Analyzing the Symptom Clusters Among Children With Acute Lymphoblastic Leukemia During Chemotherapy Based on
Yuxin Wang1, Hongxia Xie, Hao Jiang
1Author Affiliations: School of Nursing, Wenzhou Medical University (Ms Wang, Mr Jiang, Mss Chen and Ren, and Dr Dong); and School of Computer and Computing Science, Hangzhou City University (Ms Xie), China.
Insights
Symptom clusters in children with acute lymphoblastic leukemia (ALL) during chemotherapy are dynamic yet stable. Understanding these patterns helps improve symptom management for pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Nursing Informatics
- Symptom Science
Background:
- Children undergoing chemotherapy for acute lymphoblastic leukemia (ALL) experience numerous physical and psychological symptoms.
- Previous research using fixed inventories has limitations in capturing complex symptom dynamics.
Purpose of the Study:
- To investigate the evolving symptom clusters in pediatric ALL patients during different chemotherapy phases.
- Utilize electronic nursing records for a comprehensive analysis of symptom presentation.
Main Methods:
- Analysis of 14,490 electronic nursing records from a pediatric hematology department.
- Natural language processing identified 46 symptoms across induction, consolidation, and maintenance chemotherapy phases.
- Principal component and cluster analyses were applied to symptoms with >15% incidence.
Main Results:
- Common symptoms included bleeding, cough, and vomiting.
- Symptom clusters varied by phase: 7 in induction, 6 in consolidation, 4 in maintenance.
- Persistent clusters (gastrointestinal, respiratory, skin) were observed, with neurological and other discomfort emerging in consolidation.
Conclusions:
- Symptom clusters in pediatric ALL chemotherapy exhibit both stability and dynamic changes.
- Findings support the development of continuous, phase-specific symptom management strategies for healthcare providers.
- Targeted interventions based on cluster characteristics can enhance symptom management efficiency and reduce patient burden.
Background:
Children with acute lymphoblastic leukemia often experience various physical and psychological symptoms during chemotherapy. Previous studies have used predetermined symptom inventories to analyze the complex relationships between these symptoms, which has certain limitations.
Objective:
The aim of this study was to explore the dynamic changes in symptom clusters among children with acute lymphoblastic leukemia during chemotherapy using electronic nursing records.
Methods:
Electronic nursing records for 2021 (N = 14 490) were obtained from a pediatric hematology department. A natural language processing tool was used to identify the presence of 46 symptoms in 3 chemotherapy phases of induction, consolidation, and maintenance. Incidence of symptom documentation was calculated by notes and patients, and principal component analysis and cluster analysis were performed for symptoms with an incidence above 15%.
Results:
The most common symptoms included bleeding, cough, and vomiting. The number of symptom clusters in each chemotherapy period was 7, 6, and 4, respectively. There were upper gastrointestinal, respiratory system, lower gastrointestinal, skin-related, psychological, self-image disorder, and other discomfort symptom clusters in the induction period. Notably, the upper gastrointestinal, respiratory system, lower gastrointestinal, and skin-related symptom clusters persisted through the consolidation and maintenance periods. Neurological and other discomfort symptom clusters were observed during the consolidation period.
Conclusion:
Symptom clusters of children with acute lymphoblastic leukemia at various stages of chemotherapy showed a certain level of stability and dynamics, informing healthcare providers in developing continuous symptom management.
Implications For Practice:
Medical staff should explore targeted intervention programs based on characteristics of symptom clusters at different chemotherapy stages, to improve the efficiency of symptom management and alleviate the symptom burden of children.
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