1
|
Park HS, DeGroote NP, Lange A, Kavalieratos D, Brock KE. The Scope of Practice of an Embedded Pediatric Palliative Oncology Clinic. J Pain Symptom Manage 2024; 67:250-259.e5. [PMID: 38065424 DOI: 10.1016/j.jpainsymman.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/22/2023]
Abstract
CONTEXT Pediatric palliative care (PPC) improves end-of-life (EOL) outcomes for children with cancer. Though PPC visits are the 'intervention' in studies focused on EOL care, the content of PPC visits within pediatric oncology is poorly understood. OBJECTIVES This study aimed to understand the scope of PPC practice during visits for children with cancer and their families. METHODS This was a retrospective cohort study of patients 0-27 years with cancer seen in PPC clinic within an academic pediatric oncology center between 2017 and 2022. During each PPC visit, documenting providers chose the domains discussed or managed (goals of care, symptom management, and care coordination with respective subdomains). Data was abstracted from the electronic health record, PPC clinic database, and Cancer Registry. The differences in frequency and addressed domains were analyzed by demographics, visit type, diagnosis group, and proximity to EOL. RESULTS Across 351 patients, 1919 outpatient PPC visits occurred. Median domains were higher in visits <90 days vs. 91+ days from EOL (12.0 vs. 10.0; p < 0.0001); pain and hospice collaboration were particularly discussed closer to EOL. Psychological symptoms like anxiety (30.7% vs. 21.1%; p < 0.001) were addressed more in follow-ups than initial visits. Compared to brain tumor or leukemia/lymphoma visits, solid tumor visits addressed more symptom management subdomains, especially pain (79.9%; p < 0.0001). CONCLUSION The scope of PPC practice is broad and varied. Each visit encompasses many subdomains, the most common being care coordination with oncology teams and helping patients/families cope with the disease. More domains were addressed in solid tumor visits and near EOL.
Collapse
Affiliation(s)
- Hee Su Park
- Emory University School of Medicine (H.S.P), Atlanta, Georgia, USA
| | - Nicholas P DeGroote
- Aflac Cancer & Blood Disorders Center (N.P.D, A.L., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Anna Lange
- Aflac Cancer & Blood Disorders Center (N.P.D, A.L., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine (D.K.), Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Katharine E Brock
- Aflac Cancer & Blood Disorders Center (N.P.D, A.L., K.E.B.), Children's Healthcare of Atlanta, Atlanta, Georgia, USA; Divisions of Pediatric Hematology/Oncology and Palliative Care (K.E.B.), Department of Pediatrics, Emory University, Atlanta, Georgia, USA.
| |
Collapse
|
2
|
Lai JS, Jensen SE, Peipert JD, Mitchell SA, Garcia SF, Cella D, Goldman S, Lenzen A. Using IT to Improve Outcomes for Children Living With Cancer (SyMon-SAYS): Protocol for a Single-Institution Waitlist Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50993. [PMID: 37682593 PMCID: PMC10517385 DOI: 10.2196/50993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Children and adolescents with cancer may experience multiple disease- and treatment-related symptoms that negatively affect health-related quality of life. Routine symptom surveillance thus constitutes an important component of supportive care in pediatric oncology. The Symptom Monitoring and Systematic Assessment and Reporting System in Young Survivors (SyMon-SAYS) system will administer, score, interpret, and display the results of symptom assessments captured weekly using patient-reported outcomes presented via the electronic health record (EHR) portal between clinic visits in oncology ambulatory settings, when patients are likely to be more symptomatic. This study is testing a digital system for routine symptom surveillance that includes EHR-based reports to clinicians and alerts for severe symptoms. OBJECTIVE In this randomized trial, we are examining the effects of the SyMon-SAYS system on perceived barriers to symptom management, self-efficacy, and symptom severity. Better self-management and timely clinical intervention to address symptoms promote adherence to treatment plans, strengthen child and parent self-efficacy, improve interactions between children, parents, and their clinical providers, and optimize clinical outcomes. METHODS The SyMon-SAYS system is integrated into the EHR to streamline the presentation of symptom scores and delivery of alerts for severe symptoms to clinicians using EHR (Epic) messaging functionalities. Children (aged 8 to 17 years) complete the weekly symptom assessment and review the symptom report by logging into the patient portal (Epic MyChart). This single-institution waitlist randomized controlled trial is recruiting 200 children (aged 8-17 years) with cancer and their parents, guardians, or caregivers. Participating dyads are randomly assigned to receive the intervention over 16 weeks (Group A: 16-week SyMon-SAYS intervention; Group B: 8-week usual care and then an 8-week SyMon-SAYS intervention). Analyses will (1) evaluate the efficacy of SyMon-SAYS at week 8 and the maintenance of those effects at week 16; (2) evaluate factors associated with those efficacy outcomes, including contextual factors, adherence to the SyMon-SAYS intervention, demographic characteristics, and clinical factors; and (3) evaluate predictors of adherence to the SyMon-SAYS intervention and preference of SyMon-SAYS versus usual care. RESULTS Data collection is currently in progress. We hypothesize that at 8 weeks, those receiving the SyMon-SAYS intervention will report decreased parent-perceived barriers to managing their children's symptoms, increased parent and child self-efficacy, decreased child symptom burden, and ultimately better child health-related quality of life, compared to waitlist controls. Feasibility, acceptability, and engagement from the perspectives of the children with cancer, their parents, and their clinicians will be examined using mixed methods. CONCLUSIONS We anticipate that this system will facilitate prompt identification of problematic symptoms. Additionally, we hypothesize that with the availability of graphical symptom reports over time, and timely provider responses, children or parents will become better informed and take an active role in managing their symptoms, which will further improve clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04789720; https://clinicaltrials.gov/study/NCT04789720. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50993.
Collapse
Affiliation(s)
- Jin-Shei Lai
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Sally E Jensen
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - John Devin Peipert
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - Sofia F Garcia
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - David Cella
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Stewart Goldman
- Department of Child Health, College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, United States
- Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Alicia Lenzen
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
- Division of Hematology, Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States
| |
Collapse
|
3
|
Şancı Y, Yıldız S, Ayçiçek A, Möhür N. Effect of peppermint-lemon aromatherapy on nausea-vomiting and quality of life in pediatric patients with leukemia: A randomized controlled trial. J Pediatr Nurs 2023; 72:e217-e227. [PMID: 37453895 DOI: 10.1016/j.pedn.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/01/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Nausea and vomiting, frequently induced by chemotherapy, can delay treatment protocols and the healing process. PURPOSE The aim of this study is to determine how aromatherapy inhalation with peppermint and lemon using a diffuser affects nausea-vomiting management and quality of life in 2-12-year-old children undergoing chemotherapy. DESIGN AND METHODS The study utilized a pretest-posttest control group experimental design with randomized groups. A total of 90 children who met the inclusion criteria were included in the study. The experimental group received Mentha Piperita and Citrus Lemon essential oils through a diffuser, while the placebo group received water through a diffuser. The control group did not receive any intervention. RESULTS Pulse and respiratory rates of children treated with aromatherapy were found to be significantly lower than the other groups. After aromatherapy application, quality of life of the children in the experimental group was significantly higher than the other groups. The change in the Index of Nausea, Vomiting, and Retching scores of the experimental group on the 4th chemotherapy cycle compared to the 1st chemotherapy cycle was significantly higher than the change in the other groups. CONCLUSIONS Consequently, it was determined that inhalation aromatherapy with peppermint-lemon was effective in the management of chemotherapy-induced nausea-vomiting symptoms and quality of life compared to the placebo and control groups. PRACTICE IMPLICATIONS Inhalation aromatherapy with mint-lemon can be used as an alternative method to improve the quality of life in children with leukemia who suffer from chemotherapy-induced nausea and vomiting.
Collapse
Affiliation(s)
- Yağmur Şancı
- Fenerbahçe University, Faculty of Health Sciences, Department of Nursing, İstanbul, Turkey.
| | - Suzan Yıldız
- İstanbul University-Cerrahpaşa, Faculty of Nursing, Department of Pediatric Nursing, İstanbul, Turkey
| | - Ali Ayçiçek
- İstanbul Başakşehir Çam and Sakura City Hospital, Pediatric Hematology and Oncology Service, İstanbul, Turkey
| | - Naciye Möhür
- İstanbul University, Faculty of Medicine, İstanbul, Turkey
| |
Collapse
|
4
|
Ji X, Hu X, Brock KE, Mertens AC, Cummings JR, Effinger KE. Early Posttherapy Opioid Prescription, Potential Misuse, and Substance Use Disorder Among Pediatric Cancer Survivors. J Natl Cancer Inst 2022; 114:895-906. [PMID: 35262708 PMCID: PMC9194632 DOI: 10.1093/jnci/djac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/22/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric cancer survivors often have pain, which may be managed with opioids. We examined the prevalence of opioid prescriptions, potential misuse, and substance use disorders (SUDs) among pediatric cancer survivors during the first year posttherapy. METHODS Using MarketScan Commercial Database, we identified 8969 survivors (aged 21 years or younger at diagnosis) who completed cancer therapy in 2009-2018 and remained continuously enrolled for at least 1 year posttherapy and 44 845 age-, sex-, and region-matched enrollees without cancer as a comparison group. Outcomes included opioid prescriptions, any indicator of potential prescription opioid misuse, and SUDs within 1 year posttherapy. Outcomes were compared between survivors and noncancer peers in bivariate and adjusted analyses, stratified by off-therapy age (children: 0-11 years; adolescents: 12-17 years; young adults: 18-28 years). All statistical tests were 2-sided. RESULTS A higher proportion of survivors than noncancer peers filled opioid prescriptions (children: 12.7% vs 2.0%; adolescents: 22.9% vs 7.7%; young adults: 26.0% vs 11.9%). In models adjusting for sociodemographic factors and health status, survivors remained 74.4%-404.8% more likely than noncancer peer to fill opioid prescriptions (P < .001). The prevalence of potential misuse or SUDs was low, with 1.4% of child, 4.7% of adolescent, and 9.4% of young adult survivors fulfilling at least 1 criterion; however, it was higher than noncancer peers (0.1%, 1.4%, and 4.3%, respectively). In adjusted models, the likelihood of potential misuse among survivors remained at least 2 times higher than that among noncancer peers (P < .001), and the difference in SUDs became nonstatistically significant. CONCLUSION Statistically significantly higher rates of opioid prescriptions and potential misuse were found among pediatric cancer survivors within 1 year posttherapy as compared with peers without cancer.
Collapse
Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Xin Hu
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Katharine E Brock
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Janet R Cummings
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Karen E Effinger
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| |
Collapse
|
5
|
Rostagno E, Marchetti A, De Maria M, Piazzalunga M, Scarponi D, Zucchetti G, De Marinis MG, Piredda M. Psychometric properties of Pediatric Quality of Life multidimensional fatigue scale in Italian paediatric cancer patients: A multicentre cross-sectional study. Eur J Cancer Care (Engl) 2021; 30:e13510. [PMID: 34515385 DOI: 10.1111/ecc.13510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 05/06/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The original Pediatric Quality of Life-Multidimensional Fatigue Scale (PedsQL-MFS) developed in 2002 in the English language is a frequently used tool in paediatric oncology. It has been translated into several languages, and the aim of this study was to test the psychometric properties of the Italian version of this scale in paediatric patients with cancer. METHODS This was a cross-sectional validation multicentre study. RESULTS Acceptability was 100% for patients and 99.2% for parents. Confirmatory factor analysis of the three-factor model of the original scale yielded poor fit indices. A three-factor solution was found through exploratory structural equation modelling, with good fit indices. The internal consistency, evaluated through the Cronbach's alpha coefficient, ranged 0.71-0.92 for the total sample, both in the self-report and in the proxy-report questionnaire. CONCLUSION The Italian version of the PedsQL-MFS for children and adolescents with cancer shows adequate psychometric characteristics of both the self- and proxy-report. Further research with larger samples is needed ensuring all age groups are appropriately represented.
Collapse
Affiliation(s)
- Elena Rostagno
- Pediatric Oncology and Hematology Unit, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Anna Marchetti
- Research Unit of Nursing Science, Campus Bio-Medico University of Rome, Rome, Italy
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Roma "Tor Vergata", Rome, Italy
| | - Martina Piazzalunga
- Pediatric Hematology and Stem Cell Transplantation Unit, Monza and Brianza Foundation for the Child and His Mother, Pediatric Clinic, University of Milan Bicocca, Monza, Italy
| | - Dorella Scarponi
- Pediatric Oncology and Hematology Unit, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giulia Zucchetti
- Pediatric Oncology Department, Regina Margherita Children's Hospital, Turin, Italy.,Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | | | - Michela Piredda
- Research Unit of Nursing Science, Campus Bio-Medico University of Rome, Rome, Italy
| |
Collapse
|
6
|
Fei F, Koffman J, Zhang X, Gao W. Chronic Obstructive Pulmonary Disease Symptom Cluster Composition, Associated Factors, and Methodologies: A Systematic Review. West J Nurs Res 2021; 44:395-415. [PMID: 33682534 PMCID: PMC8894625 DOI: 10.1177/0193945921995773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This systematic review details symptom clusters, their compositions, and associated factors and appraises the methodologies of studies that reported symptom clusters in patients with chronic obstructive pulmonary disease (COPD). Ten studies were eligible for inclusion in this study. Four common symptom clusters were identified. Two theoretical frameworks, four statistical methods, and various symptom assessment tools were used to identify symptom clusters. Factors associated with symptom clusters included demographic, clinical, and biological factors. No studies examined the subjective experiences of symptom clusters. Overall, inconsistencies were identified in the composition of symptom clusters across studies. This may be due to variations in study design, assessment tools, and statistical methods. Future studies should attempt to arrive at a common definition, especially that is theoretically derived, for symptom clusters, standardize the criteria for symptoms for inclusion in the clusters, and focus on patients' subjective experience to inform which clusters are clinically relevant.
Collapse
Affiliation(s)
- Fei Fei
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, Jiangsu, P.R. China
| | - Jonathan Koffman
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Xiaohan Zhang
- School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, Jiangsu, P.R. China
| | - Wei Gao
- Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| |
Collapse
|
7
|
Rostagno E, Bergadano A, Piredda M, De Marinis MG. Italian nurses knowledge and attitudes towards fatigue in pediatric onco-hematology: A cross-sectional nationwide survey. Int J Pediatr Adolesc Med 2020; 7:161-165. [PMID: 33319013 PMCID: PMC7729244 DOI: 10.1016/j.ijpam.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/28/2020] [Indexed: 12/17/2022]
Abstract
Background and Objective Fatigue is one of the most debilitating and prevalent symptoms in pediatric cancer patients and it is important to know if nurses are able to recognize and manage it. The aim of this study was to investigate the knowledge and attitudes towards fatigue of nurses working in Italian pediatric onco-hematology centers. Methods Cross-sectional online survey. An existing questionnaire was adapted to the Italian context, extended with a section on attitudes, and psychometrically tested. The questionnaire was sent to all nurses working in Italian pediatric onco-hematology centers. Results Respondents (n = 189), who were working in 37/53 (∼70%) centers, reported 42% of children and 68% of adolescents experiencing fatigue, with intensity increasing with age. Contributing factors were treatments and co-morbidities; frequent symptoms were mood changes and lack of energy. Among respondents who did not assess fatigue, 36.2% did not know an appropriate tool. Nurses recognized fatigue as an important problem and their knowledge and attitudes towards fatigue seemed satisfactory. Conclusion This study provides nurses with an instrument to investigate their knowledge and attitudes about fatigue. Nurses' awareness of the significance of fatigue is a fundamental step towards improving its management and offering strategies that can help both the child and their family.
Collapse
Affiliation(s)
- Elena Rostagno
- Pediatric Oncology and Hematology Unit, S.Orsola-Malpighi Hospital, Via Massarenti, 40138, Bologna, Italy
| | - Anna Bergadano
- Pediatric Onco-Hematology Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Piazza Polonia, 94 - 10100, Torino, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
| |
Collapse
|
8
|
Fortier MA, Yang S, Phan MT, Tomaszewski DM, Jenkins BN, Kain ZN. Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities. Pediatr Blood Cancer 2020; 67:e28124. [PMID: 31850674 PMCID: PMC8266302 DOI: 10.1002/pbc.28124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
Abstract
The opioid crisis in the United States has grown at an alarming rate. Children with cancer are at high risk for pain, and opioids are a first-line treatment in this population. Accordingly, there is an urgent need to optimize pain management in children with cancer without contributing to the opioid crisis. This report details opportunities for this optimization, including clinical practice guidelines, comprehensive approaches to pain management, mobile health, and telemedicine. It is vital to balance appropriate use of analgesics with efforts to prevent misuse in order to reduce unnecessary suffering and minimize unintended harms.
Collapse
Affiliation(s)
- Michelle A. Fortier
- UCI Center on Stress and Health, School of Medicine, University of California, California, Irvine,Sue and Bill Gross School of Nursing, University of California, California, Irvine,Department of Anesthesiology and Perioperative Care, University of California, California, Irvine,Department of Pediatric Psychology, Children’s Hospital of Orange County, California, Orange
| | - Sun Yang
- School of Pharmacy, Chapman University, California, Orange
| | | | | | - Brooke N. Jenkins
- UCI Center on Stress and Health, School of Medicine, University of California, California, Irvine,Department of Psychology, Chapman University, California, Orange
| | - Zeev N. Kain
- UCI Center on Stress and Health, School of Medicine, University of California, California, Irvine,Department of Anesthesiology and Perioperative Care, University of California, California, Irvine,Child Study Center, Yale University, New Haven, Connecticut,American College of Perioperative Medicine, California, Irvine
| |
Collapse
|
9
|
Tsimicalis A, Rennick J, Le May S, Stinson J, Sarkis B, Séguin K, Siedlikowski M, Choquette A, Louli J. “Tell it as it is”: How Sisom prompts children and parents to discuss their cancer experience. Cancer Rep (Hoboken) 2019. [DOI: 10.1002/cnr2.1173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Argerie Tsimicalis
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Janet Rennick
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Quebec Canada
- Montreal Children's HospitalMcGill University Health Centre Montreal Quebec Canada
| | - Sylvie Le May
- UHC Sainte‐Justine Montreal Quebec Canada
- University of Montreal Montreal Quebec Canada
| | - Jennifer Stinson
- The Hospital for Sick Children Toronto Ontario Canada
- Lawrence S Bloomberg Faculty of NursingUniversity of Toronto Toronto Ontario Canada
| | - Bianca Sarkis
- Faculty of MedicineMcGill University Montreal Quebec Canada
| | - Karine Séguin
- Faculty of ScienceMcGill University Montreal Quebec Canada
| | - Maia Siedlikowski
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Anne Choquette
- Montreal Children's HospitalMcGill University Health Centre Montreal Quebec Canada
| | - Julie Louli
- Ingram School of Nursing, Faculty of MedicineMcGill University Montreal Quebec Canada
| |
Collapse
|
10
|
Prognostic association of demographic and clinical factors with the change rates of symptoms and depression among patients with hepatocellular carcinoma. Support Care Cancer 2019; 27:4665-4674. [DOI: 10.1007/s00520-019-04776-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/25/2019] [Indexed: 01/15/2023]
|
11
|
Bhardwaj T, Koffman J. Non-pharmacological interventions for management of fatigue among children with cancer: systematic review of existing practices and their effectiveness. BMJ Support Palliat Care 2017; 7:404-414. [PMID: 28760817 DOI: 10.1136/bmjspcare-2016-001132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/06/2017] [Accepted: 06/26/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Fatigue is common among children living with cancer, particularly in advance stages. Little is known about the effectiveness of non-pharmacological approaches to manage this complex and distressing symptom among children. Thus, the present paper aim to critically examine the effectiveness and setting for non-pharmacological interventions to manage fatigue among children with cancer. METHODS Six electronic databases were screened first in February 2013 and at second instance in March 2015. They include PsycINFO, Medline, EMBASE, CINAHL, Scopus and Cochrane library. All databases were systematically searched for literature on fatigue and cancer, limited to children (as age group) and English language. RESULTS 1498 articles were identified, of which six were reviewed. Three types of interventions for managing fatigue were identified including (1) complementary and alternative medicine (healing touch/massage therapy), (2) exercise-based interventions and (3) nursing-based interventions. Most interventions were delivered during active treatment and in hospital settings where parents were involved to optimise participation. Despite fatigue scores being lower among intervention groups, no study findings were observed as being statistically significant. CONCLUSION Fatigue is common among children treated for and living with cancer. The most appropriate setting to deliver non-pharmacological interventions to manage fatigue appears to be in hospital. However, in absence of any strong evidence, professionals need to be cautious about existing non-pharmacological interventions. Future research must adopt more rigorous research designs that are adequately powered using validated measures to identify potential benefits. In addition, researchers may wish to test psychosocial interventions shown to be of benefit in adults.
Collapse
Affiliation(s)
- Tushti Bhardwaj
- Department of Social Work, Dr B R Ambedkar College, University of Delhi, Yamuna Vihar, Delhi, India
| | - Jonathan Koffman
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| |
Collapse
|
12
|
Results of a Pilot Yoga Intervention to Improve Pediatric Cancer Patients' Quality of Life and Physical Activity and Parents' Well-being. REHABILITATION ONCOLOGY 2017. [DOI: 10.1097/01.reo.0000000000000052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Bolton LB, Donaldson NE, Rutledge DN, Bennett C, Brown DS. The Impact of Nursing Interventions. Med Care Res Rev 2016; 64:123S-43S. [PMID: 17406015 DOI: 10.1177/1077558707299248] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this article is to present findings from a review of published systematic/integrative reviews and meta-analyses on nursing interventions and patient outcomes in acute care settings. A literature search was conducted for the period 1999-2005, producing 4,000 systematic/integrative reviews and 500 meta-analyses covering seven topics selected by the authors: elder care, caregivers, developmental care of neonates and infants, symptom management, pressure ulcer prevention/treatment, incontinence, and staffing. The association between nursing care interventions/processes and patient outcomes in acute care settings was found to be limited in the articles reviewed. The strongest evidence was for the use of patient risk-assessment tools and interventions implemented by nurses to prevent patient harm. We observed significant variation in methods to measure the effect of independent variables (nursing interventions) on patient outcomes. Results indicate the need for more research measuring the effect of specific nursing interventions that may impact acute care patient outcomes.
Collapse
|
14
|
Robinson DL, Carr BA. Delayed Vomiting in Children With Cancer After Receiving Moderately High or Highly Emetogenic Chemotherapy. J Pediatr Oncol Nurs 2016; 24:70-80. [PMID: 17332421 DOI: 10.1177/1043454206298840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Delayed vomiting is a potentially significant adverse effect of chemotherapy used to treat childhood cancer, but little is known about the experience of delayed vomiting in children and adolescents. An exploratory study was conducted to determine the pattern of delayed vomiting in children and adolescents with cancer after highly emetic chemotherapy and to identify possible risk factors. In a sample of 82 children and adolescents who completed 117 cycles of highly emetic chemotherapy, the overall prevalence of delayed vomiting was 32%. The frequency of delayed vomiting was highest on delayed day 2, with 21% of participants experiencing vomiting. By delayed day 7, only 9% of participants still reported vomiting. The severity of vomiting was moderate to severe in 11% to 12% of subjects. Age and gender had no significant effect on delayed vomiting. The emetic potential of the agent, incomplete protection from acute vomiting, and treatment regimens that lasted 6 or more days significantly affected delayed vomiting. In addition, a history of motion sickness, lack of acute control, and 6 or more days of chemotherapy were predictive of delayed vomiting.
Collapse
Affiliation(s)
- Deborah L Robinson
- Pediatric Oncology, St Louis Children's Hospital, St Louis, MO 63110, USA.
| | | |
Collapse
|
15
|
Pain buddy: A novel use of m-health in the management of children's cancer pain. Comput Biol Med 2016; 76:202-14. [PMID: 27479493 DOI: 10.1016/j.compbiomed.2016.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Over 12,000 children are diagnosed with cancer every year in the United States. In addition to symptoms associated with their disease, children undergoing chemotherapy frequently experience significant pain, which is unfortunately often undertreated. The field of m-Health offers an innovative avenue for pain assessment and intervention in the home setting. The current study describes the development and initial evaluation of a tablet-based program, Pain Buddy, aimed to enhance pain management and foster improved quality of life in children ages 8-18 years undergoing cancer treatment. METHODS An animated avatar-based tablet application was developed using state-of-the-art software. Key aspects of Pain Buddy include daily pain and symptom diaries completed by children, remote monitoring of symptoms by uploading patient's data through internet to a cloud server, cognitive and behavioral skills training, interactive three-dimensional avatars that guide children through the program, and an incentive system to motivate engagement. Twelve children between the ages of 8 and 18 participated in a pilot study of Pain Buddy. RESULTS Children were highly satisfied with the program. Pain and appetite disturbances were most frequently endorsed. Symptom trigger alerts to outside providers were largely related to clinically significant pain. Children infrequently used analgesics, and reported using some non-pharmacological pain management strategies. CONCLUSION Pain Buddy appears to be a promising tool to improve pain and symptom management in children undergoing cancer treatment. Results from the current study will inform future improvements to Pain Buddy, in preparation for a randomized controlled trial to assess the efficacy of this innovative treatment.
Collapse
|
16
|
Ye Q, Liu K, Wang J, Bu X, Zhao L. Reliability and validity of the Chinese version of the PedsQL Multidimensional Fatigue Scale in children with acute leukemia. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
17
|
Usability testing of a computerized communication tool in a diverse urban pediatric population. Cancer Nurs 2016; 37:E25-34. [PMID: 24457227 DOI: 10.1097/ncc.0000000000000115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Developed in Norway, Sisom is an interactive, rigorously tested, computerized, communication tool designed to help children with cancer express their perceived symptoms/problems. Children travel virtually from island to island rating their symptoms/problems. While Sisom has been found to significantly improve communication in patient consultations in Norway, usability testing is warranted with US children prior to further use in research studies. OBJECTIVE The objective of this study was to determine the usability of Sisom in a sample of English- and Spanish-speaking children in an urban US community. METHODS A mixed-methods usability study was conducted with a purposive sample of healthy children and children with cancer. Semistructured interviews were used to assess healthy children's symptom recognition. Children with cancer completed 8 usability tasks captured with Morae 3.3 software. Data were downloaded, transcribed, and analyzed descriptively. RESULTS Four healthy children and 8 children with cancer participated. Of the 44 symptoms assessed, healthy children recognized 15 (34%) pictorial symptoms immediately or indicated 13 (30%) pictures were good representations of the symptom. Six children with cancer completed all tasks. All children navigated successfully from one island to the next, ranking their symptom/problem severity, clicking the magnifying glass for help, or asking the researcher for assistance. All children were satisfied with the aesthetics and expressed an interest in using Sisom to communicate their symptoms/problems. CONCLUSIONS A few minor suggestions for improvement and adjustment may optimize the use of Sisom for US children. IMPLICATIONS FOR PRACTICE Sisom may help clinicians overcome challenges assessing children's complex symptoms/problems in a child-friendly manner.
Collapse
|
18
|
Bastani F, Khosravi M, Borimnejad L, Arbabi N. The effect of acupressure on cancer-related fatigue among school-aged children with acute lymphoblastic leukemia. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:545-51. [PMID: 26457090 PMCID: PMC4598899 DOI: 10.4103/1735-9066.164508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fatigue is the most common side effect of chemotherapy in children with acute lymphoblastic leukemia (ALL). Acupressure is one of the most popular non-pharmacologic methods used to reduce fatigue in other settings. The aim of the study was to evaluate the effect of acupressure on reducing fatigue among children with ALL compared with a placebo treatment. MATERIALS AND METHODS In a single-blind, randomized, placebo-controlled clinical trial of 120 hospitalized school-aged children with ALL, 24 h after chemotherapy, they were randomly divided into experimental (n = 60) and placebo groups (n = 60). Intensity of fatigue was rated using the Visual Analog Scale. The intervention (finger acupressure) was applied on ST36 (true points) in the experimental group and on LI12 (sham points) in the placebo group. We evaluated the symptoms of fatigue intensity immediately and 1 h after intervention. Fatigue was also measured 24 h after intervention by Fatigue Scale-Child (FS-C). Data were analyzed by SPSS version 16.0 using descriptive statistics, independent t-test, and Chi-square and Fisher exact tests. RESULTS Significant differences were observed between the two groups in the intensity of fatigue 1 h after intervention (P < 0.001). But there was no significant difference between them regarding fatigue 24 h after intervention. CONCLUSIONS Applying one time acupressure may reduce the intensity of fatigue at 1 h post-treatment. Therefore, acupressure could be recommended as an effective, non-pharmacologic method for some CRF control. Applying one time acupressure did not have a long-term effect.
Collapse
Affiliation(s)
- Farideh Bastani
- Department of Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Khosravi
- Instructor, Tehran University of Medical Sciences and Health Services, Nurse of Children's Medical Centre, Tehran, Iran
| | - Leili Borimnejad
- Leili Borimnejad, Nursing Care Research Centre, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran, Negar Arbabi, Master of Science Tehran University of Medical Sciences and Health Services, Internationally Educated Nurse, Vancouver, Canada
| | - Negar Arbabi
- Instructor, Tehran University of Medical Sciences and Health Services, Nurse of Children's Medical Centre, Tehran, Iran
| |
Collapse
|
19
|
Lai JS, Yount S, Beaumont JL, Cella D, Toia J, Goldman S. A patient-centered symptom monitoring and reporting system for children and young adults with cancer (SyMon-SAYS). Pediatr Blood Cancer 2015; 62:1813-8. [PMID: 25856587 DOI: 10.1002/pbc.25550] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/17/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study evaluated the feasibility of implementing a patient-centered, technology-based symptom monitoring and reporting system (SyMon-SAYS) in pediatric oncology clinics using fatigue as a prototypic symptom. Timely identification of symptoms related to multi-modal therapy for children with cancer is fundamental to the overall success of cancer treatment. SyMon-SAYS was developed to address this need. PROCEDURE Patients with a cancer diagnosis, ages 7-21 years, currently on treatment, or off treatment within 6 months, were eligible. Patients/parents completed weekly fatigue assessments over 8 weeks via the internet or interactive voice response (IVR) by phone. Alert emails were generated when pre-defined fatigue score thresholds were met, and fatigue reports were forwarded to clinicians accordingly. Clinicians and parents/patients received cumulative graphic reports of fatigue scores prior to clinic visits at 4 and 8 weeks post-baseline to facilitate discussion. Parents/patients completed an exit survey at their last visit. RESULTS Fifty-seven patients/parents completed the study. The majority of patients (93%) and parents (78%) felt it was very/extremely easy to complete SyMon-SAYS; 95% of parents were satisfied with the system; 60% reported it helped deal with their child's fatigue; 70% reported that clinicians didn't discuss fatigue with them; 81% would be willing to use SyMon-SAYS to manage fatigue and other symptoms. Clinicians reported insufficient time to review reports, yet 71% were willing to receive the report on a monthly basis. CONCLUSION SyMon-SAYS is feasible and acceptable to patients and parents. Future efforts should focus on better integrating the system into the clinical workflow to improve clinicians' acceptance.
Collapse
Affiliation(s)
- Jin-Shei Lai
- Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Susan Yount
- Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Jennifer L Beaumont
- Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - David Cella
- Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, Illinois
| | - Jacquie Toia
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stewart Goldman
- Department of Pediatrics, Feinberg School of Medicine at Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| |
Collapse
|
20
|
Hooke MC, Gilchrist L, Foster L, Langevin M, Lee J. Yoga for Children and Adolescents After Completing Cancer Treatment. J Pediatr Oncol Nurs 2015; 33:64-73. [DOI: 10.1177/1043454214563936] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Survivors of childhood cancer may experience persistent symptoms, including fatigue, sleep disturbance, and balance impairment. Yoga is a complementary therapy that improves fatigue, sleep, and quality of life in adult cancer survivors. Using a one group, repeated measures design, we evaluated the feasibility of a yoga program and assessed if cancer survivor participants ages 10 to 17 years (n = 13) had significantly less fatigue and anxiety, and better balance and sleep, after a 6-week yoga intervention compared with a 6-week pre-intervention wait period. Study recruitment was challenging with a 32% enrollment rate; yoga attendance was 90%. None of the scores for anxiety, fatigue, sleep, and balance had significant changes during the wait period. After the 6-week yoga program, children (n = 7) had a significant decrease in anxiety score ( P = .04) while adolescent scores (n = 7) showed a decreasing trend ( P = .10). Scores for fatigue, sleep, and balance remained stable post-intervention. Fatigue and balance scores were below norms for health children/adolescents while sleep and anxiety scores were similar to healthy peers.
Collapse
Affiliation(s)
- Mary C. Hooke
- University of Minnesota School of Nursing, Minneapolis, MN, USA
- Children’s Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Laura Gilchrist
- Children’s Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Laurie Foster
- Children’s Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Mary Langevin
- Children’s Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Jill Lee
- University of Minnesota Children’s Hospital, Minneapolis, MN, USA
| |
Collapse
|
21
|
Macartney G, VanDenKerkhof E, Harrison MB, Stacey D. Symptom experience and quality of life in pediatric brain tumor survivors: a cross-sectional study. J Pain Symptom Manage 2014; 48:957-67. [PMID: 24704799 DOI: 10.1016/j.jpainsymman.2013.12.243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/15/2013] [Accepted: 12/19/2013] [Indexed: 11/30/2022]
Abstract
CONTEXT Little is known about the symptom experience and quality of life of children and youths who have completed treatment for a pediatric brain tumor. OBJECTIVES This study describes the symptom experience and health-related quality of life of children who have survived a brain tumor. METHODS This observational cross-sectional study used a convenience sample of 50 children who were being followed in ambulatory care after they had completed brain tumor treatment. Their symptom experience was measured using the Memorial Symptom Assessment Scale, and health-related quality of life was measured using the Pediatric Quality of Life Inventory. RESULTS The median number of symptoms reported by the participants was six. The most prevalent symptoms were lack of energy (52%), feeling drowsy (40%), difficulty with sleep (38%), lack of concentration (36%), and headaches (36%). Among those reporting symptoms, the most distressing symptoms were pain (14%), headaches (12%), lack of energy (8%), and difficulty with sleep (8%). Four symptoms-lack of energy, concentration, pain, and shortness of breath-explained most of the variance in the Pediatric Quality of Life Inventory subscales and total scores. CONCLUSION Pediatric brain tumor survivors experience many symptoms after treatment. Care providers should be particularly diligent screening for symptoms, including pain, headaches, lack of energy, and sleep problems, as these symptoms may be particularly distressing for children.
Collapse
Affiliation(s)
- Gail Macartney
- Nursing Research & Knowledge Translation, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | - Elizabeth VanDenKerkhof
- School of Nursing, Queen's University, Kingston, Ontario, Canada; Department of Anesthesiology & Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Margaret B Harrison
- School of Nursing, Queen's University, Kingston, Ontario, Canada; Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
22
|
Fortier MA, Wahi A, Bruce C, Maurer EL, Stevenson R. Pain management at home in children with cancer: a daily diary study. Pediatr Blood Cancer 2014; 61:1029-33. [PMID: 24376073 DOI: 10.1002/pbc.24907] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/26/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND With the transition of care of cancer patients from the hospital to the home setting, parents are largely responsible for children's pain management. Children's cancer pain is undermanaged, yet, there is little empirical data on the occurrence and management of cancer pain in the home setting. The purpose of the present study, therefore, was to employ a daily diary protocol to examine barriers to pain management of children's cancer pain by parents at home. PROCEDURE Parent-child dyads were recruited from the Cancer Institute at a major children's hospital in Southern California. A total of 45 patient/parent pairs completed baseline data on demographic and personality characteristics, children's quality of life, and parental beliefs regarding analgesic use for children and then completed daily diaries of pain and analgesic administration for 14 consecutive days. RESULTS Most children were reported to experience chronic pain while undergoing treatment for cancer, yet overall analgesic administration at home was low. Parents who reported misconceptions regarding analgesic use for children were less likely to administer pain medication to children. Children who were less shy, more social, or had lower quality of life were more likely to receive analgesics. CONCLUSIONS A significant proportion of children receiving outpatient treatment for cancer were rated as experiencing chronic pain and pain was not optimally managed in the home setting. Further understanding and addressing barriers to children's cancer pain management in the home setting will aid in alleviating unnecessary pain in this vulnerable patient population.
Collapse
Affiliation(s)
- Michelle A Fortier
- Department of Anesthesiology & Perioperative Care, University of California-Irvine, Orange, California; Department of Pediatric Psychology, CHOC Children's Hospital, Orange, California
| | | | | | | | | |
Collapse
|
23
|
Reeve BB, Withycombe JS, Baker JN, Hooke MC, Lyons JC, Mowbray C, Wang J, Freyer DR, Joffe S, Sung L, Tomlinson D, Gold SH, Hinds PS. The first step to integrating the child's voice in adverse event reporting in oncology trials: a content validation study among pediatric oncology clinicians. Pediatr Blood Cancer 2013; 60:1231-6. [PMID: 23335328 DOI: 10.1002/pbc.24463] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 12/10/2012] [Indexed: 11/06/2022]
Abstract
PURPOSE Children with cancer experience significant toxicities while undergoing treatment. Documentation of adverse events (AEs) in clinical trials is mandated by federal agencies. Although many AEs are subjective, the current standard is clinician reporting. Our long-term goal is to create and validate a self-report measure of subjective AEs for children aged 7 years and older that will inform AE reporting for the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE). This content validation study aimed to identify which of the AEs in the current CTCAE should be included in a pediatric self-report measure. METHODS We sought expert panel review and consensus among 187 pediatric clinicians from seven Children's Oncology Group institutions to determine which of the 790 AEs are amenable to child self-report. Two survey iterations were used to identify suitable AEs, and clinician agreement estimated by the content-validity ratio (CVR) was assessed. RESULTS Response rates for surveys 1 and 2 were 72% and 67%, respectively. After the surveys, 64 CTCAE terms met the criteria of being subjective, relevant for use in pediatric cancer trials, and amenable to self-report by a child. The most frequent reasons for removal of CTCAE terms were that they relied on laboratory or clinical measures or were not applicable to children. CONCLUSION The 64 CTCAE terms will be translated into child-friendly terms as the basis of the child-report toxicity measure. Ultimately, systematic collection of these data will improve care by enhancing the accuracy and completeness of treatment toxicity reports for childhood cancer.
Collapse
Affiliation(s)
- Bryce B Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7411, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Landier W, Leonard M, Ruccione KS. Children's Oncology Group's 2013 blueprint for research: nursing discipline. Pediatr Blood Cancer 2013; 60:1031-6. [PMID: 23255369 PMCID: PMC3645887 DOI: 10.1002/pbc.24415] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 11/05/2012] [Indexed: 01/14/2023]
Abstract
Integration of the nursing discipline within cooperative groups conducting pediatric oncology clinical trials provides unique opportunities to maximize nursing's contribution to clinical care, and to pursue research questions that extend beyond cure of disease to address important gaps in knowledge surrounding the illness experience. Key areas of importance to the advancement of the nursing discipline's scientific knowledge are understanding the effective delivery of patient/family education, and reducing illness-related distress, both of which are integral to facilitating parental/child coping with the diagnosis and treatment of childhood cancer, and to promoting resilience and well-being of pediatric oncology patients and their families.
Collapse
Affiliation(s)
- Wendy Landier
- Department of Population Sciences, City of Hope, Duarte, CA 91010, USA.
| | - Marcia Leonard
- Division of Pediatric Hematology/Oncology, C. S. Mott Children’s Hospital, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Kathleen S. Ruccione
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
25
|
Wesley KM, Zelikovsky N, Schwartz LA. Physical symptoms, perceived social support, and affect in adolescents with cancer. J Psychosoc Oncol 2013; 31:451-67. [PMID: 23844924 PMCID: PMC4479176 DOI: 10.1080/07347332.2013.798761] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Treatment for cancer among adolescents is often more intense and lasts longer than treatment for older or younger patients. It typically causes pain, fatigue, and nausea and affects social and emotional well-being. This study examined the relationships among demographics, physical symptoms, perceived social support from friends and family, and affect (positive and negative) in 102 adolescents (age 13-19) with cancer using correlational analyses. Additionally, perceived social support was explored as a mediator and moderator of the relationship between physical symptoms and affect using regression. Females reported significantly lower friend support and higher negative affect compared to males. Minority participants were more likely to endorse physical symptoms and less negative affect compared to White respondents. Higher report of physical symptoms was significantly related to greater negative affect, whereas higher perceived social support from friends was related to higher positive affect. Adolescents consistently reported high levels of social support from family and friends. Additionally, adolescents tended to report average levels of positive affect and low levels of negative affect compared to healthy populations. No significant mediation or moderation effects were found. This research highlights that females and minorities, and those with greater physical symptoms, may be more vulnerable to poor adjustment to cancer during adolescence. However, overall this study lends support to the notion that adolescents with cancer are an especially resilient population, as these patients endorsed generally high levels of social support and positive affect, with low levels of negative affect.
Collapse
Affiliation(s)
- Kimberly M Wesley
- Department of Psychology, La Salle University, Philadelphia, PA 19141, USA.
| | | | | |
Collapse
|
26
|
Robinson DL, Loman DG, Balakas K, Flowers M. Nutritional Screening and Early Intervention in Children, Adolescents, and Young Adults With Cancer. J Pediatr Oncol Nurs 2012; 29:346-55. [DOI: 10.1177/1043454212460921] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | - Karen Balakas
- Saint Louis Children’s Hospital, Saint Louis MO, USA
| | | |
Collapse
|
27
|
Hooke MC, Garwick AW, Gross CR. Fatigue and Physical Performance in Children and Adolescents Receiving Chemotherapy. Oncol Nurs Forum 2011; 38:649-57. [DOI: 10.1188/11.onf.649-657] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
28
|
Tsimicalis A, De Courcy MJ, Di Monte B, Armstrong C, Bambury P, Constantin J, Dagelman B, Eves M, Jansen P, Honeyford L, Stregger D. Tele-practice guidelines for the symptom management of children undergoing cancer treatment. Pediatr Blood Cancer 2011; 57:541-8. [PMID: 21319280 DOI: 10.1002/pbc.22993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 12/01/2010] [Indexed: 11/09/2022]
Abstract
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.
Collapse
Affiliation(s)
- Argerie Tsimicalis
- Center for Health Policy, Columbia University, New York City, New York 10032, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Miller E, Jacob E, Hockenberry MJ. Nausea, Pain, Fatigue, and Multiple Symptoms in Hospitalized Children With Cancer. Oncol Nurs Forum 2011; 38:E382-93. [DOI: 10.1188/11.onf.e382-e393] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
30
|
Temtap S, Nilmanat K. Symptom experience and management among people with acute myeloid leukaemia in Thailand. Int J Palliat Nurs 2011; 17:381-6. [DOI: 10.12968/ijpn.2011.17.8.381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Suthisa Temtap
- Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Suthisa Temtap is Advanced Nurse Practitioner, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University
| | - Kittikorn Nilmanat
- Department of Medical Nursing, Faculty of Nursing, Prince of Songkla University, Songkhla 90112, Thailand
| |
Collapse
|
31
|
Baxter AL, Watcha MF, Baxter WV, Leong T, Wyatt MM. Development and validation of a pictorial nausea rating scale for children. Pediatrics 2011; 127:e1542-9. [PMID: 21624874 DOI: 10.1542/peds.2010-1410] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The lack of a widely used, validated measure limits pediatric nausea management. The goal of this study was to create and validate a pictorial scale with regular incremental levels between scores depicting increasing nausea intensity. METHODS A pictorial nausea scale of 0 to 10 with 6 faces (the Baxter Retching Faces [BARF] scale) was developed in 3 stages. The BARF scale was validated in emergency department patients with vomiting and in healthy patients undergoing day surgery procedures. Patients were presented with visual analog scales for nausea and pain, the pictorial Faces Pain Scale-Revised, and the BARF scale. Patients receiving opioid analgesics or antiemetic agents had their pain and nausea assessed before and 30 minutes after therapy. Spearman's ρ correlation coefficients were calculated. A Wilcoxon matched-pair rank test compared pain and nausea scores before and after antiemetic therapy. RESULTS Thirty oncology patients and 15 nurses participated in the development of the scale, and 127 patients (52, emergency department; 75, day surgery) ages 7 to 18 years participated in the validation. The Spearman ρ correlation coefficient of the first paired BARF and visual analog scale for nausea scores was 0.93. Visual analog scales for nausea and BARF scores were significantly higher in patients requiring antiemetic agents (P = .0001) and decreased significantly after treatment (P = .0002), while posttreatment VAS (P = .20) and FPSR scores (P =.47) for patients receiving only antiemetic agents did not [corrected]. CONCLUSIONS We describe the development of a pictorial scale with beginning evidence of construct validity for a self-report assessment of the severity of pediatric nausea. The scale had convergent and discriminant validity, along with an ability to detect change after treatment.
Collapse
Affiliation(s)
- Amy L Baxter
- Medical College of Georgia, Pediatric Emergency Medicine Associates, Atlanta, Georgia, USA.
| | | | | | | | | |
Collapse
|
32
|
Malcolm C, Forbat L, Anderson G, Gibson F, Hain R. Challenging symptom profiles of life-limiting conditions in children: a survey of care professionals and families. Palliat Med 2011; 25:357-64. [PMID: 21228088 DOI: 10.1177/0269216310391346] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper reports on data from the initial phase of a UK-wide study exploring life-limiting conditions (LLCs) in children where, because of their rarity, little is understood regarding the significant symptom challenges of families and care professionals who support them. In this initial phase, care professionals (n=43) and families (n=16) completed a survey to identify which rare LLCs present symptom challenges and which individual symptoms prove difficult to manage. Findings led to the prioritization of mucopolysaccharidoses, Batten Disease and leukodystrophy. Care professionals' rationales for selecting these conditions included the presence of symptoms that are very difficult to manage, a requirement for additional clinical evidence to support symptom management, and the progressive nature of these diseases where symptoms frequently change and are difficult to predict. Families identified symptoms such as behavioural difficulties, visual impairments and communication impairments as those being most difficult to manage and having most impact on quality of life for children and families.
Collapse
Affiliation(s)
- Cari Malcolm
- Cancer Care Research Centre, University of Stirling, Stirling, UK
| | | | | | | | | |
Collapse
|
33
|
Yilmaz HB, Taş F, Muslu GK, Başbakkal Z, Kantar M. Health Professionals’ Estimation of Cancer-Related Fatigue in Children. J Pediatr Oncol Nurs 2010; 27:330-7. [PMID: 20966161 DOI: 10.1177/1043454210377176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Many studies show that cancer-related fatigue is one of the most common symptoms experienced by children as a side effect of cancer therapy. This problem has grown considerably in recent years; the exact mechanisms underlying fatigue remain unclear. Therefore, assessing and managing this symptom can be problematic. This article describes the findings from a survey evaluating how health professionals (n = 56) at the Pediatric Oncology Centers in Izmir currently define and assess cancer-related fatigue. The results demonstrate that while the problems associated with fatigue are acknowledged, assessment tools are not widely used, and the majority of health professionals report that they would benefit from further education on the subject to assist in the care of patients.
Collapse
Affiliation(s)
- Hatice Bal Yilmaz
- Pediatric Oncology Department and Pediatric BMT Center, Ege University School of Medicine, Bornova, Izmir, Turkey.
| | | | | | | | | |
Collapse
|
34
|
Cicogna EDC, Nascimento LC, Lima RAGD. Children and Adolescents with Cancer: experiences with Chemotherapy. Rev Lat Am Enfermagem 2010; 18:864-72. [DOI: 10.1590/s0104-11692010000500005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 03/03/2010] [Indexed: 05/26/2023] Open
Abstract
This study aimed to comprehend chemotherapy from the perspective of children and adolescents with cancer. Ten children and adolescents between eight and 18 years of age, in different phases of chemotherapy, participated in this exploratory, qualitative study. Data collection was carried out through semi-structured interviews and analysis of the patients’ medical records. Analysis of the empirical material followed the content analysis technique. The study allowed the comprehension that, for the children and adolescents, chemotherapy is mainly remembered for its collateral effects and suffering. After the initial impact, mainly due to physical changes, preoccupations are related to disease recovery, i.e. a cure. Over time, they also mentioned that the disease was seen as something to be overcome and, due to the chemotherapy, likely to be the outcome.
Collapse
|
35
|
Green R, Horn H, Erickson JM. Eating experiences of children and adolescents with chemotherapy-related nausea and mucositis. J Pediatr Oncol Nurs 2010; 27:209-16. [PMID: 20562389 DOI: 10.1177/1043454209360779] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
Collapse
|
36
|
Thygeson MV, Hooke MC, Clapsaddle J, Robbins A, Moquist K. Peaceful Play Yoga: Serenity and Balance for Children With Cancer and Their Parents. J Pediatr Oncol Nurs 2010; 27:276-84. [DOI: 10.1177/1043454210363478] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Children with a cancer diagnosis experience symptom distress, including anxiety, because of the disease and its treatment. Parents experience stress and anxiety because of the uncertainty of the disease as well as the suffering of their children. Yoga is a complementary intervention that has physiological and psychological benefits in healthy children and healthy and chronically ill adults. On an inpatient hematology/oncology unit, 11 children aged 6 to 12 years, 5 adolescents aged 13 to 18 years, and 33 parents participated in a single yoga session tailored to the needs and abilities of the patients and parents. Sense of well-being pre- and postclass was measured with the Spielberger State Anxiety Scale. Children had normal anxiety scores preclass that did not change. Adolescents and parents experienced significant decreases in anxiety scores, and all cohorts gave positive feedback about the experience. The authors conclude that yoga is a feasible intervention for this population and is beneficial to adolescents and parents.
Collapse
Affiliation(s)
- Megan V. Thygeson
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA,
| | - Mary C. Hooke
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | | | - Angela Robbins
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Kristin Moquist
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
37
|
Linder L. Analysis of the UCSF Symptom Management Theory: implications for pediatric oncology nursing. J Pediatr Oncol Nurs 2010; 27:316-24. [PMID: 20639345 DOI: 10.1177/1043454210368532] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Symptom management research is a priority for both children and adults with cancer. The UCSF Symptom Management Theory (SMT) is a middle range theory depicting symptom management as a multidimensional process. A theory analysis using the process described by Walker and Avant evaluated the SMT with attention to application in research involving children with cancer. Application of the SMT in studies involving children has been limited to descriptive studies testing only portions of the theory. Findings of these studies have provided empiric support for the relationships proposed within the SMT. Considerations for future research involving children include attention to measurement of symptoms and clarity regarding the location of the parents and family within the model. With additional testing and refinement, the SMT has the potential to guide nursing research and practice to improve symptoms for children with cancer.
Collapse
Affiliation(s)
- Lauri Linder
- University of Utah, Salt Lake City, UT 84112, USA.
| |
Collapse
|
38
|
Evaluating cancer related fatigue during treatment according to children's, adolescents' and parents' perspectives in a sample of Greek young patients. Eur J Oncol Nurs 2009; 13:399-408. [DOI: 10.1016/j.ejon.2009.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 06/12/2009] [Accepted: 06/12/2009] [Indexed: 11/23/2022]
|
39
|
Vatne TM, Slaugther L, Ruland CM. How children with cancer communicate and think about symptoms. J Pediatr Oncol Nurs 2009; 27:24-32. [PMID: 19833978 DOI: 10.1177/1043454209349358] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND For clinicians to effectively help children with their illness and symptoms, it is important to communicate with them in a language they can understand. METHODS This study investigates how well children with cancer and healthy children understood 44 symptom terms; their thoughts about these symptoms in terms of causes, consequences, and cures; and what other terms the children use to express these symptoms. It also explores if there are differences in understanding and thoughts about symptoms between children who have the experience of cancer and those who do not. In all, 6 children with cancer and 8 healthy children participated in semistructured interviews. RESULTS Children demonstrated a good understanding of symptom terms, yet were not always able to explain the symptoms. They had a rich vocabulary to talk about symptoms but did not use childish terms. Children with cancer had a more varied vocabulary for symptoms, but they did not use more medical terms. This study contributes to knowledge about children's understanding of symptoms that can be helpful to clinicians when communicating with children about their illness.
Collapse
|
40
|
Wu M, Hsu L, Zhang B, Shen N, Lu H, Li S. The experiences of cancer-related fatigue among Chinese children with leukaemia: a phenomenological study. Int J Nurs Stud 2009; 47:49-59. [PMID: 19709657 DOI: 10.1016/j.ijnurstu.2009.05.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 04/08/2009] [Accepted: 05/23/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although cancer-related fatigue has been given priority status for study in Western countries, unfortunately, it has not received enough attention in China. Based on a different cultural perspective, qualitative study regarding cancer-related fatigue in China can provide a cultural context for enriching the system of knowledge about fatigue. OBJECTIVES To explore the real-life experiences of fatigue from the perspectives of Chinese Children with leukaemia. DESIGN A phenomenological study. SETTING A paediatric haematology oncology department of a regional tertiary children's hospital in Shanghai, China. PARTICIPANTS A total of 14 children and adolescents with leukaemia, aged 7-18 years old, without known psychiatric or developmental disorders, was selected by purposive sampling. METHODS Four focus group interviews were conducted with nine open-ended, semi-structured questions. FINDINGS Cancer-related fatigue is a common and distressing issue for Chinese children and adolescents with leukaemia. Three themes were finally generated: 'fatigue is an open interpretation among children and adolescents', 'fatigue is not a single-dimensional aspect', and 'struggles with fatigue and balancing life suffering'. Fatigue, which is closely related to physical, psychological and situational factors, has negative affects on the participants physically, psychologically and on their cognitive well-being, and can impact the family, school and social interaction of children with leukaemia. CONCLUSIONS Children and adolescents could easily distinguish cancer-related fatigue from normal fatigue. The participants' message to health professionals is that fatigue is a multidimensional and multifactorial symptom that should be comprehensively understood and managed. The findings provide insight and direction for clinical practice and research regarding intervention development and education plans for cancer-related fatigue for paediatric oncology patients.
Collapse
Affiliation(s)
- Meisi Wu
- Shanghai Children's Medical Center, Shanghai, China
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
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.
Collapse
|
42
|
Abstract
AIM This paper is a report of a concept analysis of fatigue in children with long-term conditions. BACKGROUND There is little research focused on the experience of fatigue in children. Previous work has focused primarily on children living with cancer. It is necessary to clarify and refine the concept, and add to the knowledge base that supports ongoing theoretical work in order to improve the clinical care of children with long-term conditions who experience fatigue. METHOD English language literature published from 1989 to 2007 was searched using the CINAHL, Medline and PsychINFO data bases. Sixty-two papers and two book chapters were used in this concept analysis. Rodgers' method of evolutionary concept analysis was used. This inductive method helps us to view the concept in a sociocultural and temporal context. FINDINGS The number of publications focusing on fatigue in children is increasing. The analysis yielded two surrogate terms, five attributes, three antecedents and seven consequences. Based on this analysis, fatigue in children with long-term conditions appears to be a subjective experience of tiredness or exhaustion that is multidimensional and includes physical, mental, and emotional aspects. CONCLUSIONS Evidence suggesting children with long-term conditions experience fatigue is increasing, but conceptual gaps remain. This analysis has yielded a view of fatigue in children that illustrates healthcare professionals' limited yet growing awareness of the symptom. Ongoing study as a means to refine our understanding of the concept could potentially lead to important contributions to clinical care of children with long-term conditions.
Collapse
Affiliation(s)
- Margaret McCabe
- School of Nursing, Children's Hospital Boston, Massachusetts, USA.
| |
Collapse
|
43
|
Ruland CM, Hamilton GA, Schjødt-Osmo B. The complexity of symptoms and problems experienced in children with cancer: a review of the literature. J Pain Symptom Manage 2009; 37:403-18. [PMID: 18694633 DOI: 10.1016/j.jpainsymman.2008.03.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 12/21/2007] [Accepted: 03/08/2008] [Indexed: 10/21/2022]
Abstract
To adequately help children with cancer, care providers need to understand the complexity of symptoms and problems associated with the illness that children are experiencing, which can enable them to better tailor patient care individually to each child. In this integrative literature review, we identified the types of symptoms and problems that children with cancer can experience during treatment and rehabilitation; the terms/expressions they use to describe their symptoms and problems; how children's symptoms and problems vary during the course of their illness; and how they vary and co-vary with age, gender or race. Of the 1175 titles identified, 110 articles met the inclusion criteria and were included in the review. Seventy-eight were research-based. A total of 219 distinct symptoms or problems were identified in the literature either as the main problem or a symptom of the main problem. There is significant evidence that children and adolescents experience numerous and complex symptoms, and problems during and after treatment for cancer. Children use many different expressions to talk about their symptom experiences. However, few articles looked at how children's symptoms and problems varied during the course of their illness or the variations in symptom severity and degree of bother, or examined the relationship between children's symptom experience and age, gender, or race. Most instruments that were used to measure symptoms were interviewer-administered questionnaires, often adaptations from adult versions, and in younger children, symptoms were often obtained from adult informants. The insights gained from this review can be helpful to researchers and clinicians who wish to better understand how symptoms and problems are experienced from the children's own perspective. However, more research is needed: to better understand differences in symptom experiences among different age groups; to identify differences among children from distinct cultural, ethnic, or socio-economic backgrounds; to clarify how symptoms and problems interfere with daily life; and to refine assessment methods that allow even younger children to communicate their symptom experiences in an age-adjusted manner.
Collapse
Affiliation(s)
- Cornelia M Ruland
- Center for Shared Decision Making and Nursing Research, Rikshospitalet University Hospital, Oslo, Norway.
| | | | | |
Collapse
|
44
|
Post-White J, Fitzgerald M, Savik K, Hooke MC, Hannahan AB, Sencer SF. Massage therapy for children with cancer. J Pediatr Oncol Nurs 2008; 26:16-28. [PMID: 19074355 DOI: 10.1177/1043454208323295] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This pilot study aimed to determine the feasibility of providing massage to children with cancer to reduce symptoms in children and anxiety in parents. Twenty-three children/parent dyads were enrolled; 17 completed all data points. Children with cancer, ages 1 to 18 years, received at least 2 identical cycles of chemotherapy, and one parent, participated in the 2-period crossover design in which 4 weekly massage sessions alternated with 4 weekly quiet-time control sessions. Changes in relaxation (heart and respiratory rates, blood pressure, and salivary cortisol level) and symptoms (pain, nausea, anxiety, and fatigue) were assessed in children; anxiety and fatigue were measured in parents. Massage was more effective than quiet time at reducing heart rate in children, anxiety in children less than age 14 years, and parent anxiety. There were no significant changes in blood pressure, cortisol, pain, nausea, or fatigue. Children reported that massage helped them feel better, lessened their anxiety and worries, and had longer lasting effects than quiet time. Massage in children with cancer is feasible and appears to decrease anxiety in parents and younger children.
Collapse
Affiliation(s)
- Janice Post-White
- University of Minnesota School of Nursing, 707 Kenwood Parkway, Minneapolis, MN 55403, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Perdikaris P, Merkouris A, Patiraki E, Papadatou D, Vasilatou-Kosmidis H, Matziou V. Changes in children's fatigue during the course of treatment for paediatric cancer. Int Nurs Rev 2008; 55:412-9. [DOI: 10.1111/j.1466-7657.2008.00644.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Abstract
Symptoms experienced by patients with cancer can occur as a direct effect of the disease process and be related to side effects of treatment. Many patients with cancer also are older in age and have comorbidities, such as diabetes and heart disease. Comorbid conditions also produce disease and treatment-related symptoms that may have an independent or compounding effect on cancer-related symptoms.
Collapse
|
47
|
Assessing cancer symptoms in adolescents with cancer using the Taiwanese version of the M. D. Anderson Symptom Inventory. Cancer Nurs 2008; 31:E9-16. [PMID: 18453871 DOI: 10.1097/01.ncc.0000305728.50098.51] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The purpose of this study was to evaluate the validity and reliability of the Taiwanese version of the M. D. Anderson Symptom Inventory (MDASI-T) in Taiwanese adolescent cancer patients. One hundred eight adolescent cancer patients were interviewed using the MDASI-T, and the results were then used to establish the psychometric properties of this instrument. Data were analyzed by factor analysis, cluster analysis, Pearson correlation, Mann-Whitney U test, and descriptive statistics. The construct validity was determined using a confirmatory factor analysis with oblimin rotation. The concurrent validity demonstrated moderate correlations between the MADSI-T subscale scores and the Medical Outcome Study 36-Item Short-Form Health Survey. Known-group validity was established by comparing MDASI-T scores between adolescent cancer patients with a low functional status and those with a high functional status (Karnofsky Performance Status scores <or= 80 and >80, respectively). The alpha coefficient of the symptoms severity and interference subscales demonstrated good internal consistency. There was acceptable test-retest stability of the MDASI-T in 35 adolescents during a 3-day interval. This study provides evidence that the MDASI-T is a reliable and valid instrument for measuring cancer-related symptoms in Taiwanese adolescents with cancer.
Collapse
|
48
|
|
49
|
Whitsett SF, Gudmundsdottir M, Davies B, McCarthy P, Friedman D. Chemotherapy-Related Fatigue in Childhood Cancer: Correlates, Consequences, and Coping Strategies. J Pediatr Oncol Nurs 2008; 25:86-96. [DOI: 10.1177/1043454208315546] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The aim of this research is to examine the experience and impact of chemotherapy-related fatigue in recently diagnosed pediatric oncology patients. A repeated-measures, within-subjects, mixed (quantitative plus qualitative) design was used to prospectively assess fatigue during early chemotherapy cycles and to compare fatigue to depressive symptoms. Parental interviews collected concurrently were analyzed for descriptions of the child's fatigue and mood states and for strategies to cope with fatigue. Results indicated a significant correlation between fatigue and depression, but qualitative analyses suggested that the 2 phenomena may be unique and distinguishable. Qualitative analyses of parent interviews also identified specific strategies that were frequently used in response to high levels of fatigue. The findings illustrate the significant impact of chemotherapy-related fatigue in children being treated for cancer. The study also provides guidance for the assessment of fatigue and related symptoms and identifies specific strategies for coping with fatigue.
Collapse
Affiliation(s)
- Stan F. Whitsett
- Department of Pediatrics (MCHK-PED), Tripler Army Medical Center, Honolulu, Hawaii,
| | - Maria Gudmundsdottir
- Department of Family Health Care Nursing, University of California, San Francisco
| | - Betty Davies
- Acute Care Pediatric Nurse Practitioner Program, Department of Family Health Care Nursing, University of California, San Francisco
| | - Patricia McCarthy
- Pediatric Oncology Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Debra Friedman
- Survivorship Program of the Fred Hutchinson Cancer Research Center
| |
Collapse
|
50
|
Enskär K, von Essen L. Prevalence of aspects of distress, coping, support and care among adolescents and young adults undergoing and being off cancer treatment. Eur J Oncol Nurs 2007; 11:400-8. [PMID: 17825621 DOI: 10.1016/j.ejon.2007.01.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 01/11/2007] [Accepted: 01/16/2007] [Indexed: 11/21/2022]
Abstract
The overall aim is to describe the prevalence of physical and psychosocial distress, coping, support and care among adolescents and young adults who are both undergoing and off cancer treatment, and who find life satisfying or less satisfying. Prevalence of distress, coping, support and care were investigated using the Life Situation Scale for Adolescents (LSS-A) answered by 15 adolescents and young adults undergoing cancer treatment and 39 adolescents and young adults off cancer treatment. More adolescents and young adults receiving treatment reported problems with fatigue, eating, hair loss, taking medications/tablets and having to plan everything according to hospital visits than those adolescents and young adults off treatment. Fewer adolescents and young adults who reported finding life satisfying reported problems with fatigue, eating, not having any influence on their own life, often being sad and problems with school/work than those finding life less satisfying. Whether adolescents and young adults find life satisfying or not is not related to whether they are undergoing or off cancer treatment. The findings indicate the importance for those working with adolescent cancer victims to be alert of the fact that the treatment period is connected with more problems related to physical distress than the period after treatment, whereas aspects of psychosocial distress are as prevalent during the treatment period as they are after.
Collapse
Affiliation(s)
- Karin Enskär
- Department of Nursing Science, School of Health Sciences, Jönköping University, P.O. Box 1026, S-551 11 Jönköping, Sweden.
| | | |
Collapse
|