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Published on: April 26, 2012
Profiles of Symptom Suffering and Functioning in Children and Adolescents Receiving Chemotherapy
Lei Cheng1, Bryce B Reeve, Janice S Withycombe
1Author Affiliations: School of Nursing, Fudan University (Dr Cheng), Shanghai, China; Departments of Population Health Sciences and Pediatrics, Duke Cancer Institute, Duke University School of Medicine (Dr Reeve and Ms Mann), Durham, North Carolina; School of Nursing, Clemson University (Dr Withycombe), South Carolina; Division of Oncology, Children's National Hospital (Dr Jacobs); and Department of Pediatrics, The George Washington University (Dr Jacobs), Washington, DC; Department of Pediatric Oncology and Center for Population Sciences, Dana-Farber Cancer Institute and Boston Children's Hospital (Dr Mack), Boston, Massachusetts; Division of Pediatric Palliative Care and Division of Pediatric Oncology, Children's Hospital and Medical Center (Dr Weaver), Omaha, Nebraska; Department of Nursing Science, Professional Practice and Quality, Children's National Hospital (Drs Waldron and Hinds); and Department of Pediatrics, The George Washington University (Drs Waldron and Hinds), Washington, DC; Department of Pediatrics, University of Pittsburgh School of Medicine (Dr Mauer); and Division of Palliative Medicine and Supportive Care, UPMC Children's Hospital of Pittsburgh (Dr Mauer), Pennsylvania; Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital (Dr Baker), Memphis, Tennessee; and Division of Biostatistics & Study Methodology, Children's National Hospital (Dr Wang); and The George Washington University School of Medicine and Health Sciences (Dr Wang), Washington, DC.
Insights
Pediatric cancer patients undergoing chemotherapy exhibit distinct symptom profiles. Identifying high symptom burden patients allows oncology nurses to tailor supportive care, improving treatment experiences.
Area of Science:
- Pediatric Oncology
- Symptom Management
- Patient-Reported Outcomes
Background:
- Chemotherapy causes varied symptom experiences in pediatric patients.
- Identifying patients with high symptom burden is crucial for targeted supportive care.
Purpose of the Study:
- To identify symptom profiles in pediatric cancer patients before and after chemotherapy.
- To examine sociodemographic and psychological factors associated with symptom profiles and their changes.
Main Methods:
- Latent profile/transition analyses of Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric symptom measures.
- Multinomial logit models and logistic regression to assess associations with profiles and transitions.
Main Results:
- Three symptom suffering profiles (high, medium, low) were identified.
- 57% of participants remained in their initial symptom profile.
- Psychological stress and age were associated with symptom profile classification and change.
Conclusions:
- Pediatric patients undergoing chemotherapy demonstrate diverse symptom experiences.
- Oncology nurses can utilize symptom profiles to prioritize care for high-need patients.
Background:
Some children and adolescents receiving chemotherapy experience few symptom-related adverse events, whereas others experience multiple adverse events. If oncology nurses could identify patients likely to have pronounced chemotherapy-related adverse events, tailored supportive care could be matched to these patients' symptom burdens.
Objective:
The aim of this study was to identify symptom profiles in children and adolescents before and after chemotherapy, and the sociodemographic and psychological factors associated with profile classification and change.
Methods:
Participants ranging from 7 to 18 years (n = 436) completed 6 Patient-Reported Outcomes Measurement Information System pediatric symptom measures within 72 hours preceding (T1) and 1 to 2 weeks after (T2) chemotherapy. Profile membership and change were determined by latent profile/latent transition analyses. Associations with profiles and profile transitions were examined using multinomial logit models and logistic regression.
Results:
Three symptom suffering profiles were identified at T1 and T2: high, medium, and low. The high symptom suffering profile included the fewest participants (T1, n = 70; T2, n = 55); the low symptom suffering profile included the most participants (T1, n = 200; T2, n = 207). Of the participants, 57% remained in the same profile from T1 to T2. Psychological stress was significantly associated with T1 and T2 profile classifications and profile transition; age was associated with profile classification at T1.
Conclusion:
Three symptom suffering profiles existed in a sample of pediatric patients undergoing chemotherapy, indicating that children and adolescents have differing cancer treatment experiences.
Implications For Practice:
Oncology nurses could screen pediatric oncology patients for their symptom suffering profile membership and subsequently prioritize care efforts for those with a high suffering profile.
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