Biopsychosocial Antecedents and Symptom Burden Among Children Undergoing Cancer Treatment: A Systematic Review

Children experience burden from several symptoms during cancer treatment. Despite research describing symptoms, the antecedents associated with symptom burden are not well understood.

To collate and synthesize knowledge on antecedents of symptom burden among children undergoing cancer treatment.

A multisite team registered a protocol with PROSPERO and conducted a comprehensive search using a variety of search terms for articles that reported a relationship between antecedents and symptom burden in children (<18 years) undergoing cancer treatment. Screening was conducted using Covidence Software, and data were extracted using a REDCap database.

After screening and full-text review of 5254 articles, 74 articles were included in the final analysis. Results related to age, gender, disease progression, treatment intensity, and time since diagnosis showed that although non-significant instances were more common, the significant findings demonstrated a clear and consistent directionality: older age, female gender, shorter time since diagnosis or treatment, relapse or metastatic disease, and high-intensity treatment were all associated with greater symptom burden. In contrast, some antecedents, such as biomarkers, showed a higher proportion of significant associations, but the directionality of these associations was mixed, indicating heterogeneity across studies. Finally, for race, ethnicity, cancer type, and treatment type, the literature showed mostly non-significant findings with inconsistent directional patterns, suggesting limited and variable evidence for these antecedents.

Future research should investigate antecedents with consistent significant relationships with symptom burden as potential mechanisms underlying symptom burden and inform intervention development to enable early detection of children at risk for high symptom burden.