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Semerci R, Savaş EH, Uysal G, Alki K. The predictive power of coping strategies of pediatric oncology patients on their quality of life and their attitudes toward diseases. Pediatr Blood Cancer 2024:e31196. [PMID: 39039618 DOI: 10.1002/pbc.31196] [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: 05/21/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND/OBJECTIVES Pediatric oncology patients face several physical and psychological challenges that can significantly impact their quality of life (QoL) and attitudes toward their illness. Coping strategies are pivotal in managing the emotional and physical burdens of disease. This study aimed to examine the impact of coping strategies of pediatric oncology patients on their QoL and attitudes towards their illness. DESIGN/METHODS The descriptive, correlational, and cross-sectional study was conducted with 112 pediatric oncology patients aged 10-18 years. The Sociodemographic Form, Pediatric Cancer Coping Scale (PCCS), Pediatric Quality of Life Inventory (PedsQL), and Child Attitude Towards Illness Scale (CATIS) were used for data collection. RESULTS Significant correlations were identified between cognitive coping, defensive coping, and CATIS (p < .001). The PCCS and subdimensions significantly predicted CATIS (p < .001), accounting for 15.3% of the cognitive and defensive coping variation. However, there was no relationship between PCCS total and subdimension scores on PedsQL (p = .534). The PedsQL and subdimensions significantly predicted CATIS (p < .001) and accounted for 27.2% of the variation in physical health summary score, emotional functioning, psychosocial health summary score, and total PedsQL score. CONCLUSION The study reveals that cognitive coping strategies positively predict attitudes toward illness, whereas defensive coping strategies have an inverse effect. The study proposes that comprehensive care models in pediatric oncology support effective coping mechanisms and enhance the QoL of those who receive them.
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Affiliation(s)
- Remziye Semerci
- School of Nursing, Department of Pediatric Nursing, Koç University, İstanbul, Turkey
| | - Eysan Hanzade Savaş
- School of Nursing, Department of Pediatric Nursing, Koç University, İstanbul, Turkey
| | - Gülzade Uysal
- Faculty of Health Sciences, Department of Nursing, Sakarya University of Applied Sciences, Sakarya, Turkey
| | - Kübra Alki
- Department of Pediatric Bone Marrow Transplantation Unit, Başakşehir Çam and Sakura State Hospital, İstanbul, Turkey
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The Hospitalized Adolescent. Pediatrics 2023; 151:190500. [PMID: 37184363 DOI: 10.1542/peds.2022-060647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/25/2023] Open
Abstract
This clinical report provides pediatricians evidence-based information on the developmentally appropriate, comprehensive clinical care for hospitalized adolescents. Included in this report are opportunities and challenges facing pediatricians when caring for specific hospitalized adolescent populations. The companion policy statement, “The Hospitalized Adolescent,” includes detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital setting and design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.
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Özalp Gerçeker G, Yildirim BG, Sülün A, Bektaş M, Hekimci Özdemir H, Malbora B. The effect of chemotherapy on symptoms and nutritional status in children with cancer. Eur J Oncol Nurs 2022; 61:102206. [DOI: 10.1016/j.ejon.2022.102206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/05/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
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4
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Rheel E, Heathcote LC, van der Werff Ten Bosch J, Schulte F, Pate JW. Pain science education for children living with and beyond cancer: Challenges and research agenda. Pediatr Blood Cancer 2022; 69:e29783. [PMID: 35593047 DOI: 10.1002/pbc.29783] [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: 01/31/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/05/2022]
Abstract
Pain in children living with and beyond cancer is understudied and undertreated. Pain science education (PSE) is a conceptual change strategy facilitating patients' understanding of the biopsychosocial aspects of pain. Preliminary studies on the adaptation of PSE interventions to adults with and beyond cancer provide a foundation for pediatric research. PSE could help childhood cancer survivors experiencing persistent pain and pain-related worry after active treatment. PSE may also help children receiving cancer treatment, providing them with a foundation of adaptive pain beliefs and cognitions, and preparing them for procedural and treatment-related pain. We direct this paper toward pediatric oncology clinicians, policy makers, and researchers working with children living with and beyond cancer. We aim to (a) identify challenges in adapting PSE for children living with and beyond cancer, (b) offer possible solutions, and (c) propose research questions to guide the implementation of PSE for children living with and beyond cancer.
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Affiliation(s)
- Emma Rheel
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joshua W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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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.
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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
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Fidler AL, Voorhees S, Zhou ES, Stacciarini JM, Fedele DA. A systematic review and proposed conceptual model of sleep disturbances during pediatric hospitalizations. Sleep 2022; 45:zsac038. [PMID: 35554575 DOI: 10.1093/sleep/zsac038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/19/2022] [Indexed: 09/21/2023] Open
Abstract
STUDY OBJECTIVES The current review aims to examine factors that influence pediatric inpatient sleep and determine the effectiveness of sleep promotion interventions among hospitalized children. METHODS A systematic literature search was conducted across PubMed, PsycINFO, CINAHL, Cochrane Central, Web of Science, Embase, and Scopus databases. Studies included children with a mean age between 1 and 18 years old that either described factors affecting the sleep of children who are hospitalized on a non-intensive care unit or reported on sleep-related intervention outcomes. We conducted separate narrative reviews for each of the two aims and then synthesized findings from quantitative and qualitative studies across both aims. RESULTS Forty-five articles were included for review. Despite most sleep disturbances being attributed to environmental disruptions (e.g. noise, staff interruptions), most interventions targeted the child level using relaxation techniques. Although the majority of interventions were small pilot studies, preliminary findings appear to positively impact sleep duration. The Pediatric Inpatient Sleep Model was proposed to illustrate connections between sleep disturbances, factors influencing sleep, and existing intervention components. CONCLUSIONS Replication studies are needed, including larger-scale sleep promotion interventions among hospitalized children. Given the identification of environmental factors as the main cause of night wakings, environmental modifications are crucial. Additional research examining contributors to intraindividual variability in disrupted sleep patterns during hospitalizations as well as the consequences of these disturbances is warranted.
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Affiliation(s)
- Andrea L Fidler
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Sara Voorhees
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | | | - David A Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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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.
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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.
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Zhang A, Zebrack B, Acquati C, Roth M, Levin NJ, Wang K, Schwartz S. Technology-Assisted Psychosocial Interventions for Childhood, Adolescent, and Young Adult Cancer Survivors: A Systematic Review and Meta-Analysis. J Adolesc Young Adult Oncol 2022; 11:6-16. [PMID: 33960845 PMCID: PMC8864427 DOI: 10.1089/jayao.2021.0012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: Technology-assisted interventions are essential in supporting cancer survivors' psychosocial outcomes, especially for childhood, adolescent, and young adult (AYA) cancer survivors, a tech-savvy generation. This study aims to systematically evaluate review and meta-analyze technology-assisted interventions for childhood and AYA cancer survivors. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, the study team used a pre-set of key words and searched studies across 11 electronic databases and 4 professional websites, and conducted a manual search of reference lists from published reviews. Meta-analysis of small sample size corrected Hedges' g was conducted using meta-regression with robust variance estimation. Results: Final analysis included a total of 28 clinical trials, including 237 effect sizes reported an overall statistically significant treatment effect of technology-assisted psychosocial interventions for childhood and AYA cancer survivors, g = 0.382, 95% confidence interval (CI) 0.243 to 0.521, p < 0.0001. Subgroup analysis revealed that distraction-based interventions and interventions for psychosocial and emotional health were overall statistically significant, whereas interventions for childhood and AYA cancer survivors' cancer knowledge outcomes and physical and functional health outcomes were statistically nonsignificant. Moderator analysis found intervention target was a significant moderator. Conclusions: Technology-assisted interventions for childhood and AYA cancer survivors were overall effective across domains of survivorship outcomes. Favorable evidence was found primarily for childhood cancer survivors with limited support for AYA cancer survivors. Implications for Cancer Survivors: Although existing technology-assisted interventions are overall promising, research support for cancer survivors from different age groups and with different psychosocial challenges varies and should be considered individually.
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Affiliation(s)
- Anao Zhang
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA.,Address correspondence to: Anao Zhang, PhD, MSW, University of Michigan School of Social Work, 1080 S. University Ave., Ann Arbor, MI 48109, USA
| | - Bradley Zebrack
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Chiara Acquati
- University of Houston Graduate College of Social Work; and The University of Texas MD Anderson Cancer Center Department of Health Disparities Research, Houston, Texas, USA
| | - Michael Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nina Jackson Levin
- University of Michigan School of Social Work, and Department of Anthropology, Ann Arbor, Michigan, USA
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Samantha Schwartz
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
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Silva-Rodrigues FM, Hinds PS, Nascimento LC. Compreensão dos adolescentes sobre eventos adversos relacionados à quimioterapia: um estudo de elicitação de conceitos. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6245.3718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Resumo Objetivo: documentar a compreensão dos adolescentes sobre os principais eventos adversos relacionados à quimioterapia a partir da versão Pediátrica dos Desfechos Relatados pelo Paciente (Patient-Reported Outcomes) dos Critérios de Terminologia Comum para Eventos Adversos (Common Terminology Criteria for Adverse Events), e assim iniciar o processo de validação dos itens desta ferramenta com adolescentes brasileiros. Método: trata-se de um estudo prospectivo, qualitativo, de elicitação de conceitos. Participaram do estudo 17 adolescentes de 13 a 18 anos, submetidos à quimioterapia em três hospitais da cidade de São Paulo-SP, Brasil. Foram realizadas entrevistas cognitivas com perguntas baseadas em eventos adversos relacionados à quimioterapia. Os dados foram analisados quanto à responsividade e ausência de resposta. Resultados: os adolescentes puderam e estavam dispostos a fornecer informações descritivas sobre seus eventos adversos quimioterápicos, incluindo eventos físicos e emocionais. Alguns participantes sugeriram nomes alternativos para os eventos adversos e alguns usaram termos mais complexos, mas a maioria ficou satisfeita com aqueles utilizados pelos pesquisadores. Conclusão: este estudo representa os primeiros passos para entender como os adolescentes com câncer identificam, nomeiam e descrevem esses eventos por meio de entrevistas cognitivas para ajudar a criar futuros instrumentos de avaliação focados nessa faixa etária.
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Abstract
BACKGROUND Multiple symptoms occur in children receiving cancer therapy. Decreased steps per day may be associated with burdensome symptoms. OBJECTIVE To evaluate associations between self-reported symptoms (pain interference, anxiety, depressive symptoms, psychological stress, and fatigue) and function (physical function-mobility and physical activity) and cumulative symptom count with steps per day. METHODS Five sites enrolled English-speaking children, 8 to 17 years, receiving treatment for a first cancer diagnosis. Patient-reported outcome (PRO) surveys were administered before (T1) and after (T2) a course of chemotherapy. Garmin VivoFit 3 (Garmin International, Olathe, KS) accelerometers were worn 7 days prior to each data point. Univariate changes in scores over time were evaluated with dependent-sample t tests. Pearson correlations examined associations between PRO domains and step count. Multivariable mixed-effect models examined associations between steps and PROs. RESULTS Participants' (n = 65) steps per day decreased during treatment (4099 [T1] and 3135 [T2]; P < .01), with larger reductions observed during hospitalization and in younger children compared with adolescents. Steps significantly correlated with PROMIS (Patient-Reported Outcome Measurement Information System) Pediatric physical activity and physical function-mobility. Decreased steps per day were associated with increased fatigue and cumulative symptom count. CONCLUSIONS In children and adolescents with cancer, steps per day can serve as an indicator of fatigue, cumulative symptom count, physical activity, and physical functioning-mobility. IMPLICATIONS FOR PRACTICE Child self-reports of physical activity and physical function are valid during cancer therapy and should be captured. In the absence of self-report, decreasing step count may prompt additional assessments related to fatigue or cumulative symptom count and trigger early interventions to support physical activity and physical function-mobility.
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Silva-Rodrigues FM, Hinds PS, Nascimento LC. Adolescents’ understanding of chemotherapy-related adverse events: a concept elicitation study. Rev Lat Am Enfermagem 2022; 30:e3717. [PMID: 36351085 PMCID: PMC9647878 DOI: 10.1590/1518-8345.6245.3717] [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: 05/01/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022] Open
Abstract
Objective: to document adolescents’ understanding of chemotherapy-related core adverse events from the Pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events and thus begin the validation process of this tool’s items with Brazilian adolescents. Method: this is a prospective, qualitative study of concept elicitation. The participants were 17 adolescents aged 13-18 years and undergoing chemotherapy in three hospitals in São Paulo - SP, Brazil. Cognitive interviews were conducted with questions based on chemotherapy-related adverse events. Data were analyzed for responsiveness and missingness. Results: adolescents could and were willing to provide descriptive information about their chemotherapy adverse events, including physical and emotional events. Some participants suggested alternative terms to name the adverse events and some used more complex terms, but most were satisfied with the primary terms used by the researchers. Conclusion: this study represents the first steps towards understanding how adolescent cancer patients identify, name, and describe these events by cognitive interviewing to help design future assessment instruments focused on this age group.
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Silva-Rodrigues FM, Hinds PS, Nascimento LC. La comprensión de los adolescentes de los efectos adversos relacionados con la quimioterapia: un estudio de elicitación de conceptos. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6245.3716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Resumen Objetivo: documentar la comprensión de los adolescentes de los principales eventos adversos relacionados con la quimioterapia a partir de la versión de los Criterios Terminológicos Comunes para Eventos Adversos reportados por los pacientes pediátricos y así iniciar el proceso de validación de los ítems de esta herramienta con adolescentes brasileños. Método: este es un estudio prospectivo y cualitativo de elicitación de conceptos. Los participantes fueron 17 adolescentes de entre 13 y 18 años de edad que recibían quimioterapia en tres hospitales de São Paulo-SP, Brasil. Se realizaron entrevistas cognitivas con preguntas basadas en eventos adversos relacionados con la quimioterapia. Los datos se analizaron en función de la presencia y ausencia de respuesta. Resultados: los adolescentes podían y estaban dispuestos a proporcionar información descriptiva sobre los efectos adversos de la quimioterapia, incluidos los físicos y emocionales. Algunos participantes sugirieron términos alternativos para denominar los eventos adversos y otros utilizaron términos más complejos, pero la mayoría se mostró satisfecha con los términos principales utilizados por los investigadores. Conclusión: este estudio representa los primeros pasos hacia la comprensión de cómo los pacientes adolescentes con cáncer identifican, nombran y describen estos eventos mediante entrevistas cognitivas para ayudar a diseñar futuros instrumentos de evaluación centrados en este grupo de edad.
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Ozdemir Koyu H, Tas Arslan F. The effect of physical and psychosocial symptoms on caregiver burden of parents of children with cancer. Eur J Cancer Care (Engl) 2021; 30:e13513. [PMID: 34632650 DOI: 10.1111/ecc.13513] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 08/25/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of parent's characteristics, physical and psychosocial symptoms, and child-related factors on caregiver burden of parents of children with cancer. METHODS This is a descriptive and cross-sectional study that included 172 parents of children with cancer. This study was performed between February and July 2019 in three major paediatric haematology and oncology units located in the centre of Turkey. Data were collected by using the descriptive information form, Pittsburgh Sleep Quality Index, Piper Fatigue Scale, Beck Depression Inventory, Trait Scale of the State-Trait Anxiety Inventory, Multidimensional Scale of Perceived Social Support and Zarit Caregiver Burden Scale. For data analysis, average and percentage calculations and multiple linear regression analyses were used. RESULTS It was found that most of parents had poor sleep quality, moderate depression, fatigue, anxiety, high social support and moderate to severe caregiver burden. It was found that low education level, poor sleep quality, depression, trait anxiety, social support among the factors related to the parents, and the type of treatment and duration of the treatment from the factors related to the child had an effect on the caregiver burden. It was determined that the effective predictive factors explained 73.5% of the parents' caregiver burden. CONCLUSION Caregiver burden is influenced by the parent- and child-related factors. Paediatric oncology nurses should plan interventions that support parents to cope with the caregiver burden during their children's cancer experience.
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Affiliation(s)
- Hazal Ozdemir Koyu
- Nursing Faculty, Department of Child Health and Diseases Nursing, Selcuk University, Konya, Turkey
| | - Fatma Tas Arslan
- Nursing Faculty, Department of Child Health and Diseases Nursing, Selcuk University, Konya, Turkey
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Silva-Rodrigues FM, de Lucca M, Leite ACAB, Alvarenga WDA, Nunes MDR, Nascimento LC. Management of chemotherapy-related symptoms in children and adolescents: family caregivers' perspectives. Rev Esc Enferm USP 2021; 55:e20200484. [PMID: 34423804 DOI: 10.1590/1980-220x-reeusp-2020-0484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the chemotherapy-associated symptoms and the strategies used for their management from the perspective of pediatric cancer patients' family caregivers. METHODS This is a descriptive study with qualitative data analysis. Data collection took place in a pediatric hospital, from December 2017 to December 2018, with family caregivers of pediatric patients undergoing chemotherapy. Semi-structured interviews, subjected to inductive content analysis, were carried out. Concepts from the Symptom Management Theory were used to discuss the results. RESULTS Eighteen family caregivers participated. The participants mentioned: physical symptoms, especially weakness, alopecia, low immunity, pain, mucositis, constipation, nausea, and vomiting; emotional or psychosocial symptoms such as sadness and mood changes; and constitutional symptoms such as loss of appetite and fever. Pharmacological and non-pharmacological measures were mentioned in the management of symptoms and adverse effects. CONCLUSION Participants demonstrated skills to identify and manage symptoms of chemotherapy. Knowing the experience of these families can help nurses in planning care and interventions to minimize these events.
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Affiliation(s)
| | - Milena de Lucca
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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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.
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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
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Pain Reported by Chinese Children During Cancer Treatment: Prevalence, Intensity, Interference, and Management. Cancer Nurs 2021; 45:E345-E354. [PMID: 34010216 DOI: 10.1097/ncc.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pain is a frequently reported and distressing symptoms during cancer treatment. However, there is limited evidence on pain reported by Chinese children with cancer. OBJECTIVES This study aimed to investigate the prevalence, intensity, interference, and management of pain reported by Chinese children during cancer treatment and explore the predictors of pain interference. METHODS We conducted a cross-sectional survey to investigate the pain intensity, pain interference, co-occurring symptoms (anger, anxiety, depression, fatigue), and pain management strategies reported by children 8 years and older undergoing active cancer treatment in 4 Chinese hospitals. RESULTS Data were analyzed for 187 children. The prevalence of moderate to severe pain (≥4/10) was 38.50%, with an average pain interference score of 52.97 out of 100. Approximately 24% of children were prescribed pain medicine. Pain interference and pain intensity were marginally correlated (r = 0.047, P < .01) and were both positively correlated with pain duration and co-occurring symptoms and negatively correlated with perceived pain alleviation (all P < .01). Multiple regression analyses suggested that severe pain intensity (B = 2.028, P = .003) and fatigue (B = 0.440, P < .001) significantly predicted higher levels of pain interference (R2 = 0.547, F = 23.102, P < .001). CONCLUSION Chinese children with cancer reported a low pain intensity score but a relatively high level of pain interference. According to the children's reports, pain has not been sufficiently addressed through Chinese pediatric oncology supportive care. IMPLICATIONS FOR PRACTICE There is an urgent requirement for comprehensive pain assessment and standardized, targeted interventions in Chinese pediatric oncology pain management.
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Cheng KKF, Tan LML. A pilot study of the effect of a home-based multimodal symptom-management program in children and adolescents undergoing chemotherapy. Cancer Rep (Hoboken) 2021; 4:e1336. [PMID: 33586920 PMCID: PMC8222554 DOI: 10.1002/cnr2.1336] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Prevalent symptoms that affect children and adolescents throughout the process of cancer diagnosis and treatment include nausea and vomiting, fatigue, pain, mucositis, and anxiety. Aim To examine the effect of a home‐based multimodal symptom‐management program for alleviation of nausea and vomiting, fatigue, pain, mucositis, and anxiety in children and adolescents undergoing chemotherapy for hematological malignancies or solid tumors. Methods In an exploratory pilot randomized study with qualitative interview, patients between 10 and 18 years of age were randomly assigned to either the symptom‐management program plus usual care (intervention group) or usual care (control group). The program consisted of multiple nonpharmacological interventional components. The targeted symptoms were measured at baseline (after diagnosis), at the first 2 weeks of each cycle of chemotherapy, and at 6 months after baseline, using the Memorial Symptom Assessment Scale 10‐18 and the State Anxiety Scale for Children. Results Fifty children (31 boys; mean age, 13.7 years) were randomized either to the intervention group or the control group (25 each) and underwent baseline assessment. A comparison between the groups showed that the intervention group had a significant less fatigue over time (P < .05). However, no differences were found with respect to nausea and vomiting, pain, mucositis, and anxiety between groups. Both children and parents reported a positive experience with the symptom‐management program. Conclusion The home‐based symptom‐management program may have helped to reduce fatigue in children and adolescents undergoing chemotherapy. In addition, qualitative data support the importance of improving children and parents' knowledge, coping skills, and psychological preparation for symptoms associated with chemotherapy.
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Affiliation(s)
- Karis Kin-Fong Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Laura Mei Lian Tan
- Paediatric Oncology, Department of Paediatrics, Khoo Teck Puat National University Children's Medical Institute, Singapore, Singapore
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18
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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.
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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
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Simon JDHP, Van Loon FRAA, Van Amstel J, Elmont GS, Zwaan CM, Fiocco M, Schepers SA, Tissing WJE, Michiels EMC. Pain at home during childhood cancer treatment: Severity, prevalence, analgesic use, and interference with daily life. Pediatr Blood Cancer 2020; 67:e28699. [PMID: 32926551 DOI: 10.1002/pbc.28699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pain is a common symptom in childhood cancer. Since children spend more time at home, families are increasingly responsible for pain management. This study aimed at assessing pain at home. PROCEDURE In this longitudinal observational study (April 2016-January 2017), pain severity and prevalence, analgesic use, and pain interference with daily life (Brief Pain Inventory Short Form) were assessed for 4 consecutive days around the time of multiple chemotherapy appointments. Descriptive statistics (frequencies and percentages) were used to report pain severity (with clinically significant pain defined as: score ≥ 4 on "worst pain" or "average pain in the last 24 h"), pain prevalence, and analgesic use. Mixed models were estimated to assess whether patient characteristics were associated with pain severity, and whether pain severity was associated with interference with daily life. RESULTS Seventy-three children (50.7% male) participated (1-18 years). A majority (N = 57, 78%) experienced clinically significant pain at least once, and 30% reported clinically significant pain at least half the time. In 33.6% of scores ≥ 4, no medication was used. We found an association between pain severity and interference with daily life: the higher the pain, the bigger the interference (estimated regression coefficient = 1.01 [95% CI 0.98-1.13]). CONCLUSIONS The majority of children experienced clinically significant pain at home, and families frequently indicated no medication use. A stronger focus on education and coaching of families seems essential, as well as routine screening for pain in the home setting.
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Affiliation(s)
- Julia D H P Simon
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Femke R A A Van Loon
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
| | - Juul Van Amstel
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
| | - Gina S Elmont
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Sasja A Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erna M C Michiels
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus Medical Center, Department of Pediatric Oncology, Rotterdam, The Netherlands
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Hyslop S, Tomlinson D, Baggott C, Dix D, Gibson P, Johnston DL, Orsey AD, Portwine C, Price V, Vanan M, Kuczynski S, Spiegler B, Tomlinson GA, Dupuis LL, Sung L. Feeling scared or worried self-report in children receiving cancer treatments using the Symptom Screening in Pediatrics Tool (SSPedi). Support Care Cancer 2020; 29:3137-3144. [PMID: 33067767 DOI: 10.1007/s00520-020-05818-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The objectives of this study were to describe reports of bother for feeling scared or worried among children with cancer and pediatric hematopoietic stem cell transplant (HSCT) recipients, and to identify factors associated with it. METHODS We included children receiving cancer treatments who were 8-18 years of age. Three patient types were enrolled: inpatients receiving active cancer treatment, outpatients receiving maintenance acute lymphoblastic leukemia chemotherapy, and outpatients in survivorship. Amount of bother due to feeling scared or worried yesterday or today was self-reported using the Symptom Screening in Pediatrics Tool (SSPedi) on a 0-4 scale. Risk factors were evaluated using logistic regression. RESULTS Among the 502 children included, 225 (45.0%) reported any degree of bother (score ≥ 1) and 29 (5.8%) reported severe bother (score ≥ 3) for feeling scared or worried. In multiple regression evaluating any bother, boys were less likely to be bothered (odds ratio (OR) 0.60, 95% confidence interval (CI) 0.41-0.87) and inpatients receiving active cancer treatment were more likely to be bothered compared to outpatients in survivorship (OR 3.58, 95% CI 2.00-6.52). The only factor associated with being severely bothered by feeling scared or worried was clinic visit or admission due to fever (OR 4.57, 95% CI 1.24-13.60). DISCUSSION We found 45% of children receiving cancer treatments reported being bothered by feeling scared or worried. Girls and inpatients receiving active treatment experienced more bother of any degree, while visiting the hospital due to fever was associated with being severely bothered. Future work should identify interventions to prevent or alleviate this symptom.
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Affiliation(s)
- Shannon Hyslop
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Christina Baggott
- Pediatric Hematology/Oncology, Stanford University Cancer Clinical Trials Office, 800 Welch Road, Palo Alto, CA, 94304, USA
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, BC Children's Hospital, 4480 Oak Street Room B315, Vancouver, V6H 3V4, Canada
| | - Paul Gibson
- Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Andrea D Orsey
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Carol Portwine
- Division of Haematology/Oncology, McMaster Children's Hospital, Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Magimairajan Vanan
- Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Research Institute in Oncology and Hematology, Departments of Pediatrics & Child Health and Biochemistry & Medical Genetics, University of Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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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.
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Affiliation(s)
| | | | - Jude Jonassaint
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Ryan Shaw
- Duke University School of Nursing, Durham, NC, USA
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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.
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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
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de Andrade Cadamuro S, Onishi Franco J, Paiva CE, Oliveira MAD, Sakamoto Ribeiro Paiva B. Association between multiple symptoms and quality of life of paediatric patients with cancer in Brazil: a cross-sectional study. BMJ Open 2020; 10:e035844. [PMID: 32376756 PMCID: PMC7223154 DOI: 10.1136/bmjopen-2019-035844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify the association of multiple symptoms and clinical characteristics on quality of life (QoL) of paediatric patients with cancer. DESIGN A descriptive, cross-sectional study. SETTING South American Children's Hospital for Cancer Treatment (Barretos, São Paulo, Brazil). PARTICIPANTS A total of 157 participants, 116 paediatric patients, diagnosed with cancer, undergoing chemotherapy treatment, between 7 and 18 years of age and 41 proxies for patients between 2 and 6 years of age. PRIMARY OUTCOME MEASURES The severity and prevalence ofsymptoms were identified through the use of a culturally adapted multi-symptomscreening tool, and the influence these symptoms, in association with clinicalcharacteristics, had on the QOL of Brazilian pediatric cancer patients wasassessed. RESULTS Prevalent symptoms identified by all participants were 'feeling tired' (98, 62.4%), 'feeling more or less hungry (do not feel like eating) than you usually do' (96, 61.1%), 'changes in taste (flavour of the food)' (89, 56.7%), 'throwing up or feeling like you may throw up' (77, 49%) and 'changes in how your body (visually) or face looks' (72, 45.9%). The multivariate analysis for symptom severity as reported by proxies showed that surgery (OR 0.20, 95% CI 0.04 to 0.98, p=0.047) and time of diagnosis (OR 0.14, 95% CI 0.03 to 0.66, p=0.012) were associated with a decreased OR of high severity symptoms.An analysis of the clinical characteristics associated with Pediatric Quality of Life Inventory (PedsQL) demonstrated no significant effect on QoL in any of the domains evaluated. The association between Symptom Screening in Pediatrics Tool and PedsQL in the self-report version demonstrated a significant negative influence of all symptoms on the QoL. CONCLUSIONS The prevalence of symptoms experienced among pediatric patients during treatment was high and significantly influenced all aspects of quality of life,especially in the emotional domain.
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Affiliation(s)
| | | | - Carlos Eduardo Paiva
- Learning and Research Institute, Barretos Cancer Hospital, Barretos, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil
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Optimizing symptom control in children and adolescents with cancer. Pediatr Res 2019; 86:573-578. [PMID: 31357207 DOI: 10.1038/s41390-019-0516-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 12/25/2022]
Abstract
There is growing recognition of the degree to which symptoms negatively impact on children receiving cancer treatments. A recent study described that almost all inpatient pediatric oncology patients are experiencing at least one bothersome symptom and almost 60% are experiencing at least one severely bothersome symptom. Poor symptom control occurs because of challenges with communication of bothersome symptoms to clinicians, lack of clinical practice guidelines (CPGs) for most of these symptoms, and failure to administer preventative and therapeutic interventions known to be effective for symptom control. This article reviews approaches used to improve symptom control for children receiving cancer treatments. Areas addressed include systematic symptom screening and creation of CPGs for symptom management. Challenges with electronic health integration are also addressed. Several multi-symptom assessment scales have been developed but none have yet been used to directly influence patient management. The number of CPGs applicable to symptom control in pediatric oncology is increasing but remains small. Improving the creation of and adherence to CPGs for symptom management is an important priority. Finally, identifying ways that symptom management systems can be integrated into clinical work flows is essential; these will likely need to focus on electronic health records.
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Cadamuro SDA, Franco JO, Paiva CE, de Oliveira CZ, Paiva BSR. Symptom screening in paediatrics tool for screening multiple symptoms in Brazilian patients with cancer: a cross-sectional validation study. BMJ Open 2019; 9:e028149. [PMID: 31377698 PMCID: PMC6687019 DOI: 10.1136/bmjopen-2018-028149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The objective of this study was to translate, culturally adapt and validate the Symptom Screening in Paediatrics Tool (SSPedi) into the Brazilian Portuguese language to be used by paediatric oncology patients in Brazil. DESIGN A descriptive, cross-sectional study that follows an established methodology for translation and cultural adaptation, developed in two phases: phase I, linguistic translation and cultural adaptation of the SSPedi scale and phase II, psychometric properties evaluation. SETTING Children's Hospital for Cancer Treatment in Latin America. PARTICIPANTS Paediatric patients between 7 and 18 years of age and proxies of patients between 2 and 6 years of age, diagnosed with cancer and undergoing chemotherapy treatment. Patients and proxies with significant neuropsychiatric disorders and/or visual impairment that prevented the ability to read were excluded. PRIMARY OUTCOME MEASURES Construct validation of SSPedi using convergent validity and contrasted groups. Reliability was evaluated using Cronbach's alpha test and assessing the retest using the intraclass correlation coefficient (ICC). RESULTS The psychometric properties of the symptom screening tool were evaluated using 157 participants, of which 116 were patients and 41 were proxies. Convergent validity and hypothesised correlations (Spearman's r>0.4) were confirmed for both self- and proxy-reported versions of the assessment tool. No significant differences found between the two contrasting groups. Assessment of SSPedi resulted in an internal consistency of reliability of α=0.77 (95% CI 0.70 to 0.82) for the self and α=0.81 (95% CI 0.71 to 0.88) for the proxy and overall reproducibility ICC values of (95% CI), 0.54 (0.15 to 0.77) and 0.77 (0.64 to 0.86). CONCLUSION SSPedi was found to be culturally and linguistically adaptable and considered valid and reliable for use by paediatric oncology patients in Brazil. The new translated and adapted version was named SSPedi-BR.
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Affiliation(s)
- Sandra de Andrade Cadamuro
- Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Julia Onishi Franco
- Dr. Paulo Prata School of Health Sciences of Barretos and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Carlos Eduardo Paiva
- Department of Clinical Oncology and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Cleyton Zanardo de Oliveira
- Education and Research BP - A, Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, BARRETOS, Brazil
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Linder LA, Bratton H, Nguyen A, Parker K, Wawrzynski SE. Symptoms and Self-Management Strategies Identified by Children With Cancer Using Draw-and-Tell Interviews. Oncol Nurs Forum 2019; 45:290-300. [PMID: 29683122 DOI: 10.1188/18.onf.290-300] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This cross-sectional study described how school-aged children with cancer represent their symptoms and associated characteristics using draw-and-tell interviews. PARTICIPANTS & SETTING 27 children aged 6-12 years receiving treatment for cancer at the Cancer Transplant Center at Primary Children's Hospital, a tertiary pediatric hospital in Salt Lake City, Utah. METHODOLOGIC APPROACH Children participated in draw-and-tell interviews while completing drawings depicting days when they felt well and days when they felt sick. Children's drawings and accompanying explanations were analyzed qualitatively. FINDINGS Children's drawings related symptoms and the strategies children used to self-manage those symptoms. Nausea, fatigue, pain, and sadness were the most frequently reported symptoms. Strategies to manage symptoms most often included physical and psychosocial care strategies. IMPLICATIONS FOR NURSING Children with cancer were able to relate detailed descriptions of their symptoms and symptom self-management strategies when presented with developmentally sensitive approaches. Healthcare providers are well positioned to integrate arts-based approaches to symptom assessment and to support children in implementing their preferred strategies to alleviate symptoms.
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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.
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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
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Díaz-Morales K, Reyes-Arvizu J, Morgado-Nájera K, Everardo-Domínguez D. Síntomas en niños con cáncer y estrategias de cuidado familiar. REVISTA CUIDARTE 2018. [DOI: 10.15649/cuidarte.v10i1.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Los síntomas de dolor y náusea vómito en los niños con cáncer son ocasionados por la enfermedad o tratamiento de quimioterapia. El manejo de estos síntomas es un reto en los familiares. Objetivos: Describir y analizar la relación entre los síntomas de dolor y náusea vómito en los niños con cáncer y describir las estrategias de cuidado familiar ante estos síntomas. Materiales y Métodos: Estudio descriptivo correlacional, con muestra de 31 niños y familiares de una clínica oncopediatrica de Veracruz México. Diligenciaron los instrumentos Escala de dolor con caras-Revisada, Clasificación de Náusea-Vómito Inducido por Quimioterapia y Cuestionario de estrategias de cuidado familiar para el manejo de síntomas. Los datos se analizaron con estadística descriptiva e inferencial con Rho de Spearman, utilizando el programa SPSS 20.0. Resultados: Los niños padecen dolor moderado (48%), leve (29%) e intenso (23%). Tienen náusea-vómito agudo (74%), anticipatorio (16%) y retardado (10%). Existe asociación entre la náusea-vómito retardado con el anticipatorio (r =435<0,05). Los familiares contrarrestan el dolor del niño con estrategias de espiritualidad, distracción y fármacos. Ante la náusea-vómito evitan ambientes con olor a comida y consumo de líquidos calientes. Discusión: Según el tipo de cáncer y tratamiento, es la intensidad del dolor en el niño. La náusea-vómito se considera el síntoma más problemático durante la quimioterapia. Conclusiones: La investigación aporta datos científicos para indagar a futuro estos síntomas y posibles secuelas físicas y psicológicas (depresión, ansiedad) en los niños con cáncer, así como la efectividad de las estrategias familiares para tratar estos síntomas.Como citar este artículo: Díaz-Morales K, Reyes-Arvizu J, Morgado-Nájera K, Everardo-Domínguez D. Síntomas en niños con cáncer y estrategias de cuidado familiar. Rev Cuid. 2019; 10(1): e597. http://dx.doi.org/10.15649/cuidarte.v10i1.597
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Cederberg JT, Weineland S, Dahl J, Ljungman G. A preliminary validation of the Swedish short version of the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8) for children and adolescents with cancer. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Linder LA, Wawrzynski SE. Staff Perceptions of Symptoms, Approaches to Assessment, and Challenges to Assessment Among Children With Cancer. J Pediatr Oncol Nurs 2018; 35:332-341. [PMID: 29652214 PMCID: PMC6319255 DOI: 10.1177/1043454218767888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nurses are often the first to recognize and respond to children's symptoms. This descriptive, exploratory study characterized how pediatric oncology health care providers characterize and assess children's cancer-related symptoms. The study also explored challenges associated with symptom assessment and information perceived as helpful in planning interventions. The setting was a Children's Oncology Group-affiliated hospital in the Intermountain West of the United States. Twenty-two pediatric oncology health care providers (95% female; 68% nurses) participated in one of four focus group sessions. Sessions were facilitated by two individuals and included six open-ended questions addressing participants' perspectives of cancer-related symptoms, approaches to symptom assessment, challenges and frustrations encountered when assessing symptoms, and information needed to plan interventions. Participants identified 75 physical and psychosocial responses that included both subjectively experienced symptoms and other consequences of the cancer experience. Qualitative content analysis procedures organized other responses into categories and subcategories. Participants most frequently reported using observational approaches including physical assessment findings and observation of the child's behavior to identify symptoms. Strategies that sought the child's input such as the use of a rating scale or seeking the child's verbal description were less frequently named. Participants related discerning and interpreting the child's behaviors as a challenge to symptom assessment. They also reported attention to symptom characteristics as important to planning interventions. Future directions include building capacity to support child-centric symptom assessment. Development of reliable and valid resources for use in clinical settings may support a more child-centric approach to symptom assessment.
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Affiliation(s)
- Lauri A. Linder
- University of Utah, Salt Lake City, UT, USA
- Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Sarah E. Wawrzynski
- University of Utah, Salt Lake City, UT, USA
- Primary Children’s Hospital, Salt Lake City, UT, USA
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Comparison of good days and sick days of school-age children with cancer reflected through their drawings. Qual Life Res 2017; 26:2729-2738. [PMID: 28612308 DOI: 10.1007/s11136-017-1621-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Childhood cancer disrupts children's daily life experiences. Eliciting children's perspectives regarding their life experiences during cancer treatment can be challenging. The purpose of this study was to characterize elementary school-age children's "good days" and "sick days" through their drawings. METHODS This study used draw-and-tell interviews, a developmentally sensitive arts-based technique that supports children's recall and communication of information, facilitating a deeper understanding of children's personal interpretation and meaning of a given phenomenon of interest. Children were asked to draw pictures representing both a "good day" and a "sick day." Following completion of each drawing, research team members used a semi-structured interview guide to elicit children's explanations of their pictures. Content analysis techniques were used to descriptively characterize children's drawings followed by thematic analysis to identify commonalities. RESULTS Participants were 27 children 6.33-12.83 years of age (mean 9.16 years; SD = 1.9) receiving treatment for cancer. "Good day" and "sick day" pictures were similar with regards to the presence of the child, the inclusion of other individuals, and the type of art medium used. Children's pictures characterized "good days" as being happy, outside in sunny weather, and engaged in activities. In contrast, "sick days" were characterized as feeling sad, lying down or reclining, and experiencing illness-related symptoms. CONCLUSIONS Children's drawings illustrate their capacity to provide rich personal data related to their "good days" and "sick days." Incorporating arts-based strategies in the clinical setting may provide a child-centric strategy to understand the child's perspective and direct interventions.
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