics, Section of Oncology, Baylor College of Medicine, Houston TX
| |
Collapse
|
20
|
Al-Saadi LS, Chan MF, Al-Azri M. Prevalence of Anxiety, Depression, and Post-Traumatic Stress Disorder among Children and Adolescents with Cancer: A Systematic Review and Meta-Analysis. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:114-131. [PMID: 35722683 DOI: 10.1177/27527530211056001] [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: 06/15/2023]
Abstract
Assessment of psychological and emotional disorders is an important indicator of well-being among children and adolescents with cancer. This review aimed to determine the prevalence rates of three major psychological disorders in this population, including anxiety, depression, and post-traumatic stress disorder (PTSD). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Various databases were searched to identify cross-sectional studies assessing anxiety, depression, and PTSD among children and adolescents with cancer. The Joanna Briggs Institute checklist was used to assess research quality. Of the 40 studies included in the literature review, 33 measured anxiety, 28 focused on depression, and nine assessed PTSD. A total of 18 studies were incorporated into the meta-analysis, with pooled prevalence rates of anxiety, depression and PTSD found to be 13.92% (n = 1,971; 95% confidence interval [CI] = 10.23-18.07%), 20.43% (n = 1,990, 95% CI = 13.85-27.93%), and 20.90% (n = 755, 95% CI = 13.28-29.73%), respectively. Mental health and psychological interventions are essential for children and adolescents diagnosed with cancer. Future work should be undertaken in different regions, such as the Middle East or Africa, or South America when assessing the prevalence of psychological disorders in children and adolescents diagnosed with cancer.
Collapse
Affiliation(s)
- Laila S Al-Saadi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, 37611Sultan Qaboos University, PO Box 38, Postal Code 123, Al Khoud, Muscat, Oman
| | - Moon Fai Chan
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, 37611Sultan Qaboos University, PO Box 38, Postal Code 123, Al Khoud, Muscat, Oman
| | - Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, 37611Sultan Qaboos University, PO Box 38, Postal Code 123, Al Khoud, Muscat, Oman
| |
Collapse
|
21
|
Jibb LA, Ameringer S, Macpherson CF, Sivaratnam S. The Symptom Experience in Pediatric Cancer: Current Conceptualizations and Future Directions. Curr Oncol Rep 2022; 24:443-450. [PMID: 35150393 DOI: 10.1007/s11912-022-01222-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW We aimed to review the recent research on the childhood cancer symptom experience pertaining to socioeconomic factors, biology and genetics, growth and development, family psychosocial dynamics, and social and treating environments to begin to formulate recommendations for a personalized approach to symptom management. RECENT FINDINGS Cancer symptoms are common and distressing in children and negatively impact child and family quality of life. Many interacting factors influence children's cancer symptoms experiences, including the assessment and management of such symptoms. This paper highlights several gaps in the research related to the cancer symptom experience including routine symptom assessment, the impact of socioeconomic, biological, and genetic factors on symptoms, and the establishment of effective symptom management partnerships with families. Based on our findings, we provide recommendations related to that research which is ready to be implemented into clinical practice and areas for needed future efforts.
Collapse
Affiliation(s)
- Lindsay A Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, M5T 1P8, Toronto, Canada. .,Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.
| | | | | | - Surabhi Sivaratnam
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.,Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4K1, Canada
| |
Collapse
|
22
|
Symptom Profiles of Adolescents and Young Adults in Active Cancer Treatment by Diagnostic Groups. Cancer Nurs 2022; 45:306-315. [PMID: 34966060 PMCID: PMC9207147 DOI: 10.1097/ncc.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The symptom experience of adolescents and young adults (AYAs) with cancer can differ based on the cancer and its treatments. A dearth of information exists on how symptoms differ by individual factors such as age and gender. OBJECTIVES The objectives were to describe symptoms in AYAs across 5 cancer diagnostic groups by the individual factors of age group, sex, race/ethnicity, and time since diagnosis; and then to describe symptoms based on these individual factors within diagnostic groups. METHODS This was a secondary analysis of baseline data pooled from 2 multisite studies on symptoms in AYAs with acute lymphoblastic leukemia, brain cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, and sarcoma. Symptoms were assessed using the Computerized Symptom Capture Tool. RESULTS Data from 118 AYAs with cancer, aged 13 to 29 years, were analyzed. Eight of the most commonly reported symptoms were reported in at least 4 diagnostic groups. Across diagnostic groups, symptoms varied little based on individual factors. Within groups, certain symptoms differed in frequency by individual factors. CONCLUSIONS The lack of major differences in symptom prevalence based on individual factors across diagnostic groups supports a heterogeneous approach to symptom research with AYAs. The study identified individual factors within diagnostic groups worthy of further exploration. IMPLICATIONS FOR PRACTICE Providers can facilitate discussions with AYAs about symptoms by being aware of common symptoms that may occur in certain cancer diagnostic groups and based on individual factors. The significance of the individual symptom experience should not be underestimated, emphasizing the importance of person-centered symptom assessment.
Collapse
|
23
|
Symptom Clusters, Physical Activity, and Quality of Life: A Latent Class Analysis of Children During Maintenance Therapy for Leukemia. Cancer Nurs 2022; 45:113-119. [PMID: 34387237 PMCID: PMC8831653 DOI: 10.1097/ncc.0000000000000963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Children undergoing treatment for acute lymphocytic leukemia (ALL) report co-occurring symptoms of fatigue, sleep disturbances, and depression as a symptom cluster. Physical activity (PA) may influence symptom severity and quality of life (QOL). OBJECTIVES This study examined changes in symptoms and QOL during ALL maintenance in children categorized by symptom cluster and explored the influence of PA and symptoms on QOL. METHODS Self-report of fatigue, sleep disturbance, and depression; QOL; and PA were measured at the beginning and end of maintenance in 42 children aged 3 to 18 years with ALL. Children were categorized into symptom cluster groups based on measurements at the beginning of maintenance. RESULTS Two latent classes of symptom clusters (low and high) were identified with significant differences between groups in symptoms at both the beginning and end maintenance (P < .01). Each group's symptom levels did not change during maintenance. Quality-of-life was different between groups at both time points (P < .01) and did not improve. Children with low symptoms and high PA at the beginning of maintenance had better QOL as treatment ended compared with the physically active high-symptom group and the inactive high-symptom group (P < .01). CONCLUSIONS Children with higher symptoms did not experience an improvement with time. Symptom and PA levels may influence QOL at the end of treatment. IMPLICATIONS FOR PRACTICE Maintenance therapy is a long time (1.5 years) in a child's life. Symptom assessment is needed early in maintenance; interventions are needed for children with high levels.
Collapse
|
24
|
Hooke MC, Mathiason MA, Kunin-Batson AS, Blommer A, Hutter J, Mitby PA, Moore IM, Whitman S, Taylor O, Scheurer ME, Hockenberry MJ. Biomarkers and Cognitive Function in Children and Adolescents During Maintenance Therapy for Leukemia. Oncol Nurs Forum 2021; 48:623-633. [PMID: 34673759 DOI: 10.1188/21.onf.623-633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore the relationship between biomarkers of oxidative stress and inflmmation in cerebrospinal fluid (CSF) and cognitive function in children receiving maintenance therapy for acute lymphocytic leukemia (ALL). SAMPLE & SETTING 30 participants aged 4-17 years receiving ALL maintenance therapy at two pediatric cancer centers in the United States. METHODS & VARIABLES F2-isoprostane (F2-ISoP) and interleukin-8 (IL-8) were evaluated in CSF samples, and cognitive function measures were completed during the first and last cycles of ALL maintenance. The Flanker Inhibitory Control and Attention Test (Flanker) and Dimensional Change Card Sort were completed during the last cycle. RESULTS During maintenance therapy, IL-8 decreased, and parent reports of children's cognitive function improved. Higher IL-8 was associated with better parent reports of children's cognitive function at each timepoint. Higher F2-ISoP levels were associated with lower Flanker scores. IMPLICATIONS FOR NURSING F2-ISoP may be a useful biomarker in evaluating cognitive dysfunction in children with ALL and merits further investigation.
Collapse
|
25
|
Allegra A, Sant'Antonio E, Musolino C, Ettari R. New insights into neuropeptides regulation of immune system and hemopoiesis: effects on hematologic malignancies. Curr Med Chem 2021; 29:2412-2437. [PMID: 34521320 DOI: 10.2174/0929867328666210914120228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022]
Abstract
Several neurotransmitters and neuropeptides were reported to join to or to cooperate with different cells of the immune system, bone marrow, and peripheral cells and numerous data support that neuroactive molecules might control immune system activity and hemopoiesis operating on lymphoid organs, and the primary hematopoietic unit, the hematopoietic niche. Furthermore, many compounds seem to be able to take part to the leukemogenesis and lymphomagenesis process, and in the onset of multiple myeloma. In this review, we will assess the possibility that neurotransmitters and neuropeptides may have a role in the onset of haematological neoplasms, may affect the response to treatment or may represent a useful starting point for a new therapeutic approach. More in vivo investigations are needed to evaluate neuropeptide's role in haematological malignancies and the possible utilization as an antitumor therapeutic target. Comprehending the effect of the pharmacological administration of neuropeptide modulators on hematologic malignancies opens up new possibilities in curing clonal hematologic diseases to achieve more satisfactory outcomes.
Collapse
Affiliation(s)
- Alessandro Allegra
- Department of Human Pathology in Adulthood and Childhood, University of Messina. Italy
| | | | - Caterina Musolino
- Department of Human Pathology in Adulthood and Childhood, University of Messina. Italy
| | - Roberta Ettari
- Department of Chemical, Biological, Pharmaceutical and Environmental Chemistry, University of Messina. Italy
| |
Collapse
|
26
|
Bradford N, Cashion C, Condon P, Rumble S, Bowers A. Recruitment principles and strategies for supportive care research in pediatric oncology. BMC Med Res Methodol 2021; 21:178. [PMID: 34454413 PMCID: PMC8400402 DOI: 10.1186/s12874-021-01371-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Variations in clinical practice contribute to negative outcomes for children with cancer. Research in this area is imperative to standardise practice, yet such research is challenging to undertake, and a significant proportion of studies fail. A common reason for failure is poor recruitment, yet little information is available to support researchers and clinicians planning such research. METHODS Our primary aim was to describe the recruitment strategies and outcomes in a tertiary children's hospital across multiple observational supportive care studies. Secondary aims were to establish principles to improve both recruitment strategies and the reporting of recruitment. We undertook a retrospective descriptive analysis of the recruitment logs and data from three studies in pediatric oncology. The mean time to recruit one participant was calculated. Common reasons for not approaching eligible participants and reasons potential participants declined are described. RESULTS Of the 235 potential candidates across all studies, 186 (79%) were approached and of these 125 (67%) provided consent, with 117 (63%) completing baseline measures. We estimated recruitment per participant required an average 98 min of experienced research nurse time. Four factors are described that influence recruitment and six principles are outlined to maximise recruitment and the generalisability of research findings. CONCLUSIONS We highlight the recruitment experiences across three different projects in children's cancer supportive care research and provide a roadmap for other researchers planning to undertake clinical research in pediatrics.
Collapse
Affiliation(s)
- Natalie Bradford
- Queensland University of Technology, Cancer and Palliative Care Outcomes Centre and School of Nursing, Brisbane, Australia.
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia.
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.
| | - Christine Cashion
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Paula Condon
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Shelley Rumble
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Alison Bowers
- Queensland University of Technology, Cancer and Palliative Care Outcomes Centre and School of Nursing, Brisbane, Australia
- Queensland University of Technology at Centre for Children's Health Research, 62 Graham St, South Brisbane, Queensland, 4101, Australia
| |
Collapse
|
27
|
Vaughn J, Shah N, Docherty SL, Yang Q, Shaw RJ. Symptom Monitoring in Children With Life-Threatening Illness: A Feasibility Study Using mHealth. ANS Adv Nurs Sci 2021; 44:268-278. [PMID: 33624987 PMCID: PMC8368073 DOI: 10.1097/ans.0000000000000359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children with life-threatening illness (C-LTI) experience considerable symptom distress. Mobile technology may offer opportunities to better obtain symptom data that will lead to better symptom management. A mixed-methods study was conducted to explore the feasibility of monitoring and visualizing symptoms using 2 mobile health devices in C-LTI. Participants engaged with the Apple Watch 56% and recorded in the study app 63% of their study days. Our findings showed feasibility of using mobile technology for monitoring symptoms and further explored opportunities to visualize these data showing symptom occurrences, patterns, and trajectories in C-LTI.
Collapse
Affiliation(s)
- Jacqueline Vaughn
- University of North Carolina School of Nursing, Chapel Hill (Dr Vaughn); Department of Hematology, Duke University School of Medicine, Durham, North Carolina (Dr Shah); and Duke University School of Nursing, Durham, North Carolina (Drs Docherty, Yang, and Shaw)
| | | | | | | | | |
Collapse
|
28
|
Zhang W, Stinson J, Huang Q, Makkar M, Wang J, Jibb L, Cheng L, Yuan C. Identification and Characteristics of the Three Subgroups of Pain in Chinese Children and Adolescents with Cancer. J Pediatr Nurs 2021; 59:e13-e19. [PMID: 33752933 DOI: 10.1016/j.pedn.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Pain is a distressing symptom for children and adolescents with cancer and is experienced by individuals differently. This study sought to determine subgroups according to their pain experiences, and how demographic, clinical, and quality of life (QOL)-related characteristics might differ across subgroups. DESIGN AND METHODS This cross-sectional study recruited 187 pediatric patients with cancer aged 8 to 17 years old and asked them to complete measures of pain intensity, pain duration, pain interference and pain control using the Chinese translation of the validated questionnaire from the Pain Squad app, as well as 7 PROMIS measures assessing QOL-related outcomes. Latent profile analysis (LPA) was used to identify latent subgroups. RESULTS Three subgroups of children were identified: low-pain/low-duration (69.5%), moderate-pain/high-duration (19.8%), and high-pain/moderate-duration (10.7%). Hospitalized children were more likely to be in the moderate-pain/high-duration subgroup. Children in the high-pain/moderate-duration subgroup were more likely to be cared for by unemployed caregivers. Scores on depressive symptoms (p = 0.002), anger (p < 0.001), anxiety (p = 0.045), fatigue (p = 0.044), and mobility (p = 0.008) questionnaire were significantly worse in the high-pain/moderate-duration subgroup than the other two subgroup. PRACTICE IMPLICATIONS This study provides a scientific foundation for further studies exploring predictive factors related to pain experiences. More targeted treatment strategies targeting the specific characteristics of each subgroup will help improve patients' QOL and use of medical resources. CONCLUSIONS The 3 identified pain subgroups demonstrate the heterogeneity in pain experiences among pediatric patients with cancer. Knowledge of these subgroups can assist clinicians in better identifying and targeting pain treatment for children with cancer.
Collapse
Affiliation(s)
- Wen Zhang
- School of Nursing, Fudan University, Shanghai, China
| | - Jennifer Stinson
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Qingmei Huang
- School of Nursing, Fudan University, Shanghai, China
| | - Mallika Makkar
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jiashu Wang
- School of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Lindsay Jibb
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lei Cheng
- School of Nursing, Fudan University, Shanghai, China
| | | |
Collapse
|
29
|
Linder LA, Ameringer S, Stegenga K, Macpherson CF, Erickson J. A Person-Centered Approach to Symptom Assessment and Management for Children and Adolescents Receiving Cancer Treatment. Semin Oncol Nurs 2021; 37:151164. [PMID: 34134924 DOI: 10.1016/j.soncn.2021.151164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Discuss the clinical assessment and management of symptoms for children and adolescents receiving treatment for cancer with attention to a person-centered approach to care. DATA SOURCES Review of currently published literature and guidelines pertaining to symptom assessment and management for children and adolescents receiving treatment for cancer. CONCLUSION Symptoms such as pain, nausea, and fatigue are commonly reported by children and adolescents receiving cancer treatment and are associated with greater symptom burden. Symptom assessment should be tailored to the child or adolescent and include the child's or adolescent's preference for reporting symptoms and attention to the symptoms that are of greatest priority. Evidence-based guidelines for the management of symptoms, including pain and nausea, are available to guide symptom management interventions and should be tailored to provide person-centered care. IMPLICATIONS FOR NURSING PRACTICE Nurses can lead efforts through clinical practice and research initiatives to advance person-centered symptom care for children and adolescents with cancer on a global level. Priorities for future work to advance person-centered symptom assessment and management include (1) identification of best practices for symptom assessment, (2) attention to social determinants of health and their subsequent influence on symptom outcomes, (3) compilation of evidence for management of less commonly reported symptoms, and (4) implementation of published clinical guidelines for symptom management in practice settings.
Collapse
Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, Salt Lake City; Primary Children's Hospital, Salt Lake City, UT.
| | | | | | | | - Jeanne Erickson
- Milwaukee College of Nursing, University of Wisconsin, Milwaukee
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Partanen M, Phipps S, Russell K, Anghelescu DL, Wolf J, Conklin HM, Krull KR, Inaba H, Pui CH, Jacola LM. Longitudinal Trajectories of Neurocognitive Functioning in Childhood Acute Lymphoblastic Leukemia. J Pediatr Psychol 2021; 46:168-178. [PMID: 33011782 PMCID: PMC7896273 DOI: 10.1093/jpepsy/jsaa086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Children with acute lymphoblastic leukemia (ALL) are at risk for neurocognitive deficits, and examining individual variability is essential to understand these risks. This study evaluated latent longitudinal trajectories and risk factors of neurocognitive outcomes in childhood ALL. METHODS There were 233 participants with ALL who were enrolled on a phase 3, risk-stratified chemotherapy-only clinical trial (NCT00137111) and who completed protocol-directed neurocognitive assessments [47.6% female, mean (SD) = 6.6 (3.7) years]. Measures of sustained attention, learning/memory, and parent ratings of attention were completed during and after treatment. Longitudinal latent class analyses were used to classify participants into distinct trajectories. Logistic regression was used to identify predictors of class membership. RESULTS Within the overall group, attention performance was below age expectations across time (Conners Continuous Performance Test detectability/variability, p < 0.01); memory performance and parent ratings were below expectations at later phases (California Verbal Learning Test learning slope, p < 0.05; Conners Parent Rating Scale, Revised attention/learning, p < 0.05). Most participants (80-89%) had stable neurocognitive profiles; smaller groups showed declining (3-6%) or improving (3-11%) trajectories. Older age (p = 0.020), female sex (p = 0.018), and experiencing sepsis (p = 0.047) were associated with greater attention problems over time. Lower baseline IQ was associated with improved memory (p = 0.035) and fewer ratings of attention problems (p = 0.013) over time. CONCLUSIONS Most patients with ALL have stable neurocognitive profiles. Smaller groups have significant impairments shortly after diagnosis or have worsening performance over time. A tiered assessment approach, which includes consideration of individual and clinical risk factors, may be useful for monitoring neurocognitive functioning during treatment and survivorship.
Collapse
|
33
|
Lin Y, Bailey DE, Docherty SL, Porter LS, Cooper BA, Paul SM, Kober KM, Hammer MJ, Wright F, Dunn LB, Conley YP, Levine JD, Miaskowski C. Distinct profiles of multiple co-occurring symptoms in patients with gastrointestinal cancers receiving chemotherapy. Support Care Cancer 2021; 29:4461-4471. [PMID: 33454824 DOI: 10.1007/s00520-020-05946-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Identify subgroups of gastrointestinal (GI) cancer patients with distinct multiple co-occurring symptom profiles and evaluate for differences among these subgroups in demographic and clinical characteristics and quality of life (QOL) outcomes. METHODS Patients with GI cancers (n = 399) completed the Memorial Symptom Assessment Scale (MSAS) that was used to assess for multiple co-occurring symptoms. Latent class analysis (LCA) was used to identify subgroups of patients with distinct symptom profiles using symptom occurrence ratings. Differences in demographic and clinical characteristics and QOL outcomes among the subgroups were evaluated using parametric and nonparametric tests. RESULTS All Low (36.6%), Moderate (49.4%), and All High (14.0%) classes were identified. Compared to the All Low class, patients in the other two classes were significantly younger and were more likely to report depression and back pain. Compared to the other two classes, patients in the All High class had fewer years of education and a higher number of comorbidities. Significant differences were found among the three classes for comorbidity burden and total number of MSAS symptoms (i.e., All Low < Moderate < All High), as well as for performance status (i.e., All Low > Moderate > All High). A higher symptom burden was associated with poorer QOL outcomes. CONCLUSIONS The first study to identify subgroups of patients with GI cancers based on distinct symptom profiles. LCA allowed for the identification of risk factors associated with a higher symptom burden. Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.
Collapse
Affiliation(s)
- Yufen Lin
- School of Nursing, Duke University, Durham, NC, USA
| | | | | | | | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, CA, USA.
- Department of Physiological Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA.
| |
Collapse
|
34
|
The effect of digital health technologies on managing symptoms across pediatric cancer continuum: A systematic review. Int J Nurs Sci 2021; 8:22-29. [PMID: 33575441 PMCID: PMC7859551 DOI: 10.1016/j.ijnss.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/28/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022] Open
Abstract
Objective Pediatric cancer patients endure multiple symptoms during treatment and also in survivorship. Digital health technologies provide an innovative way to support their symptom management. This review aimed to examine the effect of digital health technologies on managing symptoms among across pediatric cancer continuum. Methods A systematic literature search of six English and three Chinese electronic databases was combined with hand searching, to identify eligible research studies from database establishment to November 30, 2019. Two reviewers carried out data selection, data extraction, and quality appraisal independently. A narrative approach was taken to summarize data. Results Four randomized control trials, two quasi-experiments, and five one group pre-posttest designed studies, were included in the review with a total of 425 participants. The methodological quality of the studies was generally fair. Seven symptoms (anxiety, depression, pain, anger, fatigue, fear, distress) and seven digital health technologies (visual reality, website, humanoid robot, app, wearable devices, short messages and videoconference) were reported in the included studies. Conclusions Current evidence supports the effect of digital health technologies is generally mixed and inconclusive. There is a trend of positive effects found in the interventions that feature digital health technologies' interactive function. This review highlights the need for further investigation with rigorous research designs and the consideration of influencing factors from the symptoms, participants, and context levels to inform a better digital health implementation.
Collapse
|
35
|
Linder LA, Newman AR, Stegenga K, Chiu YS, Wawrzynski SE, Kramer H, Weir C, Narus S, Altizer R. Feasibility and acceptability of a game-based symptom-reporting app for children with cancer: perspectives of children and parents. Support Care Cancer 2021; 29:301-310. [PMID: 32358779 PMCID: PMC7606212 DOI: 10.1007/s00520-020-05495-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with cancer have difficulty identifying and describing the multiple symptoms they experience during hospitalization and between clinical encounters. Mobile health resources, including apps, are potential solutions to support child-centric symptom reporting. This study evaluated the feasibility and acceptability of a newly developed game-based symptom-reporting app for school-age children with cancer. PROCEDURE Nineteen school-age children (6-12 years of age) receiving treatment for cancer at a COG institution in the Intermountain West of the United States used a game-based symptom-reporting app between clinical visits. Feasibility was evaluated through a summary of actual days of app use and interaction with each of the app's features. Children and their parents participated in interviews regarding the app's acceptability. RESULTS Children used the app a median of 4 days (range 1-12) and interacted most frequently with the symptom reporting and the drawing features. Children enjoyed aspects of the app that supported their creativity and provided choices. Parents endorsed the interactive nature of the app and the value of the child providing his/her own report. Both children and parents identified additional opportunities to enhance the child's user experience. CONCLUSION Study results support the preliminary feasibility and acceptability of the app. Children's and parents' responses supported the developmental relevance of the app and its role in enhancing the child's autonomy and serving as an outlet for creativity. Future directions include optimizing the child user's experience and investigating the app's role as a resource to enhance shared decision-making for symptom management.
Collapse
Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah, Salt Lake City, UT, USA.
- Center for Cancer and Blood Disorders, Primary Children's Hospital, Salt Lake City, UT, USA.
| | - Amy R Newman
- College of Nursing, Marquette University, Milwaukee, WI, USA
- Children's Hospital Wisconsin, Milwaukee, WI, USA
| | | | - Yin-Shun Chiu
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Sarah E Wawrzynski
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Pediatric Critical Care Services, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Scott Narus
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
- Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Roger Altizer
- Population Health Sciences, Entertainment Arts & Engineering, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
36
|
Prospective patient-reported symptom profiles associated with pediatric acute lymphoblastic leukemia relapse. Support Care Cancer 2020; 29:2455-2464. [PMID: 32929538 DOI: 10.1007/s00520-020-05773-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Despite improvements in frontline pediatric acute lymphoblastic leukemia (ALL) treatment, relapse remains a concern. Research in adult cancer patients suggests that patient-reported symptoms may predict survival, but the relationship between symptoms and relapse for pediatric ALL has received little attention. METHODS Pediatric patients with ALL (age 2-18 years) and/or their primary caregivers completed symptom surveys at the end of induction, start of delayed intensification (DI), start of maintenance cycle 1 (MC1), and start of maintenance cycle 2 (MC2). Symptom clusters for co-occurring fatigue, pain, sleep disruptions, and nausea were defined using latent profile analysis. Hazard ratios (HR) and 95% confidence intervals (CI) for the association between symptom clusters, individual symptoms, and subsequent relapse were calculated using multivariable Cox proportional hazards models, adjusting for clinical and demographic factors. RESULTS Eligible patients (n = 208) were followed an average of 2.6 years for the incidence of relapse (n = 22). Associations between relapse and symptoms were identified for fatigue at DI (HR = 1.83, 95%CI 1.23-2.73) and MC1 (HR = 2.14, 95%CI 1.62-2.84), pain at DI (HR = 1.80, 95%CI 1.19-2.72), nausea at the end of induction (HR = 1.19, 95%CI 1.01-1.39), and sleep disturbances at the end of induction (HR = 2.00, 95%CI 1.11-3.62), DI (HR = 1.73, 95%CI 1.01-2.96), and MC1 (HR = 2.19, 95%CI 1.10-4.35). Symptom clusters comprised of individuals with a higher average symptom burden at DI were significantly (p < 0.05) associated with relapse. CONCLUSION Patient-reported symptoms may provide prognostic information to aid in the identification of pediatric ALL patients at increased risk of relapse.
Collapse
|
37
|
Parker R, Wiseman T, Twycross A, McKeever S. Manifestation and parental assessment of children's cancer pain at home: An exploratory mixed-methods study. J Clin Nurs 2020; 29:4128-4147. [PMID: 32767621 DOI: 10.1111/jocn.15442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES To describe pain manifestation in children with cancer at home and understand how parents assess this pain. BACKGROUND Pain is experienced by children with cancer throughout their cancer journey. Short-term, and into survivorship, pain has negative physical and psychological consequences. Changes in treatment location mean children with cancer spend more time at home. Little is known about pain experienced by children at home or how parents assess this pain. DESIGN A mixed-methods convergent parallel study was reported using STROBE. METHOD Parents of children with cancer on active treatment were recruited from one tertiary cancer centre. Parental attitudes towards pain expression were assessed using surveys. Parents recorded their child's pain manifestation in pain diaries kept for one month. Interviews captured a deeper understanding of pain manifestation and how parents assess this pain at home. Integration occurred after each data collection method was analysed separately. RESULTS Predominantly children were not in pain at home. However, most children experienced at least one episode of problematic pain over the pain diary period. Surveys showed parents held misconceptions regarding children's pain expression. Interviews diverge from surveys and suggest parents used a range of information sources to assess pain. CONCLUSION Children with cancer may differ from one another in the manifestation of pain at home resulting in multiple pain trajectories. Parents of children with cancer are able to adequately assess their child's pain using information from multiple sources. RELEVANCE TO CLINICAL PRACTICE It is not currently possible to predict which children will experience problematic pain at home, so all parents require pain management education prior to discharge. Teaching parents to use bundled approaches to pain assessment may accelerate their learning. Healthcare professionals may benefit from using multiple information sources to assess pain.
Collapse
Affiliation(s)
- Roses Parker
- School of Health and Social Care, London South Bank University, London, UK
| | - Theresa Wiseman
- The Royal Marsden NHS Foundation Trust, London, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Stephen McKeever
- Faculty of Health, Social Care and Education, Kingston University and St George's, University London, London, UK
| |
Collapse
|
38
|
Vaughn J, Shah N, Jonassaint J, Harris N, Docherty S, Shaw R. User-Centered App Design for Acutely Ill Children and Adolescents. J Pediatr Oncol Nurs 2020; 37:359-367. [PMID: 32646317 DOI: 10.1177/1043454220938341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background and Objectives: The high level of acceptance and consistent use of smartphones by children and adolescents present new opportunities to monitor and collect health data. For acutely ill children and adolescents, collecting symptom data via smartphone applications (apps) provides patient-reported data that can be collected daily and offers the potential to provide a more comprehensive picture of the symptom experience. The purpose of this study was to employ user-centered design principles and medical professional input in order to obtain feedback and insight into redesigning our Technology Recordings for better Understanding Blood and Marrow Transplant (TRU-PBMT) app. This redesigned app will be used for children and adolescents with cancer or undergoing blood and marrow transplantation. Method: We interviewed six pediatric blood and marrow transplant patients (ages 10-17 years) who had pilot tested the app, and we surveyed 30 pediatric oncology clinicians. Results: Interview feedback from previous app users and survey feedback from clinicians guided the app redesign. We incorporated suggestions to make the app more engaging, meaningful, personal, and motivating in order to increase symptom reporting. We added emojis to the symptom tracker, a mood scale, and personalized symptom graphs. Conclusion: Leveraging mobile health technologies may be a useful and acceptable approach to obtain symptom data; however, design and software development needs to be evidenced-based and informed by user needs. Our approach using patient and clinician feedback was valuable in the redesign of the TRU-PBMT app and will contribute to symptom research for acutely ill children and adolescents.
Collapse
Affiliation(s)
| | | | - Jude Jonassaint
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Ryan Shaw
- Duke University School of Nursing, Durham, NC, USA
| |
Collapse
|
39
|
Yang Q, Hatch D, Crowley MJ, Lewinski AA, Vaughn J, Steinberg D, Vorderstrasse A, Jiang M, Shaw RJ. Digital Phenotyping Self-Monitoring Behaviors for Individuals With Type 2 Diabetes Mellitus: Observational Study Using Latent Class Growth Analysis. JMIR Mhealth Uhealth 2020; 8:e17730. [PMID: 32525492 PMCID: PMC7317630 DOI: 10.2196/17730] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/13/2023] Open
Abstract
Background Sustained self-monitoring and self-management behaviors are crucial to maintain optimal health for individuals with type 2 diabetes mellitus (T2DM). As smartphones and mobile health (mHealth) devices become widely available, self-monitoring using mHealth devices is an appealing strategy in support of successful self-management of T2DM. However, research indicates that engagement with mHealth devices decreases over time. Thus, it is important to understand engagement trajectories to provide varying levels of support that can improve self-monitoring and self-management behaviors. Objective The aims of this study were to develop (1) digital phenotypes of the self-monitoring behaviors of patients with T2DM based on their engagement trajectory of using multiple mHealth devices, and (2) assess the association of individual digital phenotypes of self-monitoring behaviors with baseline demographic and clinical characteristics. Methods This longitudinal observational feasibility study included 60 participants with T2DM who were instructed to monitor their weight, blood glucose, and physical activity using a wireless weight scale, phone-tethered glucometer, and accelerometer, respectively, over 6 months. We used latent class growth analysis (LCGA) with multitrajectory modeling to associate the digital phenotypes of participants’ self-monitoring behaviors based on their engagement trajectories with multiple mHealth devices. Associations between individual characteristics and digital phenotypes on participants’ self-monitoring behavior were assessed by analysis of variance or the Chi square test. Results The engagement with accelerometers to monitor daily physical activities was consistently high for all participants over time. Three distinct digital phenotypes were identified based on participants’ engagement with the wireless weight scale and glucometer: (1) low and waning engagement group (24/60, 40%), (2) medium engagement group (20/60, 33%), and (3) consistently high engagement group (16/60, 27%). Participants that were younger, female, nonwhite, had a low income, and with a higher baseline hemoglobin A1c level were more likely to be in the low and waning engagement group. Conclusions We demonstrated how to digitally phenotype individuals’ self-monitoring behavior based on their engagement trajectory with multiple mHealth devices. Distinct self-monitoring behavior groups were identified. Individual demographic and clinical characteristics were associated with different self-monitoring behavior groups. Future research should identify methods to provide tailored support for people with T2DM to help them better monitor and manage their condition. International Registered Report Identifier (IRRID) RR2-10.2196/13517
Collapse
Affiliation(s)
- Qing Yang
- School of Nursing, Duke University, Durham, NC, United States
| | - Daniel Hatch
- School of Nursing, Duke University, Durham, NC, United States
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Duke University, Durham, NC, United States.,Division of Endocrinology, Diabetes and Metabolism, School of Medicine, Duke University, Durham, NC, United States
| | - Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Duke University, Durham, NC, United States
| | | | - Dori Steinberg
- School of Nursing, Duke University, Durham, NC, United States
| | | | - Meilin Jiang
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Ryan J Shaw
- School of Nursing, Duke University, Durham, NC, United States.,Center for Applied Genomics and Precision Medicine, School of Medicine, Duke University, Durham, NC, United States
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Linder LA, Hooke MC. Symptoms in Children Receiving Treatment for Cancer-Part II: Pain, Sadness, and Symptom Clusters. J Pediatr Oncol Nurs 2020; 36:262-279. [PMID: 31307323 PMCID: PMC7197222 DOI: 10.1177/1043454219849578] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Children and adolescents receiving treatment for cancer experience multiple symptoms as a consequence of their disease and its treatment that interfere with the child's quality of life. Understanding of symptom assessment in children with cancer is foundational to the work of the Children's Oncology Group Nursing Discipline, whose research aims are to address knowledge gaps including understanding illness-related distress. This article is the second of a two-part summary of current evidence addressing the assessment of symptoms frequently reported by children and adolescents receiving treatment for cancer. Studies reporting assessment of pain, sadness, and symptom clusters published between January 2008 and May 2018 were included. Forty-three publications addressed pain. Pain was highly prevalent and distressing, varied in its trajectory across a cycle of chemotherapy and across multiple cycles of treatment, and correlated with biomarkers associated with the pain response. Consequences of pain were poorer functional status and emotional health. Twenty publications addressed sadness. Sadness was the most prevalent psychosocial symptom. Its prevalence decreased over the course of treatment and over a cycle of chemotherapy. Persistent sadness was of greater severity and distress. Eight publications addressed symptom clusters. These studies identified both groups of co-occurring symptoms and groups of patients with common symptom profiles. This two-article series provides evidence for the distressing nature of symptoms among children receiving cancer treatment. Efforts to support clinicians in routine symptom assessment are needed. Additional research directed at alleviating symptoms and building resilience among the child experiencing symptoms is needed.
Collapse
Affiliation(s)
- Lauri A Linder
- 1 University of Utah College of Nursing, Salt Lake City, UT, USA
- 2 Cancer Transplant Service, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mary C Hooke
- 3 University of Minnesota School of Nursing, Minneapolis, MN, USA
- 4 Children's Minnesota, Minneapolis, MN, USA
| |
Collapse
|
42
|
Cumba-Avilés E. Systematic Review on the Use of the Children's Depression Inventory-2 among Hispanics. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2020; 42:191-214. [PMID: 35291503 PMCID: PMC8920476 DOI: 10.1177/0739986320915170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
We systematically reviewed studies reporting the use of the Children's Depression Inventory-2 (CDI-2) in samples with at least 30 children and significant Hispanics enrollment (≥ 14.5% of the sample and at least 20 Hispanics completing the scale). We grouped studies by form (short or full-length) and language used, developmental stage, report of psychometric data (particularly for Hispanics), and other characteristics. From 252 full-texts revised, 22 met selection criteria. Six reported psychometric data for Hispanics, either for the English full-length (α = .86 to .92) and short form (α = .76 to .81) or for the Spanish short form (α = .69 to .80). Criterion-related validity was supported via correlation/regression or comparing group means, but not using another depression self-report scale. Current knowledge on the CDI-2 psychometrics among Hispanics is mostly based on studies with the English-language version. No study has reported the psychometrics of the full-length Spanish-language CDI-2 with Hispanics.
Collapse
Affiliation(s)
- Eduardo Cumba-Avilés
- Institute for Psychological Research, University of Puerto Rico, Río Piedras Campus (UPR-RP)
| |
Collapse
|
43
|
Hooke MC, Hatch D, Hockenberry MJ, Whitman S, Moore I, Montgomery D, Marano K, Mitby P, Scheurer ME, Taylor O, Pan W. The Longitudinal Parallel Process Analysis of Biomarkers of Oxidative Stress, Symptom Clusters, and Cognitive Function in Children With Leukemia. J Pediatr Oncol Nurs 2020; 37:244-254. [PMID: 32141369 DOI: 10.1177/1043454220909785] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: During treatment for acute lymphoblastic leukemia (ALL), children report co-occurring symptoms of fatigue, sleep disturbance, pain, nausea, and depression as a symptom cluster. Central nervous system-directed ALL therapies also put children at risk for cognitive impairments. Cancer therapies can cause an increase in oxidative stress, which may contribute to treatment-related symptoms. This study examined the longitudinal relationships between biomarkers of oxidative stress in the cerebrospinal fluid, the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L), and cognition, in children over the first year of ALL treatment. Methods: Glutathione (GSH) biomarkers of oxidative stress were measured in cerebrospinal fluid collected during treatment lumbar punctures. GSH biomarkers, symptoms, and cognitive function of 132 children aged 3 to 18 years were evaluated at four time points during the first year of leukemia treatment. Participants, 7 years and older, completed self-report measures, and parents reported for younger children. Cognitive function measurements for all participants were completed by parents. A longitudinal parallel-process model was used to explore the influence of the initial measurement and the subsequent change over four time points of the GSH biomarkers on the CCSC-L and cognition. Results: GSH biomarkers increased over the four time points indicating decreasing oxidative stress. When GSH biomarkers were higher (less oxidative stress) at the initial measurement, the CCSC-L severity was lower, cognition was better, and cognition improved over the four measurements. Screening children for high levels of oxidative stress would be a foundation for future intervention studies to address symptom distress and cognitive impairments.
Collapse
Affiliation(s)
- Mary C Hooke
- University of Minnesota, Minneapolis, MN, USA
- Children's Minnesota Cancer and Blood Disorders Program, Minneapolis, MN, USA
| | | | - Marilyn J Hockenberry
- Children's Minnesota Cancer and Blood Disorders Program, Minneapolis, MN, USA
- Texas Children's Cancer and Hematology Centers/Baylor College of Medicine, Houston, TX, USA
| | | | - Ida Moore
- University of Arizona, Tucson, AZ, USA
| | | | | | - Pauline Mitby
- Children's Minnesota Cancer and Blood Disorders Program, Minneapolis, MN, USA
| | - Michael E Scheurer
- Texas Children's Cancer and Hematology Centers/Baylor College of Medicine, Houston, TX, USA
| | - Olga Taylor
- Texas Children's Cancer and Hematology Centers/Baylor College of Medicine, Houston, TX, USA
| | - Wei Pan
- Duke University, Durham, NC, USA
| |
Collapse
|
44
|
Lin Y, Docherty S, Porter L, Bailey D. Common and Co-Occurring Symptoms Experienced by Patients With Gastric Cancer. Oncol Nurs Forum 2020; 47:187-202. [DOI: 10.1188/20.onf.187-202] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
45
|
|
46
|
Linder LA, Stegenga K, Erickson J, Ameringer S, Newman AR, Chiu YS, Macpherson CF. Priority Symptoms, Causes, and Self-Management Strategies Reported by AYAs With Cancer. J Pain Symptom Manage 2019; 58:774-783. [PMID: 31319104 PMCID: PMC6823142 DOI: 10.1016/j.jpainsymman.2019.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 12/28/2022]
Abstract
CONTEXT Cancer and symptom experiences of adolescents and young adults (AYAs) with cancer can be highly variable, creating challenges for clinicians and researchers who seek to optimize AYAs' health outcomes. Understanding the heuristics AYAs use to designate priority symptoms can provide insight into the meaning they assign to their symptoms and self-management behaviors. OBJECTIVES This study described the frequency and characteristics of priority symptoms. It qualitatively explored reasons for a symptom's designation as a priority symptom, perceived causes of priority symptoms, and strategies AYAs use to manage priority symptoms. METHODS Participants in this single-group, longitudinal study reported symptoms using a heuristics-based symptom reporting tool, the Computerized Symptom Capture Tool, at two scheduled visits for chemotherapy. AYAs designated priority symptoms and responded to three short answer questions: What makes this a priority symptom?, What do you think causes it?, and What do you do to make it better? RESULTS Eighty-six AYAs, 15-29 years of age (median 19 years), identified 189 priority symptoms. Priority symptoms were of greater severity (t = 3.43; P < 0.01) and distress (t = 4.02; P < 0.01) compared with nonpriority symptoms. Lack of energy, nausea, difficulty sleeping, and pain comprised 39% of priority symptoms. Reasons for priority designation included the impact of the symptom and the attributes of the symptom. Categories of self-management strategies included "Physical Care Strategies," "Things I take (or not)," and "Psychosocial Care Strategies." CONCLUSION Supporting AYAs to identify their priority symptoms may facilitate a more personalized approach to care. Seeking the patient's perspective regarding priority symptoms could enhance patient-clinician collaboration in symptom management.
Collapse
Affiliation(s)
- Lauri A Linder
- University of Utah & Primary Children's Hospital, Salt Lake City, Utah, USA.
| | | | - Jeanne Erickson
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | | | | | | |
Collapse
|
47
|
Physical Activity, the Childhood Cancer Symptom Cluster-Leukemia, and Cognitive Function: A Longitudinal Mediation Analysis. Cancer Nurs 2019; 41:434-440. [PMID: 30124481 DOI: 10.1097/ncc.0000000000000634] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Children undergoing leukemia treatment report co-occurring symptoms of fatigue, sleep disturbances, pain, nausea, and depression as a symptom cluster. Physical activity (PA) is essential for development and may influence symptom severity. Children with leukemia are at risk of cognitive impairments from central nervous system therapies. Using a longitudinal parallel-process model, relationships among function and symptom clusters were explored. OBJECTIVE This study examined the longitudinal mediation effects of PA on cognition via a symptom cluster during leukemia treatment. METHODS Symptoms, PA, and cognitive function of 327 children aged 3 to 18 years were measured over 4 intervals during the first year of leukemia treatment. Children 7 years or older self-reported and parents reported for younger children. Parents completed cognitive function measurements for all children. The influence of the first time point and the subsequent change between all 4 time points of PA on the symptom cluster were explored. Analysis determined whether the symptom cluster mediated the effect of cognition over the treatment period. RESULTS Patients with a higher PA at time 1 reduced their symptom cluster severity over the measurements. However, when PA increased over the measurements, symptom cluster severity also increased. When the symptom cluster was more severe at time 1, cognitive function was lower at time 1, and cognitive function decreased over time. When symptoms became more severe over time, cognitive function declined. CONCLUSIONS The symptom cluster acted as a mediator between PA and cognition. IMPLICATIONS FOR PRACTICE Symptom management during treatment may be an additional strategy for protecting cognitive function.
Collapse
|
48
|
Hockenberry MJ, Pan W, Scheurer ME, Hooke MC, Taylor O, Koerner K, Montgomery D, Whitman S, Mitby P, Moore I. Influence of Inflammatory and Oxidative Stress Pathways on Longitudinal Symptom Experiences in Children With Leukemia. Biol Res Nurs 2019; 21:458-465. [PMID: 31315444 DOI: 10.1177/1099800419863160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to explore the influence of oxidative stress (F2-isoprostanes) and inflammatory (interleukin [IL]-8) biomarkers on symptom trajectories during the first 18 months of childhood leukemia treatment. METHOD A repeated-measures design was used to evaluate symptoms experienced by 218 children during treatment. A symptom cluster (fatigue, pain, and nausea) was explored over four time periods: initiation of post-induction therapy, 4 and 8 months into post-induction therapy, and the beginning of maintenance therapy (12 months postinduction). F2-isoprostanes and IL-8 were evaluated in cerebrospinal fluid (CSF) samples collected at baseline (diagnosis) and then at the four time periods. The longitudinal relationships of these biomarkers with the symptom cluster were examined using the longitudinal parallel process. RESULTS Pain and fatigue levels were highest during the post-induction phases of treatment and decreased slightly during maintenance therapy, while nausea scores were relatively stable. Even in the later phases of treatment, children continued to experience symptoms. CSF levels of the biomarkers increased during the post-induction phases of treatment. Early increases in the biomarkers were associated with more severe symptoms during the same period; patients who had increased biomarkers over time also experienced more severe symptoms over time. CONCLUSIONS Findings reveal that children experienced symptoms throughout the course of leukemia treatment and support hypothesized longitudinal relationships of oxidative stress and inflammatory biomarkers with symptom severity. Activation of the biomarker pathways during treatment may explain underlying mechanisms of symptom experiences and identify which children are at risk for severe symptoms.
Collapse
Affiliation(s)
| | - Wei Pan
- 1 School of Nursing, Duke University, Durham, NC, USA
| | - Michael E Scheurer
- 2 Baylor College of Medicine, Houston, TX, USA.,3 Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Mary C Hooke
- 4 School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Olga Taylor
- 2 Baylor College of Medicine, Houston, TX, USA.,3 Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Kari Koerner
- 5 College of Nursing, University of Arizona, Tucson, AZ, USA
| | | | - Susan Whitman
- 5 College of Nursing, University of Arizona, Tucson, AZ, USA
| | | | - Ida Moore
- 5 College of Nursing, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
49
|
Duffy EA, Dias N, Hendricks-Ferguson V, Hellsten M, Skeens-Borland M, Thornton C, Linder LA. Perspectives on Cancer Pain Assessment and Management in Children. Semin Oncol Nurs 2019; 35:261-273. [PMID: 31078340 DOI: 10.1016/j.soncn.2019.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To report evidence regarding pain assessment and management for children and adolescents receiving treatment for cancer. DATA SOURCES Published research and clinical guidelines. CONCLUSION Children and adolescents experience multiple sources of pain across the cancer continuum. They require developmentally relevant approaches when assessing and managing pain. This review suggests that consideration of the developmental stage and age of the child are essential in both pain assessment and pain management. IMPLICATIONS FOR NURSING PRACTICE Pediatric oncology nurses play a key role in developmentally appropriate pain assessment, identification of potential strategies to manage pain, and delivery of pharmacologic and nonpharmacologic therapies.
Collapse
Affiliation(s)
| | - Nancy Dias
- East Carolina University College of Nursing, Greenville, NC
| | | | - Melody Hellsten
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | - Cliff Thornton
- Herman & Walter Samuelson Children's Hospital of Sinai, Division of Pediatric Hematology/Oncology, Johns Hopkins School of Nursing, Baltimore, MD
| | - Lauri A Linder
- University of Utah, College of Nursing, Salt Lake City, UT; Primary Children's Hospital, Salt Lake City, UT
| |
Collapse
|
50
|
Rodgers CC, Hooke MC, Taylor OA, Koerner KM, Mitby PA, Moore IM, Scheurer ME, Hockenberry MJ, Pan W. Childhood Cancer Symptom Cluster: Leukemia and Health-Related Quality of Life. Oncol Nurs Forum 2019; 46:228-237. [PMID: 30767969 DOI: 10.1188/19.onf.228-237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the relationship of the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L) with health-related quality of life (HRQOL). SAMPLE & SETTING 327 children receiving treatment for acute lymphoblastic leukemia from four pediatric oncology programs across the United States. METHODS & VARIABLES Participants completed fatigue, sleep disturbance, pain, nausea, and depression symptom questionnaires at four time points; these symptoms comprised the CCSC-L. HRQOL was measured at the start of postinduction therapy and then at the start of maintenance therapy. Relationships between the CCSC-L and HRQOL scores were examined with longitudinal parallel-process modeling. RESULTS The mean HRQOL significantly increased over time (p < 0.001). The CCSC-L had a significant negative association with HRQOL scores at the start of postinduction therapy (beta = -0.53, p < 0.005) and the start of maintenance therapy (beta = -0.33, p < 0.015). Participants with more severe symptoms in the CCSC-L over time had significantly lower HRQOL at the start of maintenance therapy (beta = -0.42, p < 0.005). IMPLICATIONS FOR NURSING Nurses are pivotal in providing management strategies to minimize symptom severity that may improve HRQOL.
Collapse
|