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Procedural State Anxiety in Pediatric Leukemia Patients Undergoing Bone Marrow Aspiration or Lumbar Puncture: A
Xiuli Qin1, Xin Zhao1, Ting Zhou1
1Department of Nursing, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, 430030, China.
Insights
Pediatric leukemia patients undergoing bone marrow aspiration or lumbar puncture experience significant anxiety, especially younger patients and those undergoing procedures for the first time. Interventions are needed to reduce this procedural anxiety.
Area of Science:
- Pediatric Oncology
- Medical Psychology
Background:
- Invasive procedures like bone marrow aspiration (BMA) and lumbar puncture (LP) are critical for pediatric leukemia management.
- These procedures frequently cause significant state anxiety in children.
Purpose of the Study:
- To evaluate procedural state anxiety in Chinese pediatric leukemia patients using the Chinese Version of the State Anxiety Scale for Children (CSAS-C).
- To identify socio-demographic and clinical factors associated with this anxiety.
Main Methods:
- A cross-sectional study involving 119 pediatric patients (8-18 years) with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) undergoing BMA or LP.
- Anxiety assessed using CSAS-C; data analyzed with Mann-Whitney U and Kruskal-Wallis tests, and multivariable linear regression.
Main Results:
- Median CSAS-C score indicated mild to moderate anxiety.
- Higher anxiety linked to younger age (8-12 years), primary education, AML diagnosis, hospitalization, and first-time procedures.
- First-time procedures independently predicted higher anxiety.
Conclusions:
- Procedural state anxiety is common in pediatric leukemia patients undergoing BMA or LP.
- Younger, less educated, AML, inpatient, and first-time patients are particularly vulnerable.
- Tailored anxiety-reduction interventions are crucial for improving patient experience and compliance.
Background:
Invasive procedures such as bone marrow aspiration (BMA) and lumbar puncture (LP) are essential in the management of pediatric leukemia but often induce significant state anxiety. This cross-sectional study aimed to evaluate procedural state anxiety using the Chinese Version of the State Anxiety Scale for Children (CSAS-C) and identify associated socio-demographic and clinical factors in Chinese pediatric leukemia patients.
Methods:
A convenience sample of 119 patients aged 8-18 years with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) undergoing BMA or LP was recruited from a tertiary pediatric oncology center in China. State anxiety was assessed via the CSAS-C (score range: 20-60, higher scores indicating greater anxiety). Socio-demographic (gender, age, education) and clinical data (diagnosis, treatment history, procedural type, site, history) were collected. Data were analyzed using R software (version 4.4.3). Non-normally distributed variables were presented as median (P25, P75). Group comparisons employed the Mann-Whitney U test for two groups and the Kruskal-Wallis test with Dunn's post-hoc for multiple groups, with P < 0.05 considered significant.
Results:
The overall median CSAS-C score was 27.0 (21.0, 32.0), indicating mild to moderate anxiety. Significantly higher anxiety was associated with younger age (8-12 years; P < 0.001), primary school education (P < 0.001), AML diagnosis (P = 0.004), hospitalization setting (P < 0.001), and first-time procedures (P < 0.001). No significant differences were observed by gender (P = 0.439), treatment history (P = 0.066), or procedural type (P = 0.238). Multivariable linear regression confirmed that first-time procedures were an independent predictor of higher anxiety (β = 11.82, p = 0.001), with a marginal effect for lumbar puncture (β = 7.16, p = 0.056).
Conclusion:
Procedural state anxiety is prevalent among pediatric leukemia patients undergoing BMA or LP, particularly in younger, less educated, AML, inpatient, and novice patients. These findings underscore the need for tailored anxiety-reduction interventions in pediatric oncology to improve patient experience and compliance.
