Remote Ischemic Conditioning in Pediatric Cancer Patients Receiving Anthracycline Chemotherapy: A Sham-Controlled Single-Blind Randomized Trial.

Background: Anthracycline cardiotoxicity is a concern in survivors of childhood cancers. Recent evidence suggests that remote ischemic conditioning (RIC) may offer myocardial protection. Objectives: This randomized sham-controlled single-blind study tested the hypothesis that RIC may reduce myocardial injury in pediatric cancer patients receiving anthracycline chemotherapy. Methods: We performed a phase 2 sham-controlled single-blind randomized controlled trial to determine the impact of RIC on myocardial injury in pediatric cancer patients receiving anthracycline-based chemotherapy. Patients were randomized to receive RIC (3 cycles of 5-minute inflation of a blood pressure cuff placed over 1 limb to 15 mm Hg above systolic pressure) or sham intervention. The intervention was applied within 60 minutes before initiation of the first dose and before up to 4 cycles of anthracycline therapy. The primary outcome was the plasma high-sensitivity cardiac troponin T (hs-cTnT) level. The secondary outcome measures included echocardiographic indexes of left ventricular systolic and diastolic function and the occurrence of cardiovascular events. Results: A total of 68 children 10.9 ± 3.9 years of age were randomized to receive RIC (n = 34) or sham (n = 34) intervention. Plasma levels of hs-cTnT showed a progressive increase across time points in the RIC (P < 0.001) and sham (P < 0.001) groups. At each of the time points, there were no significant differences in hs-cTnT levels or LV tissue Doppler and strain parameters between the 2 groups (all P > 0.05). None of the patients developed heart failure or cardiac arrhythmias. Conclusions: RIC did not exhibit cardioprotective effects in childhood cancer patients receiving anthracycline-based chemotherapy. (Remote Ischaemic Preconditioning in Childhood Cancer [RIPC]; NCT03166813).

Systematic Review of the Effectiveness of Complementary and Alternative Medicine on Nausea and Vomiting in Children With Cancer.

BACKGROUND: Nausea and vomiting are distressing symptoms reported by pediatric oncology patients during cancer treatment. More than 40% of them experience these symptoms even after receiving antiemetics. OBJECTIVE: Given the limitations of pharmacological interventions, this systematic review synthesized the evidence for the effectiveness of complementary and alternative medicine in controlling nausea and vomiting among pediatric oncology patients. METHODS: Ten databases were searched to identify relevant randomized controlled trials. The risk of bias of selected studies was graded using the Cochrane risk-of-bias tool for randomized trials. The primary outcomes were nausea and vomiting. The secondary outcomes were intervention adherence and number of adverse events. RESULTS: Nineteen papers met the inclusion criteria and were included in the review. Sixteen studies showed high risk of bias. The tested interventions were acupuncture, acupressure, aromatherapy, hypnosis, massage, active cognitive distraction/relaxation techniques, creative arts therapy, psychoeducation, and combined massage and acupressure. Acupuncture, hypnosis, and massage interventions improved nausea and vomiting. Fifteen trials reported intervention adherence; only 7 monitored adverse events. The most common reason for dropout was refusal from patients and/or their guardians. A total of 34 adverse events were noted. CONCLUSIONS: There is insufficient evidence that complementary and alternative medicine is effective, feasible, or safe in controlling nausea and vomiting among pediatric oncology patients due to high risk of bias. IMPLICATIONS FOR PRACTICE: Acupuncture, hypnosis, and massage appear to have therapeutic benefits. However, more robust studies are needed to address the identified methodological issues and determine the real value of these 3 interventions.

Comparing the Impact of Cancer and Treatment-Related Effects on Psychological Well-being and Quality of Life Between Hong Kong Survivors of Childhood Solid Tumors and Leukemia.

BACKGROUND: Evidence shows that survivors of solid tumors have a lower survival rate and shorter disease-free survival time than survivors of leukemia. However, the psychological well-being and health-related quality of life (HRQOL) of these 2 groups of cancer survivors have not been compared. OBJECTIVE: To examine and compare the impact of cancer and treatment-related effects on psychological well-being and HRQOL between survivors of childhood solid tumors and leukemia. METHODS: We conducted a cross-sectional study involving 65 Hong Kong survivors of solid tumors and 70 survivors of leukemia aged 8 to 18 years who had their medical follow-up in a pediatric outpatient clinic. Participants' depressive symptoms, self-esteem, and HRQOL were assessed. Twenty-two survivors of childhood solid tumors and 15 survivors of childhood leukemia were then selected for semistructured interviews. RESULTS: Survivors of childhood solid tumors reported significantly higher mean scores for depressive symptoms, and lower mean self-esteem and HRQOL scores than survivors of childhood leukemia. Qualitative data revealed that survivors of childhood solid tumors faced more challenges in their daily life than survivors of childhood leukemia. CONCLUSIONS: Survivors of childhood solid tumors reported poorer psychological well-being and HRQOL than survivors of childhood leukemia. This vulnerable group warrants more attention and support. IMPLICATIONS FOR PRACTICE: It is vital for healthcare professionals to understand the impact of cancer and treatment-related effects in the context of different types of cancer. This will facilitate development and evaluation of appropriate psychological interventions to promote psychological well-being and HRQOL among childhood cancer survivors.

Systematic review of the effectiveness of complementary and alternative medicine on nausea and vomiting in children with cancer: a study protocol.

INTRODUCTION: Nausea and vomiting are two most common symptoms reported by children with cancer when they undergo active treatment. However, pharmacological treatment is not sufficient to manage these two symptoms, with over 40% of children still experience nausea and vomiting after receiving antiemetics. There has been an exponential growth of studies to demonstrate the effectiveness of different complementary complementary medicine (CAM) to control nausea and vomiting during cancer treatment. Appropriate application of CAM enhances the effectiveness of antiemetics, thus reducing the symptom burden on children as well as improving their general condition and quality of life during cancer treatment. Nevertheless, it remains unclear which CAM is the best approach to help children to prevent or reduce nausea and vomiting during and after cancer treatment. This paper describes a protocol for identifying, analysing and synthesising research evidence on the effectiveness of CAM on nausea and vomiting in children with cancer. METHODS AND ANALYSIS: A total of 10 databases will be searched to identify appropriate literature: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CINAHL, PsycINFO, LILACS, OpenSIGLE, the Chinese Biomedical Literature Database, the Chinese Medical Current Contents and the Chinese National Knowledge Infrastructure. All randomised controlled trials which meet the inclusion criteria will be included. The primary outcome is the changes in nausea and vomiting either assessed by self-reported and/or objective measures. Review Manager 5.3 will be used to synthesise the data, calculate the treatment effects, perform any subgroup analysis and assess the risk of bias. ETHICAL AND DISSEMINATION: The results will be presented at international conferences and published in peer-reviewed journals. As no individual data will be involved in this review, ethical approval is not required. PROSPERO REGISTRATION NUMBER: CRD42019135404.

The Impact of Hematologic Cancer and Its Treatment on Physical Activity Level and Quality of Life Among Children in Mainland China: A Descriptive Study.

BACKGROUND: The effects of hematologic cancer and its treatment on Chinese children's physical activity level and quality of life (QoL) remain unclear despite numerous studies conducted in Western countries and Hong Kong. OBJECTIVE: The aim of this study was to examine the effects of hematologic cancer and its treatment on the physical activity level and QoL among Chinese children. METHODS: A cross-sectional study was conducted. One hundred twenty-five children who were admitted for treatment of hematologic cancer and 243 healthy counterparts of similar age participated in this study. All participants were asked to complete the Chinese University of Hong Kong: Physical Activity Rating for Children and Youth and Pediatric Quality of Life Inventory. The children with hematologic cancer also completed a therapy-related symptom checklist. RESULTS: There were statistically significant differences in the mean physical activity and QoL between children with hematologic cancer and their healthy counterparts. Multiple regression analyses showed that physical activity levels and the adverse effects of hematologic cancer treatment had statistically significant effects on the children's QoL. CONCLUSIONS: Physical activity level and QoL in children with hematologic cancer were both lower than those in their healthy counterparts. IMPLICATIONS FOR PRACTICE: This study provides further evidence that hematologic cancer and the adverse effects of its treatment have negative effects on Chinese children's QoL. Although a lack of physical activity is deeply embedded in Chinese culture, nurses should take a proactive role in effecting change by educating parents about the benefits to their children's physiologic and psychological well-being of physical activity during and after treatment.

Efficacy of musical training on psychological outcomes and quality of life in Chinese pediatric brain tumor survivors.

BACKGROUND: Evidence has shown that survivors of pediatric brain tumors have more negative psychological sequela, particularly depression, than do survivors of other childhood cancers. This study examined the efficacy of a musical training program in reducing depressive symptoms and enhancing self-esteem and quality of life in Hong Kong Chinese pediatric brain tumor survivors. METHODS: A prospective randomized controlled trial, two-group pretest and repeated posttest, between-subjects design was conducted to 60 pediatric brain tumor survivors (8-5 years old). Participants in the experimental group received a weekly 45-min lesson on musical training for 52 weeks. Participants in the control group received a placebo intervention. The primary outcome was depressive symptoms at 12 months. Secondary outcomes were self-esteem and quality of life at 12 months. Data were collected at baseline and 6 and 12 months after the intervention began. RESULTS: Participants in the experimental group reported statistically significant fewer depressive symptoms (P < 0.001), higher levels of self-esteem (P < 0.001), and better quality of life (P < 0.001) than the control group at 12-month follow-up. CONCLUSIONS: This study provides evidence that musical training is effective in reducing depressive symptoms and enhancing self-esteem and quality of life in Hong Kong Chinese pediatric brain tumor survivors. These results indicate that musical training is not only a leisure activity but also carries therapeutic effects in promoting psychological well-being and quality of life in pediatric brain tumor survivors.

The Psychometric Properties of the Chinese Version of the Fatigue Scale for Children.

BACKGROUND: The availability of a valid and reliable instrument that accurately assesses the level of fatigue among childhood cancer survivors is a prerequisite for developing and evaluating interventions designed to reduce fatigue. There is a lack of such an instrument for use in the Hong Kong Chinese context. OBJECTIVE: The aim of the study was to examine the psychometric properties of the Chinese version of the Fatigue Scale for Children. In particular, confirmatory factor analysis was conducted to examine its factorial structure. METHODS: A convenience sample of 200 Hong Kong Chinese children surviving cancer was recruited in an outpatient clinic. The psychometric properties of the Chinese version of the Fatigue Scale for Children were assessed. RESULTS: The content validity index was 0.83. There was a strong positive correlation between children's level of fatigue and depressive symptoms (r = 0.53) and a strong negative correlation between children's levels of fatigue and quality of life (r = -0.54). The mean levels of fatigue of the survivor group were significantly lower than those of those hospitalized with cancer, but significantly higher than those of their healthy counterparts. Confirmatory factor analysis indicated that there were 3 factors underlying the Chinese version of the Fatigue Scale for Children. CONCLUSION: The study adds further evidence that the Chinese version of the Fatigue Scale for Children can be used as a reliable and valid tool in assessing cancer-related fatigue among Chinese children who have survived cancer. IMPLICATIONS FOR PRACTICE: The translated scale can be used to develop and evaluate appropriate fatigue reduction interventions.

Effective Prevention and Management of Tumor Lysis Syndrome in Children With Cancer: The Important Contributions of Pediatric Oncology Nurses.

The practice guidelines aimed to identify appropriate nursing management for the prevention and treatment of tumor lysis syndrome, in line with the current evidence-based medical guidelines. Using a systematic approach, 15 relevant articles were identified for the review. The evaluation of patient risk factors for tumor lysis syndrome and the appropriate medical and nursing assessment were identified. The treatment algorithms for the prevention of tumor lysis syndrome from both the medical and nursing perspectives have been established. In particular, the guidelines highlight the importance of pediatric oncology nurses in contributing to the prevention and management of tumor lysis syndrome.

Sustainability of an Integrated Adventure-Based Training and Health Education Program to Enhance Quality of Life Among Chinese Childhood Cancer Survivors: A Randomized Controlled Trial.

BACKGROUND: Physical activity is of paramount importance to enhance the quality of life of childhood cancer survivors. OBJECTIVE: The objectives of this study were to examine the sustainability, feasibility, and acceptability of an adventure-based training and health education program in changing the exercise behavior and enhancing the physical activity levels, self-efficacy, and quality of life of childhood cancer survivors. METHODS: A follow-up study (12 and 18 months) of a previous study was conducted. Participants in the experimental group (n = 33) joined a 4-day integrated adventure-based training and health education program. The control group (n = 36) received the standard medical care. Changes in exercise behavior, levels of physical activity, self-efficacy, and quality of life were assessed from the time of recruitment, and at 12 and 18 months after starting the intervention. Process evaluation was conducted to determine whether the program was feasible and acceptable to participants. RESULTS: From baseline to 18 months after the intervention, the experimental group reported statistically significant differences in the stages of change in physical activity and higher levels of physical activity, self-efficacy, and quality of life than did the control group. The results of process evaluation revealed that the program was both feasible and acceptable to participants. CONCLUSIONS: The program was found to have substantial effects on enhancing the physical activity levels, self-efficacy, and quality of life of childhood cancer survivors over at least 18 months. IMPLICATIONS FOR PRACTICE: Healthcare professionals should consider adopting such programs to promote the regular physical activity among childhood cancer survivors.

The impact of cancer and its treatment on physical activity levels and behavior in Hong Kong Chinese childhood cancer survivors.

BACKGROUND: Research indicates that regular physical activity is associated with numerous physiological and psychological health benefits for childhood cancer survivors. A review of the literature reveals that no study has so far examined the physical activity levels and behavior of Hong Kong Chinese childhood cancer survivors, and how the cancer and its treatment affect the physical activity and other behavior of these children remains unclear. OBJECTIVE: The aims of this study were to assess the physical activity levels of Hong Kong Chinese childhood cancer survivors and to explore the factors that affect their adherence to and maintenance of regular physical activity. METHODS: A cross-sectional study was used. A total of 128 childhood cancer survivors (9-16-year-olds) who underwent medical follow-up in the outpatient clinic were invited to participate in the study. RESULTS: There was a significant decline in physical activity levels among childhood cancer survivors. Most of them did not take physical exercise regularly. Concern about academic performance, fatigue, and a decrease in physical strength and endurance after remission prevented them from engaging in regular physical activity. CONCLUSIONS: This study indicates that many childhood cancer survivors did not engage in regular physical activity and that they overlooked or underestimated its importance. IMPLICATIONS FOR PRACTICE: It is essential for nurses to correct misconceptions about physical activity among childhood cancer survivors and their parents and, most importantly, to advocate the principle of regular physical activity for these children, with the aim of enhancing their physical and psychological well-being.

Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors.

BACKGROUND: There is growing concern about declining levels of physical activity in childhood cancer survivors. This study aimed to examine the effectiveness of an integrated adventure-based training and health education program in promoting changes in exercise behavior and enhancing the physical activity levels, self-efficacy, and quality of life of Hong Kong Chinese childhood cancer survivors. METHODS: A randomized controlled trial, two-group pretest and repeated post-test, between-subjects design was conducted to 71 childhood cancer survivors (9- to 16-year-olds). Participants in the experimental group joined a 4-day integrated adventure-based training and health education program. Control group participants received the same amount of time and attention as the experimental group but not in such a way as to have any specific effect on the outcome measures. Participants' exercise behavior changes, levels of physical activity, self-efficacy, and quality of life were assessed at the time of recruitment, 3, 6, and 9 months after starting the intervention. RESULTS: Participants in the experimental group reported statistically significant differences in physical activity stages of change (p < 0.001), higher levels of physical activity (p < 0.001) and self-efficacy (p = 0.04) than those in the control group. Besides, there were statistically significant mean differences (p < 0.001) in physical activity levels (-2.6), self-efficacy (-2.0), and quality of life (-4.3) of participants in the experimental group from baseline to 9 months after starting the intervention. CONCLUSIONS: The integrated adventure-based training and health education program was found to be

Confirmatory factor analysis of the Chinese version of the Pediatric Quality-of-Life Inventory Cancer Module.

BACKGROUND: Before the Chinese version of the Pediatric Quality-of-Life Inventory Cancer Module can be used to assess the multidimensional construct of quality of life among Hong Kong Chinese pediatric patients with cancer, its psychometric properties need to be further empirically tested. OBJECTIVE: The objectives of the study were to establish the construct validity, including hypothesis testing and a confirmatory factor analysis of factor structure, of the Chinese version of the Pediatric Quality-of-Life Inventory Cancer Module. METHODS: A cross-sectional study was used; 200 children hospitalized with cancer (9- to 16-year-olds) were recruited. Participants were asked to respond to the Chinese version of the Cancer Module, Therapy-Related Symptom Checklist, and Rosenberg's Self-esteem Scale. RESULTS: The results showed that there was a strong positive correlation between children's self-esteem and quality of life (r = 0.50) and a strong negative correlation between children's therapy-related symptoms and quality of life (r = -0.65). Confirmatory factor analysis indicated that there were 7 factors underlying the Chinese version of the Cancer Module. CONCLUSION: The study added further evidence of the construct validity of the Chinese version of the Cancer Module, patient version. IMPLICATION FOR PRACTICE: The Cancer Module can be used to assess and evaluate psychological interventions directed toward promoting the quality of life of children hospitalized with cancer.

Relationships among therapy-related symptoms, depressive symptoms, and quality of life in Chinese children hospitalized with cancer: an exploratory study.

BACKGROUND: Recent advances in cancer screening and treatment have resulted in a decrease in mortality rates in children and adolescents. However, despite the improved prognosis, the course of cancer treatment continues to be a very stressful experience in the life of a child. OBJECTIVES: The objectives of the study were to assess the occurrence and severity of treatment-related symptoms manifested by children and adolescents undergoing active cancer treatment and to examine the relationships between therapy-related symptoms, depressive symptoms, and quality of life of these pediatric patients. METHODS: A cross-sectional study design was used, and 135 Hong Kong Chinese children (9- to 16-year-olds) who were admitted for treatment of cancer in a pediatric oncology unit were invited to participate in the study. RESULTS: Results indicated that children and adolescents receiving combined cancer treatment generally experienced greater symptom occurrence and severity. In addition, children reporting greater symptom occurrence and severity experienced higher levels of depression and a lower level of quality of life. The study revealed that therapy-related symptoms are a strong predictor of quality of life of children and adolescents hospitalized for cancer treatment. CONCLUSIONS: Cancer and its treatments significantly affect the psychosocial well-being and quality of life of children and adolescent hospitalized for cancer care. Therapy-related symptoms can be a useful indicator for screening those pediatric patients who are likely to exhibit psychosocial distress or are at high risk of depression. IMPLICATIONS FOR PRACTICE: It is essential for nurses to be sensitive and knowledgeable about the therapy-related symptoms of cancer treatment and their effects on children and adolescents to promote the psychosocial well-being of these patients and enhance their quality of life.

Predisposing factors to the quality of life of childhood cancer survivors.

The aim of this study was to examine the predisposing factors to the quality of life of Hong Kong Chinese childhood cancer survivors. A cross-sectional study was conducted with 153 survivors (9-16 years of age) during follow-up at the oncology outpatient clinic. The study found that depressive symptoms are a strong predictor of quality of life in childhood cancer survivors and that systematic screening of this population is important. It is essential for health care professionals to develop, plan, and evaluate interventions with the aim of alleviating depressive symptoms for childhood cancer survivors so as to enhance their quality of life.

A descriptive study of the psychosocial well-being and quality of life of childhood cancer survivors in Hong Kong.

BACKGROUND: Research indicates that increased survival rates are accompanied by an increase in associated psychosocial problems. Whereas much of the attention has focused on the physiological care of childhood cancer survivors, the consequences of cancer and its treatments on psychosocial well-being and quality of life remain relatively underexplored. OBJECTIVE: The aim of this study was to describe the psychosocial well-being and quality of life of Hong Kong Chinese childhood cancer survivors. METHODS: A cross-sectional study was used. A total of 137 childhood cancer survivors (9- to 16-year olds) who underwent medical follow-up in the outpatient clinic were invited to participate in the study. RESULTS: A significant number of childhood cancer survivors had low self-esteem and experienced high levels of depression. The study also indicated that greater symptoms of depression in childhood cancer survivors were associated with higher state anxiety, lower self-esteem, and poor quality of life. CONCLUSIONS: Cancer and its treatments can have adverse effects on the psychosocial well-being and quality of life of survivors. IMPLICATIONS FOR PRACTICE: It is essential for nurses to develop and evaluate interventions with the aim of promoting psychosocial well-being and quality of life for childhood cancer survivors. Knowing the self-esteem and coping behavior of survivors can help design appropriate and effective psychosocial interventions to promote their psychosocial well-being.

Effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of Hong Kong Chinese children hospitalized with cancer.

PURPOSE. To examine the effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of children hospitalized with cancer. DESIGN AND METHODS. A nonequivalent control group design was employed. Children (8-16 years of age; n= 122) admitted to a pediatric oncology ward during a 14-month period were recruited. RESULTS. The results support the effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of children hospitalized with cancer. PRACTICE IMPLICATIONS. The results heighten the awareness in nurses of the importance of integrating play activities as an essential component of holistic and quality nursing care.

Coping strategies used by children hospitalized with cancer: an exploratory study.

OBJECTIVES: The treatment of cancer is a stressful and threatening experience, particularly for children. Knowing how children cope with cancer is a crucial step toward designing appropriate psychological interventions that help them ease the burden of cancer treatment. The purpose of this study was to examine the coping strategies used by Chinese children hospitalized with cancer, an area of research that is under-represented in the existing literature. METHODS: Hong Kong Chinese children (9-16-year olds) admitted for cancer treatment to the pediatric oncology units of two different regional acute public hospitals were invited to participate. A short one-to-one structured interview was conducted with each participant. Content analysis was conducted to analyze the interview data. RESULTS: A convenience sample of 88 children was recruited and participated in the interviews during an 8-month period. The coping strategies used by Chinese children hospitalized with cancer did not differ according to gender and diagnosis, but only according to age, with younger children using less problem-focused and more emotion-focused coping strategies than older children. The overall results indicated that 30% of these Chinese patients used problem-focused coping strategies, while 70% used emotion-focused coping. CONCLUSIONS: Findings from this study indicated that children use different coping strategies at different developmental stages. The study also revealed that Chinese children used more emotion-focused than problem-focused coping strategies than their Western counterparts. The information derived from this study will help health-care professionals design and shape appropriate psychological interventions that can help reduce the burden of cancer treatment. Copyright © 2010 John Wiley & Sons, Ltd.

The impact of cancer on children's physical, emotional, and psychosocial well-being.

The diagnosis and treatment of cancer are a stressful and threatening experience, which can be emotionally devastating to children. Despite the improved prognosis, the course of cancer treatment has tremendous impact on children. This article aims to examine the impact of cancer on physical, emotional, and psychosocial well-being of Hong Kong Chinese children, an area of research that has been underrepresented in the literature. Ninety-eight Hong Kong Chinese children aged 7 to 15 years, admitted for treatment of cancer in 2 pediatric oncology units of 2 different hospitals, were invited to participate in the study. Findings from this study indicated that the children scored considerably high state anxiety on admission, and more than half of the participants presented some depressive symptoms during their stay in the hospital. Moreover, semistructured interviews indicated that nearly all children expressed different degrees of sadness and worry. The findings suggested that there is a room for improvement in existing nursing intervention regarding preparing children for hospitalization and treatment of cancer. There is an imperative need for nurses to evaluate appropriate nursing interventions that can help children resume their normal growth and development, in particular, to help them ease the physical, emotional, and psychological burden of life-threatening disease.