Symptom Clusters in Children With Leukemia Receiving Chemotherapy: A Scoping Review.

BACKGROUND: Leukemia represents the most prevalent childhood malignancy. Understanding the symptom clusters (SCs) associated with leukemia may help develop an effective care plan for affected children. OBJECTIVES: The aims of this study were to summarize the methods of identifying SCs; ascertain the types, attributes, and changing patterns of SCs during different chemotherapy phases; and provide a point of reference for the subsequent improvement of symptom management in pediatric leukemia. METHODS: The methodological framework employed was the Joanna Briggs Institute Scoping Review Guide. A comprehensive search was conducted across various databases, including PubMed, EMBASE, CINAHL, Web of Science, MEDLINE, Scopus, and China National Knowledge Infrastructure from inception until July 15, 2023. RESULTS: A total of 14 articles were included in this review, 6 in English and 8 in Chinese. The Memorial Symptom Assessment Scale 10-18 is the most commonly used instrument, whereas factor analysis is the most common statistical method for SC identification. The SCs were classified into 12 categories. The most severe SCs varied across different phases. Specifically, the emotional cluster dominated the prechemotherapy phase, the gastrointestinal cluster surfaced during postinduction therapy, and the consolidation and maintenance therapy phases revealed the self-image disorder cluster. CONCLUSION: Various consistent and dynamic SCs manifest among pediatric patients with leukemia undergoing chemotherapy. IMPLICATIONS FOR PRACTICE: Future research endeavors should formulate clear criteria to determine the stability and consistency of SCs, validate SC composition and characteristics, and devise precise symptom management protocols based on SC characteristics in the distinct chemotherapy phases.

Parental Postoperative Pain Management Perceptions, Attitudes, and Practices in Pediatric Limb Fractures.

BACKGROUND: Post-surgical pain in children is common, severe, and inadequately controlled. An effective model should involve the participation of parents. AIMS: To investigate parental perceptions, attitudes, and practices in postoperative pain management in children with limb fractures and analyze the factors affecting parental practices. DESIGN: This was a descriptive cross-sectional study. SETTINGS: Research was conducted at a tertiary Children's Hospital Affiliated with Soochow University. PARTICIPANTS: Parents whose children (age, 6-18 years) underwent orthopedic fracture surgery between January 1, 2020, and August 31, 2020, were recruited using purposive sampling. METHODS: The parents were asked to complete self-report questionnaires: "Pain Management Knowledge and Attitudes Questionnaire" and "Parents' Use of Pain Relief Strategies Questionnaire." The Wong-Baker Faces Scale was used to measure pain intensity in children. The Mann-Whitney U test, Kruskal-Wallis H test, and correlation and regression analyses were used for statistical analyses. RESULTS: Data of 180 parents were collected. Of the participants, 80.6%, 78.3%, and 71.7% had low-to-moderate scores for knowledge, general attitudes, and use of pain relief strategies, respectively. Moreover, 93.9% of parents had moderate-to-high scores for negative attitudes toward medication, despite 89.5% of them reporting moderate-to-high pain intensities in their children (median proxy-report of pain intensity, 7.0 [3.00]). Multivariate linear stepwise regression showed that parents' use of pain-relief strategies was related to their general attitudes, knowledge, and sex. CONCLUSIONS: Most parents had low-to-moderate scores for perceptions and general attitudes toward children's postoperative pain management, and use of pain relief strategies. Moreover, they lacked knowledge of and had negative attitudes toward pain assessment and analgesics, which significantly impacted their practices. CLINICAL IMPLICATIONS: Clinical pediatric nurses should provide appropriate support for the entire family of the child. Moreover, to enhance parental practices, they should develop targeted parental education programs for pain management, particularly regarding pain assessment tools and pain medications.

Effects of Child Life intervention on the symptom cluster of pain-anxiety-fatigue-sleep disturbance in children with acute leukemia undergoing chemotherapy.

Objective: This study aims to explore the application effect of Child Life intervention on pain, anxiety, fatigue, and sleep disturbance in children with acute leukemia. Methods: In a single-blinded, parallel-group randomized controlled trial, 96 children with acute leukemia were randomized to either the intervention group, which received Child Life intervention twice a week for 8 weeks, or the control group, which received routine care. Outcomes were evaluated at baseline and day 3 postintervention. Results: All of the participants completed the study. Compared with the control group, the intervention group showed a significant reduction in pain, anxiety, fatigue, and sleep disturbance (P â€‹< â€‹0.001). However, no significant differences were observed in the disorders of excessive somnolence. Conclusions: Child Life intervention can effectively improve pain, anxiety, fatigue, and sleep disturbance in children with acute leukemia undergoing chemotherapy. The results suggest that symptom cluster management intervention based on Child Life provided a promising approach for simultaneously treating multiple symptoms within a cluster.

Stability of Symptom Clusters in Children With Acute Lymphoblastic Leukemia Undergoing Chemotherapy.

BACKGROUND: Children with acute lymphoblastic leukemia (ALL) experience multiple symptoms during chemotherapy. Assessing how symptoms cluster together and how these symptom clusters (SCs) change over time may lay a foundation for future research in SC management and the pathophysiological mechanisms of SCs. OBJECTIVES: This study aimed to assess the stability of SCs in children with ALL during chemotherapy. METHODS: A longitudinal investigation was carried out. The Chinese version of the Memorial Symptom Assessment Scale 10 to 18 was used to assess the occurrence, severity, and distress of symptoms in 134 children with ALL (8-16 years old) at the following 4 separate points: before chemotherapy (T1), start of post-induction therapy (T2), 4 months post-induction therapy (T3), and start of maintenance therapy (T4). Exploratory factor analyses were used to extract SCs. RESULTS: Six SCs were identified. Emotional and somatic clusters were identified across all dimensions and time points. Gastrointestinal cluster was all identified except for occurrence at T1. Neurological cluster was identified at T2 and T3 for all dimensions and at T4 for severity and distress. Self-image disorder cluster was all identified except at T1. Skin mucosa cluster was identified at T2 and T3 for all dimensions. Emotional cluster exhibited common symptoms across dimensions and time points. CONCLUSION: The number and types of SCs determined by scoring the occurrence, severity, and distress are different, but some SCs are relatively stable. IMPLICATIONS FOR PRACTICE: Clinicians should not only focus on the common trajectory of symptoms and SCs, but also assess each child individually.

Correlation Between Symptom Clusters and Quality of Life in Children With Acute Leukemia During Chemotherapy.

BACKGROUND: Children with acute leukemia experience various distressing symptoms due to the disease and its treatment during chemotherapy. These symptoms cluster together and have negative impacts on patient outcomes. OBJECTIVE: The aim of this study was to examine symptom clusters that children with acute leukemia undergoing chemotherapy are experiencing and the impact of these symptom clusters on their quality of life. METHODS: A cross-sectional study design was used, and 184 Chinese children with acute leukemia who were undergoing chemotherapy were invited to participate in the study. Memorial Symptom Assessment Scale 10-18 and Pediatric Quality of Life Inventory General Core Module version 4.0 were applied. Exploratory factor analysis and multiple regression were used to identify symptom clusters and their influence on the quality of life. RESULTS: Six symptom clusters were identified as gastrointestinal, emotional, neurological, skin mucosal, self-image disorder, and somatic cluster. The severity of each symptom cluster was negatively correlated with quality of life. Among them, gastrointestinal, emotional, and somatic clusters were significant predictors of quality of life. CONCLUSIONS: There are multiple symptom clusters in children with acute leukemia, which seriously affect children's quality of life. To relieve symptom burden and improve quality of life, nursing and medical staff should pay attention to the symptom management and control in a symptom cluster perspective. IMPLICATIONS FOR PRACTICE: The results of this study will provide suggestions for the healthcare provider to plan for these symptoms and manage any concurrent symptoms for the successful promotion of children's quality of life.

Symptom Clusters and Influencing Factors in Children With Acute Leukemia During Chemotherapy.

BACKGROUND: Acute leukemia is the most common malignancy in childhood. Identification of symptom clusters and their influencing factors in children with acute leukemia may improve the management of symptoms. OBJECTIVE: The aims of this study were to investigate symptom clusters in children with acute leukemia during chemotherapy and analyze the factors influencing their severity. METHODS: A cross-sectional survey was administered to 159 Chinese children with acute leukemia during chemotherapy. A demographic questionnaire and the Memorial Symptom Assessment Scale 10-18 were completed by the patients and their parents. Exploratory factor analysis was used to identify symptom clusters. Univariate analyses and multiple linear regression analyses were performed to analyze the factors affecting symptom clusters. RESULTS: Six clusters were identified, including gastrointestinal cluster, emotional cluster, head-related cluster, self-image disorder cluster, skin itching/irritation cluster, and somatic cluster. Factors influencing the severity of symptom clusters included age, gender, stage of chemotherapy, and medical reimbursement. CONCLUSIONS: There are multiple symptom clusters in children with acute leukemia during chemotherapy. Medical care staff should manage symptoms from the perspective of symptom cluster and carry out personalized interventions according to factors influencing these clusters. IMPLICATIONS FOR PRACTICE: The ability to predict symptom clusters in children with acute leukemia undergoing chemotherapy may assist with optimal clinical decision making in order to alleviate the symptom burden and improve children's quality of life.