Sentinel and Networked Symptoms During Remission Induction Chemotherapy in Acute Lymphoblastic Leukemia Children
Xinyi Shen1, Jinling Ma, Yuying Chan
1Author Affiliations: Department of Hematology (Mrs Shen, Ms Ma, and Dr Li) and Trade Union, (Ms Chan), Children's Hospital of Soochow University, Suzhou, China.
Insights
Identifying key symptoms in children with acute lymphoblastic leukemia (ALL) during treatment is crucial. This study highlights constipation, sadness, and cough as sentinel symptoms to guide better symptom management and improve quality of life.
Area of Science:
- Pediatric Oncology
- Symptom Science
- Clinical Nursing
Background:
- Children undergoing acute lymphoblastic leukemia (ALL) remission induction often experience diverse adverse symptoms.
- Understanding symptom interrelationships is vital for effective management strategies.
Purpose of the Study:
- To identify symptom clusters and sentinel symptoms in pediatric ALL patients during remission induction.
- To analyze core and bridge symptoms within a symptom network.
Main Methods:
- Cross-sectional survey of 226 children (aged 8-16) with newly diagnosed ALL undergoing remission induction chemotherapy.
- Utilized the Chinese version of the Memorial Symptom Assessment Scale 10-18.
- Employed exploratory factor analysis, Apriori algorithm, and network analysis to identify symptom clusters, sentinel, core, and bridge symptoms.
Main Results:
- Identified five symptom clusters: gastrointestinal (constipation as sentinel), emotional (sadness as sentinel), somatic (cough as sentinel), neurological, and self-image.
- Feeling sad and nausea emerged as core symptoms in the network.
- Dizziness and lack of energy were identified as bridge symptoms.
Conclusions:
- Prioritize interventions for the somatic symptom cluster, particularly constipation, during remission induction.
- Extend network and sentinel symptom analyses to pediatric cancer symptom research for evidence-based management.
- Nurses should target sentinel and networked symptoms to support children, reduce symptom burden, and enhance quality of life.
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.
