Symptom Monitoring and Dependent Care During Cancer Treatment in Children

Patient-reported outcome measures in children, adolescents, and young adults with palliative care needs-a scoping review

BACKGROUND

Measuring outcomes facilitates evaluation of palliative services for children, adolescents, and young adults (CAYAs) with life-limiting and/or life-threatening (LL/LT) conditions. Implementation of patient-reported, proxy-reported, or patient-centered outcome measures (hereafter PROMs) is recommended to ensure palliative services. The purpose of this scoping review was to provide an overview of PROMs relevant for CAYAs living with LL/LT conditions eligible for pediatric palliative care (PPC).

METHODS

Arksey and O'Malley's 6-stage scoping review framework was used to guide the review. The identified citations had to report on PROMs in any context including CAYAs with LL/LT conditions up to 25 years of age. A systematic search of Medline, EMBASE, CINAHL, APA PsycInfo, Health and Psychosocial Instruments, and AMED took place in January 2021 and was updated in June 2022. Citations were screened independently by pairs of researchers. The scoping review protocol was registered, and peer-review published.

RESULTS

Of 3690 identified citations, 98 reports were included, of which the majority were from Western countries and about PROMs in CAYAs living with cancer or organ failure. A total of 80 PROMs were identified, assessing a range of phenomena, where quality of life and symptoms (especially pain) during the stage of ongoing care were the most frequent. There were only a few reports about outcome measures at time of diagnosis or in end-of-life care. CAYAs self-reported on the PROMs or collaborated with their parents in about half of the reports, while the remaining had proxies answering on behalf of the CAYAs. In the identified reports, PROMs were used to characterize a sample through cross-sectional or longitudinal research, and less often to assess effects of interventions.

CONCLUSION

The identified PROMs in the CAYA population eligible for PPC is characterized by studies in high-income countries during ongoing care, primarily in patients with cancer or organ failure. More research is needed in patients living with other LL/LT conditions, and during different stages of the disease course, especially at time of diagnosis, during transition to adulthood, and in end-of-life care. This scoping review of PROMs relevant for young patients eligible for PPC may inform future research about patient-/proxy-reported or patient-centered outcome measures in PPC.

TRIAL REGISTRATION

Review registration: ( https://osf.io/yfch2/ ) and published protocol (Holmen et al. Syst Rev. 10:237, 2021).

Requirements of mobile-based self-management application for patients with gastric cancer: specialists and patients perspective (Preprint)

Background

Objective

Methods

Results

Conclusions

Symptom Occurrence, Severity, and Self-Care Methods by Ethnicity and Age Group Among Adults With Cancer

OBJECTIVES

To examine the relationships among cancer therapy-related symptom occurrence and severity, selected cancer-related variables, and demographic variables. Secondary purposes were to examine participants' reported symptom occurrence and severity by ethnicity and by age group and to identify self-care methods.

SAMPLE & SETTING

Convenience sampling was used and included 110 adults receiving cancer treatment from a major hospital in the northeast region of the United States.

METHODS & VARIABLES

A descriptive correlational design was used. Study variables were symptom occurrence and severity and selected demographic and cancer-related variables. The Therapy-Related Symptom Checklist was used to measure symptom occurrence and severity, and the Symptom Alleviation.

RESULTS

Significant relationships were found between symptom occurrence and severity and gender, economic status, and disease stage. Feeling sluggish was the most frequently reported symptom.

IMPLICATIONS FOR NURSING

Oncology nurses are in an influential position to educate and manage participants' cancer therapy-related symptoms.

Smartphone apps to help children and adolescents with cancer and their families: a scoping review

Introduction: Considering the importance of empowering patients and their families by providing appropriate information and education, it seems smartphone apps provide a good opportunity for this group. The purpose of this review was to identify studies which used smartphone apps to help children and adolescents with cancer and their families. Method: Arksey and O'Malley's framework was employed in this review. To examine the evidence on the design and use of smartphone apps for the target group, PubMed, Embase, Scopus and Web of Science databases were searched from 2007 to November 2018. Results: Twenty-four articles met the inclusion criteria, with 33% being conducted in the USA and 21% in Canada. Moreover, in 20 studies (83%), app was specifically designed for children and adolescents, with only three studies (13%) for parents and one study (4%) for both. The main modules of smartphone apps in these studies included symptom assessment (90%), provision of information and education (74%), communication with caregivers (57%), social support (30%) and calendar and reminder (21%). Conclusions: Due to the easy access to smartphones without a costly infrastructure compared to landline phones, the use of mobile health (m-Health) has become a suitable method of providing healthcare services, especially for cancer. Use of smartphone apps, increases patient and families' access to reliable and suitable education and information regarding the disease. Thus, healthcare policy-makers in developing or underdeveloped countries can exploit the health-related potentials of m-Health following the experience of developed countries.

How Can We Use Symptom Clusters in Nursing Care of Children with Leukemia?

The incidence of childhood cancers has been gradually rising worldwide. The rate of leukemia, which is the most common cancer type in childhood, has been increasing as well. In recent years, multiple chemotherapeutic agents, radiotherapy and bone marrow transplantation have been using in leukemia treatment. Children receiving treatment for leukemia may experience many symptoms due to the disease and its treatment. These concurrent symptoms may have a complex relationship. The aim of this paper is to review and compile current literature data related to symptom clusters used to explain multiple symptoms that occur in a complex structure due to leukemia and its treatment. Symptom clustering is used in oncology nursing to explain the complex relationship among multiple symptoms and to find out the effects that symptoms have on each other and patient outcomes. There are generally two statistical approaches to modeling symptom clusters. One is to establish the symptom clusters by grounding on clinical experiences, while the other is to establish them according to the results of statistical analysis and then clinical experiences. With the latter method, symptom clusters can be established more objectively and more number of symptoms can be assessed. In the literature, there are four instruments available for the measurement of a large number of symptoms in children. It is important to increase use of symptom clusters in nursing care for a better understanding of the relationship among multiple symptoms experienced during leukemia treatment, a more effective symptom management, and a more holistic care.

Retracted: Symptom trajectories and occurrence in older Saudi children with cancer during a course of chemotherapy

This research aimed to describe changes in symptom occurrence and severity of the 31 symptoms during the chemotherapy cycle at three time points. This descriptive, longitudinal study investigated Saudi children who underwent a cycle of chemotherapy (n = 132) in four tertiary hospitals. The Arabic version of the Memorial Symptom Assessment Scale, Karnofsky Performance Status and a demographic questionnaire were used. More than 30% of children reported 10 or more symptoms during the cycle. Symptom occurrence trajectories were analysed using multilevel logistic regression. Six symptoms (i.e. fatigue, sadness, irritability, worrying, weight loss, sweating) showed a decreasing linear trend. Significant quadratic patterns of change were found for feeling drowsy, nausea and vomiting. No significant differences, over time were found in any of the symptom severity scores by using multilevel negative binomial regression. This study is the first to examine the trajectory of multiple symptoms that children experience during a cycle of chemotherapy in Saudi Arabia. Children in this study reported a high number of symptoms across the entire cycle of chemotherapy. Intervention studies are needed to improve care for these symptoms.

Symptom alleviation and self-care among breast cancer survivors after treatment completion

BACKGROUND

This article elucidates the symptom experiences of breast cancer survivors after completion of their treatment. It also provides self reports of the types, frequency of use, and effectiveness of self-care measures to treat the symptoms they are experiencing.

OBJECTIVES

The purpose of this article is to describe the self-care strategies used to alleviate symptoms reported by breast cancer survivors recruited from a secure state coalition database.

METHODS

The Therapy-Related Symptom Checklist (TRSC) was used to identify the occurrence and severity of ongoing symptoms in breast cancer survivors who were six months or more post-treatment. Two groups were identified for further exploration of self-care.

FINDINGS

The self-care method category most commonly reported was diet/nutrition/lifestyle and the least common category was herbs/vitamins/complementary therapy. With few exceptions, the reported methods were perceived as effective.

Patterns of Response in Parents of Children With Cancer: An Integrative Review

PROBLEM IDENTIFICATION

To identify patterns of response of parents in relation to taking care of their child with cancer.
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LITERATURE SEARCH

The search was performed using CINAHL® and Scopus in February 2013.
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DATA EVALUATION

The selection process resulted in 18 articles with a wide range of methodologic approaches. The description of the research methods of each study and the relevance of the results in comparison to the purpose of this review were established as assessment criteria.
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SYNTHESIS

The results of the studies were analyzed using Meleis's Transition Theory, identifying a vast number of patterns of response developed by the parents. These patterns of response were analyzed, compared, and split into four themes.
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CONCLUSIONS

Using this methodology, a wide range of behaviors, attitudes, and competencies associated with the circumstance of parents caring for a child with cancer could be identified. 
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IMPLICATIONS FOR PRACTICE

Knowledge of the patterns of response will enable nurses to lead parents through a healthy transition process in caring for their children with cancer.

Antiemetic medication for prevention and treatment of chemotherapy-induced nausea and vomiting in childhood

BACKGROUND

Nausea and vomiting remain a problem for children undergoing treatment for malignancies despite new antiemetic therapies. Optimising antiemetic regimens could improve quality of life by reducing nausea, vomiting, and associated clinical problems. This is an update of the original systematic review.

OBJECTIVES

To assess the effectiveness and adverse events of pharmacological interventions in controlling anticipatory, acute, and delayed nausea and vomiting in children and young people (aged less than 18 years) about to receive or receiving chemotherapy.

SEARCH METHODS

Searches included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, PsycINFO, conference proceedings of the American Society of Clinical Oncology, International Society of Paediatric Oncology, Multinational Association of Supportive Care in Cancer, and ISI Science and Technology Proceedings Index from incept to December 16, 2014, and trial registries from their earliest records to December 2014. We examined references of systematic reviews and contacted trialists for information on further studies. We also screened the reference lists of included studies.

SELECTION CRITERIA

Two review authors independently screened abstracts in order to identify randomised controlled trials (RCTs) that compared a pharmacological antiemetic, cannabinoid, or benzodiazepine with placebo or any alternative active intervention in children and young people (less than 18 years) with a diagnosis of cancer who were to receive chemotherapy.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted outcome and quality data from each RCT. When appropriate, we undertook meta-analysis.

MAIN RESULTS

We included 34 studies that examined a range of different antiemetics, used different doses and comparators, and reported a variety of outcomes. The quality and quantity of included studies limited the exploration of heterogeneity to narrative approaches only.The majority of quantitative data related to the complete control of acute vomiting (27 studies). Adverse events were reported in 29 studies and nausea outcomes in 16 studies.Two studies assessed the addition of dexamethasone to 5-HT3 antagonists for complete control of vomiting (pooled risk ratio (RR) 2.03; 95% confidence interval (CI) 1.35 to 3.04). Three studies compared granisetron 20 mcg/kg with 40 mcg/kg for complete control of vomiting (pooled RR 0.93; 95% CI 0.80 to 1.07). Three studies compared granisetron with ondansetron for complete control of acute nausea (pooled RR 1.05; 95% CI 0.94 to 1.17; 2 studies), acute vomiting (pooled RR 2.26; 95% CI 2.04 to 2.51; 3 studies), delayed nausea (pooled RR 1.13; 95% CI 0.93 to 1.38; 2 studies), and delayed vomiting (pooled RR 1.13; 95% CI 0.98 to 1.29; 2 studies). No other pooled analyses were possible.Narrative synthesis suggests that 5-HT3 antagonists are more effective than older antiemetic agents, even when these agents are combined with a steroid. Cannabinoids are probably effective but produce frequent side effects.

AUTHORS' CONCLUSIONS

Our overall knowledge of the most effective antiemetics to prevent chemotherapy-induced nausea and vomiting in childhood is incomplete. Future research should be undertaken in consultation with children, young people, and families that have experienced chemotherapy and should make use of validated, age-appropriate measures. This review suggests that 5-HT3 antagonists are effective in patients who are to receive emetogenic chemotherapy, with granisetron or palonosetron possibly better than ondansetron. Adding dexamethasone improves control of vomiting, although the risk-benefit profile of adjunctive steroid remains uncertain.

Symptom assessment in pediatric oncology: how should concordance between children's and parents' reports be evaluated?

BACKGROUND

Clinical evaluations in pediatric oncology are often triadic, involving children or adolescents, parents, and clinicians. However, few studies have evaluated the concordance between children's and parents' reports of symptom occurrence.

OBJECTIVES

The purposes of this study were to evaluate the concordance between children's and parents' symptom reports during the week of chemotherapy administration using 5 statistical approaches and determine which factors are associated with higher levels of dyadic concordance.

METHODS

Independent assessments of symptom occurrence were obtained from children and adolescents with cancer (n = 107) and their parents using the Memorial Symptom Assessment Scale 10-18. Concordance was assessed using (1) percentage of overall agreement, (2) Cohen κ coefficients, (3) McNemar tests, (4) positive percentage agreement, and (5) negative percentage agreement.

RESULTS

For each dyad, an average of 20 of the 31 symptom reports were concordant. Using children's reports as the "gold standard," parents rarely underestimated the children's symptoms. However, compared with children's reports, parents overestimated 7 symptoms. Advantages and disadvantages of each of the statistical approaches used to evaluate concordance are described in this article.

CONCLUSIONS

A variety of statistical approaches are needed to obtain a thorough evaluation of the concordance between symptom reports. Discordance was most common for symptoms that children refuted, particularly psychosocial symptoms.

IMPLICATIONS FOR PRACTICE

Clinicians need to interview children and adolescents along with their parents about the occurrence of symptoms and evaluate discrepant reports. Effective approaches are needed to improve communication between children and parents to improve symptom assessment and management.

Self-reported assessment of symptoms and self-care within a cohort of U.S. veterans during outpatient care for cancer

BACKGROUND

This study was undertaken as part of a feasibility study of the use of a symptom checklist and self-care assessment of veterans receiving oncology outpatient treatment within the U.S. Department of Veterans Affairs system.

OBJECTIVES

The study aimed to examine (a) symptom occurrence and severity as self-reported on the Therapy-Related Symptom Checklist (TRSC) by veterans at a cancer clinic, (b) symptom alleviation strategies and use of self-care, and (c) the relationship between symptom occurrence and severity and functional status and quality of life.

METHODS

Veterans (N = 100) undergoing chemotherapy and/or radiation therapy participated in a cross-sectional study. Tools used, including TRSC, Symptom Alleviation.

FINDINGS

Thirteen symptoms were reported by more than 35% of patients. Top-ranked symptoms by percentage occurrence and severity were feeling sluggish, taste changes, nausea, pain, constipation, loss of appetite, numbness of fingers and toes, difficulty sleeping, weight loss, hair loss, difficulty concentrating, shortness of breath, and decreased interest in sexual activity. Occurrence and severity of symptoms had significant negative correlations with functional status and with overall quality of life. Self-care (symptom alleviation) strategies that helped were medicines, diet and nutrition, and lifestyle change. Checklist use (TRSC) facilitated patient-report of symptoms during cancer treatments; self-care strategies helped relieve symptoms.

Cancer-Related Pain and Pain Management: Sources, Prevalence, and the Experiences of Children and Parents

Advances in treatment mean children are increasingly cared for by their parents at home, leading to a shift in responsibility from health care professionals to parents. Little is known about parents' pain management experiences and the etiology of pain experienced by children with cancer especially when at home. A rapid review of the literature was undertaken investigating children's cancer-related pain, with emphasis on the management of pain outside the health care setting. Electronic databases were searched and a quality assessment was conducted. Forty-two articles were included. Despite advances in pain management techniques, children with cancer regularly cite pain as the most prevalent symptom throughout the cancer trajectory. The source of pain is usually treatment side effects or painful procedures. Parents find dealing with their child's pain distressing and demanding and may hold misconceptions about pain management. Findings indicate a need for more robust research into parental pain management leading to the development of effective pain management resources for parents.

Monitoring and Alleviation of Symptom Occurrence and Severity Among Thai Children and Adolescents During Cancer Treatments

BACKGROUND

Symptom monitoring and alleviation are important during pediatric cancer treatments.

AIMS

To examine the use of the Therapy-Related Symptom Checklist for Children (TRSC-C; Thai version) for reported occurrence, severity, and management of treatment-related symptoms within a cohort of Thai pediatric oncology patients/parents

METHOD

Cross-sectional study; convenience sample: 100 parents of 71 male children/29 females, 63% with leukemia, 37%, other diagnoses; age-groups: <5 years, n = 33; 5 to 11 years, n = 44; 12 to 17 years, n = 25. Parents reported children's symptom occurrence/severity on the TRSC-C; and complementary care methods on the Symptom Alleviation: Self-Care Methods and their symptom alleviation methods. All tools had good psychometric properties.

RESULTS

18 symptoms on the 30-item TRSC-C occurred in 42% to 95% of children. Mean severity of symptoms was between 1.0 ("a bit") and 2.0 ("quite a bit"); 5-month to 11-year-old children had higher (worse) TRSC-C total scores. Complementary care was used and reported.

CONCLUSIONS

Monitoring of multiple symptoms with the TRSC-C and parental symptom alleviation helped children.

CLINICAL IMPLICATIONS

Thai parents/patients need and accept assistance in monitoring/managing side effects of pediatric cancer therapy.

Parents' and health-care providers' perspectives on side- effects of childhood cancer treatment in Indonesia

BACKGROUND

Efficacy of childhood cancer treatment in low-income countries may be impacted by parents' and health-care providers' perspectives on chemotherapy-related side-effects. This study explores prevalence and severity of side-effects in childhood cancer, and compares health beliefs about side-effects between parents and health-care providers, and between nurses and doctors in Indonesia.

MATERIALS AND METHODS

Semi-structured questionnaires were filled in by 40 parents and 207 health-care providers in an academic hospital.

RESULTS

Parents exporessed a desire to receive more information about side-effects (98%) and worried about this aspect of treatment (90%), although side-effects were less severe than expected (66%). The most frequent was behavior alteration (98%) and the most severe was hair loss. Only 26% of parents consulted doctors about side-effects. More parents, compared to health-care providers, believed that medicines work better when side-effects are more severe (p<0.001), and accepted severe side-effects (p=0.021). More health-care providers, compared to parents, believed that chemotherapy can be stopped or the dosage altered when there are side-effects (p=0.011). More nurses, compared to doctors, stated that side-effects were unbearable (p=0.004) and made them doubt efficacy of treatment (p<0.001).

CONCLUSIONS

Behavior alteration is the most frequent and hair loss the most severe side-effect. Apparent discrepancies in health beliefs about side-effects exist between parents and health-care providers. A sustainable parental education program about side-effects is recommended. Health-care providers need to update and improve their knowledge and communication skills in order to give appropriate information. Such measures may improve outcome of childhood cancer treatment in low-income countries, where adherence to therapy is a major issue.

Symptom monitoring, alleviation, and self-care among Mexican Americans during cancer treatment

Monitoring the occurrence and severity of symptoms among Mexican American adults undergoing cancer treatments, along with their self-care to alleviate symptoms, are understudied; the current study aimed to fill this gap in the literature. A total of 67 Mexican Americans receiving outpatient oncology treatments in the southwestern United States participated. Instruments included a patient-report checklist, the Therapy-Related Symptom Checklist (TRSC), the Symptom Alleviation: Self-Care Methods tool, and a demographic and health information form. At least 40% of participants reported the occurrence of 12 symptoms: hair loss, feeling sluggish, nausea, taste change, loss of appetite, depression, difficulty sleeping, weight loss, difficulty concentrating, constipation, skin changes, and numb fingers and toes. More than a third also reported pain, vomiting, decreased interest in sexual activity, cough, and sore throat. The helpful self-care strategies reported included diet and nutrition changes; lifestyle changes; and mind, body control, and spiritual activities. Patient report of symptoms during cancer treatments was facilitated by the use of the TRSC. Patients use symptom alleviation strategies to help relieve symptoms during their cancer treatment. The ability to perform appropriate, effective self-care methods to alleviate the symptoms may influence adherence to the treatment regimen.

A pilot exploration of symptom trajectories in adolescents with cancer during chemotherapy

BACKGROUND

Chemotherapy is frequently administered in repetitive cycles. Adolescents with cancer have multiple symptoms related to chemotherapy, but knowledge of symptom trajectories across a cycle is limited. Examining trajectories over a cycle may reveal key periods to manage symptoms.

OBJECTIVES

The aims of this pilot were to describe the trajectory of symptoms (pain, sleep, appetite, nausea, fatigue) and biological and behavioral variables (anxiety, stress, hematologic function) across 1 cycle and examine relationships between variables.

METHODS

Nine adolescents with cancer within 6 months of diagnosis participated. Data were collected by surveys, chart review, and biologic measures on days 1 and 2 of the cycle, 1 week later (nadir), and day 1 of the following cycle. To evaluate the trajectory, a simple random-effects repeated-measures analysis was computed.

RESULTS

The significant trajectories were fatigue (P = .003), difficulty sleeping (P = .032), and nausea (P = .04). Most of the adolescents reported some anticipatory anxiety about receiving chemotherapy. Significant correlations between symptoms and biobehavioral variables included anticipatory anxiety and nausea (r = .86, P = .003), trait anxiety and fatigue (r = -0.82, P < .001), and stress and pain (r = 0.78, P = .039).

CONCLUSIONS

Multiple symptoms were experienced across the cycle. Three symptoms displayed significant trajectories indicating that patterns of symptoms may be anticipated.

IMPLICATIONS FOR PRACTICE

Pilot findings suggest that monitoring symptoms, stress, and anxiety across a cycle is important, not only during chemotherapy administration, but also prior to being admitted for chemotherapy.

Parental caregiving of children with cancer and family impact, economic burden: nursing perspectives

Pediatric cancer diagnoses affect the entire family: parents, well siblings, the ill child, and others. The objective of this study was to review nursing studies on parental caregiving of children with cancer, family impact, and costs. The study used inclusion/exclusion criteria and family systems theory, self/dependent-care, and symptom management (monitoring, alleviation) concepts. Regarding "levels of evidence," 3 studies were Level II; 7 were Level IV; 7 were Level VI; 1 review was Level V and the second was Level I. Of 19 studies: 11 were qualitative; 4, quantitative; 2 were mixed methods. Content analysis themes were: Parental caregiving and family impact, economic burden. Conclusions were that (a) qualitative studies are predominant; findings supported quantitative findings; (b) quantitative nursing studies are less common: found one longitudinal, randomized controlled trial (RCT) focused on outcomes of an intervention for well siblings and parents, implemented by Clinical Nurse Specialists, CNSs; (c) few quantitative studies with large samples were found, especially ones with theoretical models of the family system and measures of illness impact on families; and (d) "mixed methods" longitudinal nursing research is illustrated. There is a need for "evidence-based" practice (EBP) nursing studies of interventions focused on parent education/support/assistance; respite care, and increasing family/well sibling knowledge/other information on the child's illness.

Nutritional Screening and Early Intervention in Children, Adolescents, and Young Adults With Cancer

Children and adolescents with cancer who receive chemotherapy and/or radiation treatments are at risk for malnutrition due to side effects such as nausea, vomiting, anorexia, and mouth sores. Malnutrition during treatment for childhood cancer increases the risk of infection, decreases tolerance to treatment, and even affects overall survival. A retrospective analysis of 79 children, adolescents, and young adults was conducted to evaluate nutritional screening at baseline and for the first 6 months of treatment. Interventions were also documented. Forty-nine participants had a positive screen for risk of malnutrition. In the patients with a positive screen, 78% had intervention within 24 hours of the identified risk for malnutrition. Thirty-five patients had a nutritional referral, which resulted in a full nutritional assessment and plan. Key independent variables were analyzed to determine if they were associated with an increased risk of malnutrition. In addition, individual risk factors were analyzed to determine their association with malnutrition. Future studies should find whether early intervention is effective in reversing the risk of malnutrition during treatment for childhood cancer.

A systematic review of symptom assessment scales in children with cancer

Background

The objective was to describe symptom assessment scales that have been used in children with cancer.

Methods

We conducted electronic searches of OVID Medline and EMBASE in order to identify all symptom assessment scales that have been used in pediatric cancer. Two reviewers abstracted information from each identified study. Data collected included study demographics and information related to the instrument and children enrolled. We also collected information about the purpose of instrument administration and whether treatment was altered as a result of this information.

Results

Fourteen studies were identified which evaluated eight different symptom assessment scales. Eight studies used child self-report and all studies included children on active treatment for cancer although 4 studies also included children following completion of treatment. The most common purpose of instrument administration was to measure the prevalence of symptom burden (n = 8). None of the 14 studies used the scale to screen for symptoms and none changed patient management on the basis of identified symptoms.

Conclusions

We failed to identify any symptom assessment scales that were used as a symptom screening tool. There is a need to develop such a tool for use in children with cancer.

Reduction in nausea and vomiting in children undergoing cancer chemotherapy by either appropriate or sham auricular acupuncture points with standard care

BACKGROUND

Over 40% of children with cancer have reported that chemotherapy-induced nausea and vomiting (CINV) are the two most distressing side-effects of treatment even when antiemetic drugs have been used.

OBJECTIVES

The purpose of this article is to report the findings from a feasibility and pilot study using auricular point acupressure point for CINV in a small group of children in Taiwan.

METHODS

This was a crossover randomized design study. CINV symptoms were assessed on 10 patients just prior to and for 7 days following each of three rounds of chemotherapy drugs (CTX). They received standard care (SC) and were not entered into a test treatment group until they completed the baseline assessment, which was conducted during their first round of chemotherapy after entering the study. Just prior to receiving the second round of CTX, patients were randomized into one of two treatment conditions: auricular acupressure intervention, in addition to standard care (AAP) or auricular acupressure using sham auricular points (SAP) in addition to standard care. For the third round of CTX, they were switched to the other treatment group.

RESULTS

The enrollment rate for this study was 77% of the children invited to participate and of those, 88% provided completed data sets for all three treatment conditions. Patients in the AAP group reported significantly lower occurrence and severity of nausea and vomiting than patients in the SC group (p<0.05). There were no significant differences of nausea and vomiting for patients between the AAP and SAP groups. All of the patients took antiemetic medication on the day they received CTX, and 80% of patients reported that the antiemetics did not help to treat CINV.

CONCLUSIONS

These preliminary findings did show evidence that AAP is acceptable to the children and their parents to prevent/treat CINV. However, there were no statistically significant differences between the AAP and SAP groups in the prevention/treatment of CINV. There were clinical trend differences between the groups, which may due to the small sample size. In a larger study, it would be important to determine whether the effects of the AAP and SAP treatment are independent of any psychologic effects, such as the researcher's increased presence in both treatment groups.

Pediatric chronic illness (cancer, cystic fibrosis) effects on well siblings: parents' voices

This study is a secondary analysis of data gathered during baseline data collection prior to a cognitive-psychosocial-respite intervention provided in a randomized controlled trial (RCT). Content analysis was used to identify themes in parents' responses to an open-ended item about their perceptions of the effects on siblings of having a brother or sister who has either cancer or cystic fibrosis (CF). Of 91 themes tallied in the cancer group (n = 29), 74.5% reflected negative manifestations of increased risk in siblings, 1.1% no risk; and 24.2%, positive outcomes. Of 53 themes tallied in the CF group (n = 15), the same three categories had 67.9 %, 0%, and 32.1%, respectively. Contemporary life in these families portrayed in parents' descriptions not only validate the rationale for the RCT done, but also suggest the need in ambulatory pediatrics for intervention research on these vulnerable populations.

Review of symptom experiences in children and adolescents with cancer

BACKGROUND

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR PRACTICE

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

Symptom cluster analyses based on symptom occurrence and severity ratings among pediatric oncology patients during myelosuppressive chemotherapy

BACKGROUND

Symptom cluster research is an emerging field in symptom management. The ability to identify symptom clusters that are specific to pediatric oncology patients may lead to improved understanding of symptoms' underlying mechanisms among patients of all ages.

OBJECTIVE

The purpose of this study, in a sample of children and adolescents with cancer who underwent a cycle of myelosuppressive chemotherapy, was to compare the number and types of symptom clusters identified using patients' ratings of symptom occurrence and symptom severity.

METHODS

Children and adolescents with cancer (10-18 years of age; N = 131) completed the Memorial Symptom Assessment Scale 10-18 on the day they started a cycle of myelosuppressive chemotherapy, using a 1-week recall of experiences. Symptom data based on occurrence and severity ratings were examined using exploratory factor analysis. The defined measurement model suggested by the best exploratory factor analysis model was then examined with a latent variable analysis.

RESULTS

Three clusters were identified when symptom occurrence ratings were evaluated, which were classified as a chemotherapy sequela cluster, mood disturbance cluster, and a neuropsychological discomfort cluster. Analysis of symptom severity ratings yielded similar cluster configurations.

CONCLUSIONS

Cluster configurations remained relatively stable between symptom occurrence and severity ratings. The evaluation of patients at a common point in the chemotherapy cycle may have contributed to these findings.

IMPLICATIONS FOR PRACTICE

Additional uniformity in symptom clusters investigations is needed to allow appropriate comparisons among studies. The dissemination of symptom cluster research methodology through publication and presentation may promote uniformity in this field.

Tele-practice guidelines for the symptom management of children undergoing cancer treatment

The provision of tele-practice symptom management is often without the provision of evidence-based guidelines. Under the auspices of the Pediatric Oncology Group of Ontario, a nursing task force was established to appraise the evidence and develop guidelines. Promising new efforts to enhance symptom management through tele-practice are emerging. Seven guidelines and one documentation tool were created from evidence compiled from case reports, clinical examples, and nonexperimental studies. The symptom management guidelines contribute to the paucity of literature and may serve as a useful resource for health professionals providing telephone advice and conducting tele-practice symptom management assessments.

Multidisciplinary care in pediatric oncology

This paper describes the significant advances in the treatment of childhood cancer and supportive care that have occurred over the last several decades and details how these advances have led to improved survival and quality of life (QOL) for children with cancer through a multidisciplinary approach to care. Advances in the basic sciences, general medicine, cooperative research protocols, and policy guidelines have influenced and guided the multidisciplinary approach in pediatric oncology care across the spectrum from diagnosis through long-term survival. Two case studies are provided to highlight the nature and scope of multidisciplinary care in pediatric oncology care.

An evaluation of the factors that affect the health-related quality of life of children following myelosuppressive chemotherapy

PURPOSE

The purposes of this study, in children who were assessed 1 week after the administration of myelosuppressive chemotherapy were: to compare the total and subscale scores on a generic measure of health-related quality of life (HRQOL) to normative data from healthy children and describe the relationships between demographic, clinical, and symptom characteristics of children with cancer and generic and disease-specific dimensions of HRQOL.

METHODS

Patients (n = 61) were predominantly male (52.5%), minority (63.9%), and 14.7 years of age. Children completed the Memorial Symptom Assessment Scale for 10- to 18-year olds, the PedsQL™ Generic and Cancer Modules, and the Karnofsky Performance Status (KPS) scale 1 week after the start of a chemotherapy cycle.

RESULTS

The mean number of symptoms per patient was 10.6. Compared with the normative sample, children with cancer reported significantly lower scores for the total scale and all of the subscales except emotional and social functioning. No significant differences were found between any demographic characteristics and total or subscale scores on the generic or disease-specific measures of HRQOL. Lower KPS scores were associated with poorer generic and disease-specific HRQOL scores. In addition, a higher number of symptoms was associated with poorer generic and disease-specific HRQOL scores. Finally, higher symptom distress scores were associated with poorer generic and disease-specific HRQOL scores.

CONCLUSION

Among the demographic, clinical, and symptom characteristics studied, poorer functional status and higher symptom burden were associated with significant decreases in HRQOL in children who received myelosuppressive chemotherapy.

Parents' perceptions of their children's cancer-related symptoms during treatment: a prospective, longitudinal study

CONTEXT

This article describes a comprehensive assessment of treatment-related symptoms in children aged 0-18 years undergoing cancer treatment from the perspective of their parents.

OBJECTIVES

The aim was to describe which symptoms that, according to parents, cause most problems for children receiving cancer treatment and to explore whether there is a relationship between parents' ratings of their children's symptoms and their own post-traumatic stress at one week (T1), two months (T2), and four months (T3) after a child's cancer diagnosis.

METHODS

In total, 214 parents (107 mothers and 107 fathers) of 115 children answered a modified version of the Memorial Symptom Assessment Scale 10-18 and the PTSD Checklist Civilian Version over the telephone at T1-T3.

RESULTS

According to parents, the following symptom areas cause the most problems for children undergoing cancer treatment: emotional distress, fatigue, nutrition, and pain. Pain is the most problematic area. The prevalence of most symptoms and the symptom burden decreases over time. Parents' ratings of their children's symptom burden and their own emotional distress, and mothers' and fathers' ratings of their child's symptom burden, are associated. Parents of adolescents report a greater symptom burden for their child than the parents of the youngest children.

CONCLUSION

The opinions of both the patient and the parent are important in pediatrics. The results of this study can be used to guide health care professionals within pediatric oncology in their discussions of cancer treatment's adverse effects with patients and families. Not only the expectations and potential interventions but also the sources of worry should be discussed.

Eating experiences of children and adolescents with chemotherapy-related nausea and mucositis

Despite many advances in symptom management, children and adolescents with cancer still have trouble maintaining adequate oral intake during routine chemotherapy treatment. The purpose of this qualitative study was to explore the eating experiences of children and adolescents receiving chemotherapy when they had problems with nausea and mucositis. Eight children and adolescents and their caregivers were interviewed to describe how and what the children and adolescents ate when they were nauseated and/or had a sore mouth. Findings reveal that these children and adolescents all experienced nausea and frequently preferred not to eat during these periods. Eating problems related to mucositis also limited oral intake in this sample. These children and adolescents and their caregivers tried a variety of foods and strategies to maintain intake, including those recommended by health care providers. Prevention and management of nausea remains a challenge for children and adolescents receiving chemotherapy. Health care providers need to offer detailed eating suggestions throughout therapy so that these patients can maintain adequate nutrition and weight for optimal treatment tolerance as well as normal growth and development. Continued research is needed to test the effectiveness of interventions focused on maintaining oral intake during cancer treatment.

Antiemetic medication for prevention and treatment of chemotherapy induced nausea and vomiting in childhood

BACKGROUND

Nausea and vomiting are still a problem for children undergoing treatment for malignancies despite new antiemetic therapies. Optimising antiemetic regimens could improve quality of life by reducing nausea, vomiting and associated clinical problems.

OBJECTIVES

To assess the effectiveness and adverse events of pharmacological interventions in controlling anticipatory, acute and delayed nausea and vomiting in children and young people (aged < 18 years) about to receive/receiving chemotherapy.

SEARCH STRATEGY

Searches included CENTRAL, MEDLINE, EMBASE and LILACS, trial registries from their earliest records to February 2008, and ASCO, MASCC and SIOP conference proceedings from 2001 to 2007. We examined references of systematic reviews and contacted trialists for information on further studies.

SELECTION CRITERIA

Two authors independently screened abstracts to identify randomised controlled trials (RCTs) that compared a pharmacological antiemetic, cannabinoid or benzodiazepine with placebo or any alternative active intervention in children and young people (< 18 years) with a diagnosis of cancer who were to receive chemotherapy.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted outcome and quality data from each RCT. When appropriate, we undertook meta-analysis.

MAIN RESULTS

We included 28 studies which examined a range of different antiemetics, used different doses and comparators, and reported a variety of outcomes. The quality and quantity of included studies limited the exploration of heterogeneity to narrative approaches only.The majority of quantitative data related to the complete control of acute vomiting (22 studies). Adverse events were reported in 24 studies and nausea outcomes in 10 studies.The addition of dexamethasone to 5-HT(3) antagonists was assessed in two studies for complete control of vomiting (pooled relative risk (RR) 2.03; 95% CI 1.35 to 3.04). Three studies compared granisetron 20 mcg/kg with 40 mcg/kg for complete control of vomiting (pooled RR 0.93; 95% CI 0.80 to 1.07). No other pooled analyses were possible.Narrative synthesis suggests 5-HT(3) antagonists are more effective than older antiemetic agents even when combined with a steroid. Cannabinoids are probably effective but produce frequent side effects.

AUTHORS' CONCLUSIONS

Our overall knowledge of the most effective antiemetics to prevent chemotherapy-induced nausea and vomiting in childhood is incomplete. Future research should be undertaken in consultation with children, young people and families that have experienced chemotherapy and should make use of validated, age-appropriate measures. This review suggests that 5-HT(3) antagonists with dexamethasone added are effective in patients who are to receive highly emetogenic chemotherapy although the risk-benefit profile of additional steroid remains uncertain.

Changes in children's reports of symptom occurrence and severity during a course of myelosuppressive chemotherapy

The purposes of this study in children who underwent a cycle of myelosuppressive chemotherapy were to describe changes in symptom occurrence and severity during the chemotherapy cycle. Patients (N = 66) 10 to 18 years of age completed the Memorial Symptom Assessment Scale for 10- to 18-year-olds (MSAS 10-18) at the start of a chemotherapy cycle (T1) and weekly for the next 2 weeks (T2 and T3). More than 30% of children reported 10 or more symptoms at all 3 time points. Symptom occurrence trajectories were tested with multilevel logistic regression. In all, 6 symptoms (ie, fatigue, sadness, irritability, worrying, weight loss, sweating) showed a decreasing linear trend. Significant quadratic patterns of change were found for feeling drowsy, nausea, and vomiting. Changes in symptom severity over time were evaluated with multilevel negative binomial regression. No significant differences over time were found in any of the symptom severity scores on the MSAS. Children experienced a high number of symptoms at the initiation of a chemotherapy cycle that persisted over the subsequent 2 weeks.

How to Improve Resilience in Adolescents With Cancer in Japan

This case study made use of semistructured interviews and a social network map to explore how adolescents with cancer develop resilience during the cancer experience. Seven adolescents with cancer aged 11 to 18 years and their mothers participated in this research. Pattern-matching logic using a 4-stage Self-Sustaining Process Model was applied to arrive at a comparative analysis. Findings indicated that initially, 5 adolescents who were told of their cancer diagnoses moved through the process during the cancer experience. Also, in newly diagnosed adolescents and in those who experienced relapse, a slight difference was noticed in terms of their response to studies and their hope levels. Second, 2 adolescents who were told of their diagnoses indirectly did not experience a complete passage through the phases comprising the process. Finally, the adolescents received social support from their families, friends, and relatives. This study suggests that an understanding of individual and cultural differences is important to improve resilience in adolescents with cancer. Because of the small sample surveyed by this research, further studies are needed to validate these conclusions and develop appropriate nursing intervention techniques.

Assessment of symptoms reported by 10- to 18-year-old cancer patients in Taiwan

The purposes of this study were 1) to assess and describe the occurrence, frequency, severity, and distress of symptoms reported by Taiwanese pediatric cancer patients who were between 10 and 18 years of age, and 2) to use statistical analysis to determine whether the multiple dimensions (i.e., frequency, severity, or distress) of the Memorial Symptom Assessment Scale (MSAS) 10-18 alone can provide sufficient useful information for the assessment of symptoms that patients report as distressing. A total of 144 Taiwanese pediatric cancer patients and their mothers participated in this cross-sectional study. The frequency of symptoms for all patients ranged from 52% for "lack of energy" to 10% for "feeling nervous." The most common symptoms (occurrence >40%) were "lack of energy," "lack of appetite," "feeling drowsy," "sweating," "worrying," "nausea," "dry mouth," "pain," and "lack of concentration." Patients in the "on-treatment group" had more distressing symptoms than those in the "off-treatment group." The severity and distress subscales did provide the most information for symptom assessment and were the two best subscales to represent the impact of symptoms on quality of life, fatigue, and internalizing behaviors. The findings of this study suggest that revising the current format of the MSAS 10-18 into three separate instruments (one for each of the subscales) might provide more accurate data for assessments. Such a modification would change the scoring system and provide for more accurate data analysis.

Multiple Symptoms in Pediatric Oncology Patients: A Systematic Review

Clinical experience suggests that children with cancer experience multiple symptoms as a result of their disease and/ or its treatment. These symptoms may have a negative impact on children’s ability to function and on their quality of life. No systematic review has summarized the findings from studies that assessed multiple symptoms in these patients. The purposes of this article are to summarize the findings from the studies of multiple symptoms in pediatric oncology patients and to describe directions for future research. Although there has been a recent increase in the studies of the multiple symptoms in pediatric cancer patients, only 9 studies were found that met the inclusion criteria for this review. Thus, little is known about the relationships between demographic and clinical characteristics and the occurrence of multiple symptoms. Additional research is warranted on the prevalence and impact of multiple symptoms, particularly among homogeneous samples of patients. Future directions for symptom studies in pediatric oncology include symptom cluster research and the search for biological bases for the untoward effects of cancer treatment.