Exploring core symptoms and interrelationships among symptoms in children with acute leukemia during chemotherapy: A network analysis

Changes in Symptom Clusters Over the Course of Chemotherapy in Children With Acute Lymphoblastic Leukemia: A Longitudinal Survey

BACKGROUND

Acute Lymphoblastic Leukemia (ALL) in children is associated with diverse symptoms affecting quality of life and treatment efficacy. This study aimed to evaluate symptom progression in children with ALL to inform targeted interventions.

METHODS

We assessed children with ALL from January 2023 to June 2024 using the Memorial Symptom Assessment Scale for Children (MSAS-C) at different chemotherapy stages.

RESULTS

A total of 102 children were included and they experienced an average of 15.52 symptoms. Initially, three symptom clusters predominated: emotional, gastrointestinal, and somatic. As chemotherapy advanced through induction and consolidation phases, the symptom profile expanded to include neurological, self-image disturbance, and skin and mucosal symptoms. During the maintenance phase, the clusters were emotional, gastrointestinal, somatic, neurological, and self-image disturbance.

CONCLUSION

Symptom clusters in pediatric ALL patients change dynamically with chemotherapy phases, highlighting the need for meticulous assessment tailored interventions to enhance clinical management and patient care.

Sentinel and Networked Symptoms During Remission Induction Chemotherapy in Acute Lymphoblastic Leukemia Children

BACKGROUND

Children with acute lymphoblastic leukemia experience various adverse symptoms during remission induction. Elucidating the interrelationships among symptoms can facilitate precise and efficacious symptom management.

OBJECTIVE

This study aimed to elucidate symptom clusters and sentinel symptoms and to examine core and bridge symptoms within the symptom network in children with acute lymphoblastic leukemia during remission induction.

METHODS

A cross-sectional survey of 226 children aged 8 to 16 years with a new diagnosis of acute lymphoblastic leukemia during remission induction chemotherapy was conducted using the Chinese version of the Memorial Symptom Assessment Scale 10-18. Symptom clusters and sentinel symptoms were identified using exploratory factor analysis and Apriori algorithm. Core and bridge symptoms were identified using network analysis.

RESULTS

Five symptom clusters and sentinel symptoms were identified: gastrointestinal (constipation as the sentinel symptom), emotional (feeling sad as the sentinel symptom), and somatic (cough as the sentinel symptom); however, the sentinel symptoms of neurological and self-image impairment symptom clusters were not specified. In symptom network, feeling sad and nausea were core symptoms, whereas dizziness and lack of energy were the bridge symptoms.

CONCLUSIONS

The somatic symptom cluster should be prioritized for intervention during remission induction. Network analysis and sentinel symptom analysis must be extended to the symptom research in pediatric cancer to provide a scientific basis for symptom management.

IMPLICATIONS FOR PRACTICE

Nurses should aim to identify and intervene with sentinel and networked symptoms to ensure that children are effectively supported during the remission induction, reducing symptom burden and improving quality of life.

Exploring Symptom Cluster Patterns in Adult Cancer Patients Undergoing Chemotherapy: A Systematic Review

PURPOSE

This systematic review aimed to scrutinize the progression of symptom cluster research in adult cancer patients who received primary or adjuvant chemotherapy between 2001 and 2023, providing a comprehensive understanding of clinical practice and future research.

METHODS

PubMed, Ovid MEDLINE, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Web of Science databases were searched for theme words and free words related to symptom clusters, cancer, and chemotherapy. Eligible studies were published between January 1, 2001, and May 30, 2023; adults who were diagnosed with cancer and received primary or adjuvant chemotherapy were evaluated.

RESULTS

Twenty-nine studies were included in this review. The Memorial Symptom Assessment Scale emerged as the predominant instrument and exploratory factor analysis was the most frequently employed statistical method to identify symptom clusters. Psychological, gastrointestinal, and physical image symptom clusters were the most commonly delineated. Furthermore, the temporal stability of the symptom clusters showed varying dynamics, with psychological symptom clusters displaying relative consistency over time.

CONCLUSION

Interventions are needed for the most common and stable symptoms in patients with cancer undergoing chemotherapy. Future endeavors may necessitate more longitudinal studies to delve deeper into the temporal stability and dynamic variations of symptom clusters. Such investigations hold promise for advancing symptom cluster research, elucidating the underlying mechanisms, and fostering the development of targeted interventions, thereby enriching the symptom management paradigm in oncological care.

Sentinel and networked symptoms in patients with breast cancer undergoing chemotherapy

PURPOSE

It was designed to identify the symptom clusters and sentinel symptoms among patients with breast cancer receiving chemotherapy at the community level, and to explore core and bridge symptoms at the global level.

METHODS

A cross-sectional survey was conducted using the MD Anderson Symptom Inventory. Patients with breast cancer receiving chemotherapy, recruited from the "Be Resilient to Breast Cancer" project between January 2023 and December 2023, were included in the study. Symptom clusters and their sentinel symptoms were identified using exploratory factor analysis and Apriori algorithm. Core and bridge symptoms were identified using network analysis.

RESULTS

A total of 468 patients with breast cancer participated in the current study. At the community level, three symptom clusters and their corresponding sentinel symptoms were identified: a gastrointestinal symptom cluster (with nausea as the sentinel symptom), a psycho-sleep-related symptom cluster (with distress as the sentinel symptom), and a neurocognition symptom cluster (with dry mouth as the sentinel symptom). At the global level, fatigue emerged as the core symptom, while disturbed sleep and lack of appetite as bridge symptoms.

CONCLUSION

Addressing nausea, distress, and dry mouth are imperative for alleviating specific symptom clusters at the community level. Furthermore, targeting fatigue, disturbed sleep, and lack of appetite are crucial to break the interactions among diverse symptoms at the global level.

Chemotherapy-related symptoms in children with leukemia: application of latent profile analysis and network analysis

PURPOSE

Children with leukemia may experience a range of chemotherapy-related symptoms. Identifying subgroups and their distinct characteristics of symptoms may improve symptom management. We aimed to identify subgroups and their distinct characteristics of chemotherapy-related symptoms in children with leukemia.

METHODS

A cross-sectional survey was conducted among 500 children with leukemia, who completed questionnaires that assessed their demographic and clinical characteristics, as well as the Memorial Symptom Assessment Scale. Latent profile analysis was conducted to identify subgroups of symptoms. Additionally, multiple regression analysis and network analysis were utilized to reveal the characteristics of each subgroup.

RESULTS

Four subgroups were identified: "Profile 1: low symptom burden subgroup" (26.2%), "Profile 2: moderate symptom burden subgroup in transitional period" (14.8%), "Profile 3: moderate psychological symptom burden subgroup" (35.6%), and "Profile 4: high symptom burden subgroup" (23.4%). Multiple logistic regression analysis indicated that lower primary caregiver's education level, lower family monthly income, self-paid medical expenses, induction remission period, and consolidation enhancement period were associated with more severe symptoms of subgroups. Network analysis further revealed that nausea was the core symptom in Profiles 1 and 2, while the core symptom in Profile 3 was "I don't look like myself." Additionally, worrying was the core symptom in Profile 4.

CONCLUSION

There exists heterogeneity in chemotherapy-related symptoms. Four subgroups and their corresponding characteristics of children with varying symptom severity were identified. Identifying these subgroups will facilitate personalized care, maximize intervention effectiveness, and alleviate symptom burden.