Symptom Occurrence and Severity on the Therapy-Related Symptom Checklist for Children Among Hispanic Pediatric Oncology Outpatients

The Therapy-Related Symptom Checklist for Children as a Method for Monitoring Symptoms in Chinese Children With Cancer: Linguistic Validation and Cross-Cultural Adaptation

BACKGROUND

Children with cancer commonly experience severe symptoms. These may be managed by routine monitoring of their occurrence andseverity using a validated tool.

AIM

This study aimed to translate and culturally validate a simplified Chinese version of the Therapy-Related Symptom Checklist for Children (TRSC-C).

DESIGN

Qualitative method.

PARTICIPANTS AND SETTING

We recruited children with cancer from a pediatric department of a tertiary hospital in Guangzhou, China.

METHODS

We used forward and backward translation by bilingual translators and standardized cognitive interviewing for linguistic validation and to check cross-cultural adaptation. A panel of experts assessed content validity.

RESULTS

Agreement was reached on cultural applicability, suitability for intended purpose, and clarification of the pre-test version. The content validity was good (indices ranged from 0.80-0.90). Fifteen Chinese children with cancer (aged 8-18 years) were included in cognitive interviews. The cognitive debriefing showed that the instrument was easy to understand and appropriate for monitoring symptoms in children with cancer. Some words were adjusted following participants' comments.

CONCLUSIONS

The simplified Chinese version of the TRSC-C was semantically and conceptually equivalent to the original version. Children between 8-18 years old can use this instrument to report symptoms and share their experiences about their disease and treatment.

Pain science education for children living with and beyond cancer: Challenges and research agenda

Pain in children living with and beyond cancer is understudied and undertreated. Pain science education (PSE) is a conceptual change strategy facilitating patients' understanding of the biopsychosocial aspects of pain. Preliminary studies on the adaptation of PSE interventions to adults with and beyond cancer provide a foundation for pediatric research. PSE could help childhood cancer survivors experiencing persistent pain and pain-related worry after active treatment. PSE may also help children receiving cancer treatment, providing them with a foundation of adaptive pain beliefs and cognitions, and preparing them for procedural and treatment-related pain. We direct this paper toward pediatric oncology clinicians, policy makers, and researchers working with children living with and beyond cancer. We aim to (a) identify challenges in adapting PSE for children living with and beyond cancer, (b) offer possible solutions, and (c) propose research questions to guide the implementation of PSE for children living with and beyond cancer.

Effects of cognitive-behavioural therapy on psychological, physical and social outcomes of children with cancer: A systematic review and meta-analysis

OBJECTIVE

This systematic review aimed to summarise the effects of cognitive-behavioural therapy on psychological, physical and social outcomes of children with cancer without limitations on publication date.

METHODS

Thirteen English and seven Chinese electronic databases were searched from April to June 2021. Randomised control trials, quasi-experimental studies, pre-test post-test studies with a control group, factorial or cross-over designs that included children ≤18 years old and during various stages of the cancer trajectory, who have received cognitive-behavioural therapy, and reported (anxiety, depression, stress, quality of life, self-efficacy, fatigue, pain, behavioural distress, anger, and/or academic performance) were included.

RESULTS

Eight studies with quality of evidence ranging from low to high risk of bias were included. The results show cognitive-behavioural therapy has favourable effects on anxiety, depression, pain and behavioural distress. The meta-analysis also show that it reduces anxiety (SMD = -0.89, 95% CI (-1.45, -0.32), p < 0.002), depression (SMD = -0.90, 95% CI (-1.40, -0.39), p < 0.0005), and pain (SMD = -0.56, 95% CI (-1.04, -0.08), p < 0.002). It also has a favourable effect on stress, anger and self-efficacy, though the results are drawn from a single study.

CONCLUSION

Cognitive-behavioural therapy has the potential to reduce anxiety, depression and pain for children with cancer. It also shows promise in reducing behavioural distress. Although effects on stress, anger, and self-efficacy have been found to be significant, there have been limited studies on these aspects of functioning and more research is needed. The findings are drawn from heterogeneous participants and interventions, thus emphasising the need to conduct well-designed intervention studies, including cancer survivors.

Psychometric validation of the simplified Chinese version of the therapy-related symptom checklist in children with cancer

PURPOSE

To validate a simplified Chinese version of the therapy-related symptom checklist for children (TRSC-C) in children with cancer.

METHODS

Reliability was assessed by internal consistency and test-retest coefficients. Dimensionality and construct validity were clarified using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Pearson's correlation coefficient was calculated between the TRSC-C and the PedsQL 3.0 cancer model (PedsQL 3.0) and the Lansky Play Performance Scale (LPPS) to test concurrent validity. A Student's t-test was used to compare the scores of the simplified Chinese version of the TRSC-C subscales by gender, age groups, and functional status to test sensitivity of the TRSC-C.

RESULTS

A sample of 170 children with cancer was recruited (11.27 ± 2.31 years). Cronbach's alpha (0.89) and interclass correlation coefficient (0.98) were acceptable. Seven factors with eigenvalues >1 explained 56.86% of the total variances. CFA demonstrated an acceptable model (CFI = 0.93, RMSE = 0.04). Concurrent validity was supported by moderate to high correlations between the TRSC-C and both the PedsQL 3.0 (r = -0.71) and LPPS (r = -0.43). The TRSC-C scores significantly differed by age groups and functional status (effect size 0.40-0.93), indicating adequate sensitivity.

CONCLUSION

The simplified Chinese version of the TRSC-C demonstrated acceptable reliability, validity, and sensitivity to support its use in clinical practice and future studies.

Symptoms in Children Receiving Treatment for Cancer-Part II: Pain, Sadness, and Symptom Clusters

Children and adolescents receiving treatment for cancer experience multiple symptoms as a consequence of their disease and its treatment that interfere with the child's quality of life. Understanding of symptom assessment in children with cancer is foundational to the work of the Children's Oncology Group Nursing Discipline, whose research aims are to address knowledge gaps including understanding illness-related distress. This article is the second of a two-part summary of current evidence addressing the assessment of symptoms frequently reported by children and adolescents receiving treatment for cancer. Studies reporting assessment of pain, sadness, and symptom clusters published between January 2008 and May 2018 were included. Forty-three publications addressed pain. Pain was highly prevalent and distressing, varied in its trajectory across a cycle of chemotherapy and across multiple cycles of treatment, and correlated with biomarkers associated with the pain response. Consequences of pain were poorer functional status and emotional health. Twenty publications addressed sadness. Sadness was the most prevalent psychosocial symptom. Its prevalence decreased over the course of treatment and over a cycle of chemotherapy. Persistent sadness was of greater severity and distress. Eight publications addressed symptom clusters. These studies identified both groups of co-occurring symptoms and groups of patients with common symptom profiles. This two-article series provides evidence for the distressing nature of symptoms among children receiving cancer treatment. Efforts to support clinicians in routine symptom assessment are needed. Additional research directed at alleviating symptoms and building resilience among the child experiencing symptoms is needed.

Symptom Trajectories in Children Receiving Treatment for Leukemia: A Latent Class Growth Analysis With Multitrajectory Modeling

CONTEXT

Cancer treatment symptoms play a major role in determining the health of children with cancer. Symptom toxicity often results in complications, treatment delays, and therapy dose reductions that can compromise leukemia therapy and jeopardize chances for long-term survival. Critical to understanding symptom experiences during treatment is the need for exploration of "why" inter-individual symptom differences occur; this will determine who may be most susceptible to treatment toxicities.

OBJECTIVES

This study examined specific symptom trajectories during the first 18 months of childhood leukemia treatment. Symptom measures included fatigue, sleep disturbances, pain, nausea, and depression.

METHODS

Symptom trajectories of 236 children with leukemia three to 18 years old were explored prospectively over four periods: initiation of post-induction therapy, four and eight post-induction therapy, and the last time point was at the beginning of maintenance/continuation therapy. Latent class growth analysis was used to classify patients into distinctive groups with similar symptom trajectories based on patients' response patterns on the symptom measures over time.

RESULTS

Three latent classes of symptom trajectories were identified and classified into mild, moderate, and severe symptom trajectories. The only demographic characteristic with a significant relationship to membership in the latent class symptom trajectories was race/ethnicity. All other demographic characteristics including leukemia risk levels showed no significant relationships.

CONCLUSION

This study is unique in that groups of patients with similar symptoms were identified rather than groups of symptoms. Further research using latent class growth analysis is needed.

Validity and Reliability Assessment of the Persian Version of Therapy-Related Symptom Checklist

Therapy-related symptom checklist for children (TRSC-C) was developed as a symptom assessment tool in children receiving chemotherapy. The objective of the present study was to evaluate the validity and reliability of the Persian version of TRSC-C. This cross-sectional study was conducted in 2013-2014 in Tehran, Iran. TRSC-C was translated using backward-forward approach. The content validity, face validity, and comprehensiveness were investigated based on the opinion of experts. The item content validity index (I-CVI) and scale content validity index (S-CVI) were calculated by the mean approach and inter-rater agreement. The scale was revised based on the comments from a team of five experts, after which it was evaluated by an additional group of four experts. To assess the inter-rater reliability, two raters filled the scale with 29 and 30 patients in the outpatient clinic of Hazrat-e Ali Asghar Hospital. The Cronbach's alpha was calculated and factor analysis was performed. The scores of content validity were analyzed in Excel. Other statistical analyses were performed using the SPSS software version 20.0. Based on the initial assessment, the S-CVI with less conservative approach was 60% for clarity, 33% for relevancy, and 60% for simplicity. After revising the scale, the S-CVI reached 100%. The comprehensiveness and face validity of the scale were appropriate. The scale was inter-rater reliable and the Cronbach's alpha was 0.803. Eleven subscales were found in the TRSC-C. It is concluded that the Persian TRSC-C is a valid and reliable tool for measuring children symptoms. Availability of a valid and reliable checklist is a fundamental step in monitoring the symptoms of patients while receiving chemotherapy.

Retracted: Symptom trajectories and occurrence in older Saudi children with cancer during a course of chemotherapy

This research aimed to describe changes in symptom occurrence and severity of the 31 symptoms during the chemotherapy cycle at three time points. This descriptive, longitudinal study investigated Saudi children who underwent a cycle of chemotherapy (n = 132) in four tertiary hospitals. The Arabic version of the Memorial Symptom Assessment Scale, Karnofsky Performance Status and a demographic questionnaire were used. More than 30% of children reported 10 or more symptoms during the cycle. Symptom occurrence trajectories were analysed using multilevel logistic regression. Six symptoms (i.e. fatigue, sadness, irritability, worrying, weight loss, sweating) showed a decreasing linear trend. Significant quadratic patterns of change were found for feeling drowsy, nausea and vomiting. No significant differences, over time were found in any of the symptom severity scores by using multilevel negative binomial regression. This study is the first to examine the trajectory of multiple symptoms that children experience during a cycle of chemotherapy in Saudi Arabia. Children in this study reported a high number of symptoms across the entire cycle of chemotherapy. Intervention studies are needed to improve care for these symptoms.

Self-reported assessment of symptoms and self-care within a cohort of U.S. veterans during outpatient care for cancer

BACKGROUND

This study was undertaken as part of a feasibility study of the use of a symptom checklist and self-care assessment of veterans receiving oncology outpatient treatment within the U.S. Department of Veterans Affairs system.

OBJECTIVES

The study aimed to examine (a) symptom occurrence and severity as self-reported on the Therapy-Related Symptom Checklist (TRSC) by veterans at a cancer clinic, (b) symptom alleviation strategies and use of self-care, and (c) the relationship between symptom occurrence and severity and functional status and quality of life.

METHODS

Veterans (N = 100) undergoing chemotherapy and/or radiation therapy participated in a cross-sectional study. Tools used, including TRSC, Symptom Alleviation.

FINDINGS

Thirteen symptoms were reported by more than 35% of patients. Top-ranked symptoms by percentage occurrence and severity were feeling sluggish, taste changes, nausea, pain, constipation, loss of appetite, numbness of fingers and toes, difficulty sleeping, weight loss, hair loss, difficulty concentrating, shortness of breath, and decreased interest in sexual activity. Occurrence and severity of symptoms had significant negative correlations with functional status and with overall quality of life. Self-care (symptom alleviation) strategies that helped were medicines, diet and nutrition, and lifestyle change. Checklist use (TRSC) facilitated patient-report of symptoms during cancer treatments; self-care strategies helped relieve symptoms.

Monitoring and Alleviation of Symptom Occurrence and Severity Among Thai Children and Adolescents During Cancer Treatments

BACKGROUND

Symptom monitoring and alleviation are important during pediatric cancer treatments.

AIMS

To examine the use of the Therapy-Related Symptom Checklist for Children (TRSC-C; Thai version) for reported occurrence, severity, and management of treatment-related symptoms within a cohort of Thai pediatric oncology patients/parents

METHOD

Cross-sectional study; convenience sample: 100 parents of 71 male children/29 females, 63% with leukemia, 37%, other diagnoses; age-groups: <5 years, n = 33; 5 to 11 years, n = 44; 12 to 17 years, n = 25. Parents reported children's symptom occurrence/severity on the TRSC-C; and complementary care methods on the Symptom Alleviation: Self-Care Methods and their symptom alleviation methods. All tools had good psychometric properties.

RESULTS

18 symptoms on the 30-item TRSC-C occurred in 42% to 95% of children. Mean severity of symptoms was between 1.0 ("a bit") and 2.0 ("quite a bit"); 5-month to 11-year-old children had higher (worse) TRSC-C total scores. Complementary care was used and reported.

CONCLUSIONS

Monitoring of multiple symptoms with the TRSC-C and parental symptom alleviation helped children.

CLINICAL IMPLICATIONS

Thai parents/patients need and accept assistance in monitoring/managing side effects of pediatric cancer therapy.