A Symptom Checklist for Children With Cancer

School of Nursing, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Cancer nursing (Impact Factor: 1.97). 07/2011; 35(2):89-98. DOI: 10.1097/NCC.0b013e31821a51f6
Source: PubMed


Symptom monitoring and alleviation are basic to the care of children and adolescents with cancer. A symptom checklist helps facilitate this process.
The primary objective of this study was to calibrate a child-friendly, clinically usable checklist capturing symptom occurrence and severity; a secondary objective was to examine age group differences: 5 to 11 years (n = 222) and 12 to 17 years (n = 163) and sex differences: males (54%) and females (46%), and correlate symptom severity, functional status, and quality of life.
Three hundred eighty-five children/adolescents at 5 university-affiliated outpatient oncology clinics: central, western, eastern, southeastern United States. Diagnoses were acute lymphoblastic leukemia (45%), solid tumors (14%), nervous system tumors (18%), and others (23%). Principal component factor analysis, confirmatory factor analysis, correlational statistics, t test, Wilcoxon test were performed.
(a) Robust 30-item checklist, 7 factors; (b) 14 of 30 symptoms reported by at least 40% of patients. Top 5 are feeling sluggish (77%), nausea (72%), appetite loss (66%), irritable (61%), and vomiting (54%). (c) Sixteen of 30 symptoms reported at severity 2 or greater: "quite a bit." (d) Therapy-Related Symptom Checklist-Children (TRSC-C) scores are as follows: range, 0 to 89; mean, 25.14 (SD, 18.68). (e) Cronbach α = .9106. (f) Older children reported greater symptom severities: TRSC-C (t = 2.73, P = .003). (g) There were no sex differences on the TRSC-C total score. (h) Lansky correlations with TRSC-C (r = -0.32; P = .02); factors: nutrition related (r = -0.36; P = .05); oropharyngeal (r = -0.51; P = .0002); and respiratory (r = - 0.25; P = .06). (i) Pediatric Quality of Life Inventory correlation with TRSC-C (r = -0.68; P = .0001).
The new TRSC-C has good measurement properties and is ready for use in clinics and research.
Use of the TRSC-C is consistent with guidelines emphasizing self-report of patient symptoms, shared patient decision making, and improved communications among patients, clinicians, and significant others.

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    ABSTRACT: BACKGROUND:: Cancer treatment efficacy has improved with therapies at high or sustained dosages. However, there is increasing concern about symptom management and patients' quality of life. OBJECTIVE:: The objective of this study was to assess whether use of a Therapy-Related Symptom Checklist (TRSC) with oncology outpatients increases the number of symptoms documented and managed and whether this improves patients' health-related quality of life (HRQOL). METHODS:: This was a sequential cohort trial. Fifty-five oncology outpatients in treatment received standard of care (group 1, G1). Afterward, another 58 patients (group 2, G2) received standard of care at the same clinic; however, these patients additionally answered the TRSC immediately prior to each consultation. The TRSC results were then shared with clinicians. Repeated measures (2-11 visits) were obtained of the number of patient treatment symptoms documented (medical records G1 and TRSC G2), HRQOL, and Karnofsky scores, n = 696 observations (328 G1 and 368 G2). The number of symptoms reported and HRQOL were covariate adjusted using population averaged generalized estimating equations. RESULTS:: G2 patients had a 7.2% higher population averaged covariate-adjusted HRQOL than G1 patients (3.3 more points on HRQOL, P = .012). One hundred sixteen percent more covariate- and non-covariate-adjusted symptoms were documented/managed in G2 than G1 (6.14 symptoms vs 2.84, P < .0001). The HRQOL, TRSC, and Karnofsky scores correlated r > 0.40. CONCLUSION:: Use of patient-reported TRSC improves symptom documentation/management and patient HRQOL. IMPLICATIONS FOR PRACTICE:: Study findings were consistent with recent research that has shown that use of checklists can have powerful influences on both quality and safety of healthcare services and patient outcomes.
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    ABSTRACT: BACKGROUND:: Recent advances in cancer screening and treatment have resulted in a decrease in mortality rates in children and adolescents. However, despite the improved prognosis, the course of cancer treatment continues to be a very stressful experience in the life of a child. OBJECTIVES:: The objectives of the study were to assess the occurrence and severity of treatment-related symptoms manifested by children and adolescents undergoing active cancer treatment and to examine the relationships between therapy-related symptoms, depressive symptoms, and quality of life of these pediatric patients. METHODS:: A cross-sectional study design was used, and 135 Hong Kong Chinese children (9- to 16-year-olds) who were admitted for treatment of cancer in a pediatric oncology unit were invited to participate in the study. RESULTS:: Results indicated that children and adolescents receiving combined cancer treatment generally experienced greater symptom occurrence and severity. In addition, children reporting greater symptom occurrence and severity experienced higher levels of depression and a lower level of quality of life. The study revealed that therapy-related symptoms are a strong predictor of quality of life of children and adolescents hospitalized for cancer treatment. CONCLUSIONS:: Cancer and its treatments significantly affect the psychosocial well-being and quality of life of children and adolescent hospitalized for cancer care. Therapy-related symptoms can be a useful indicator for screening those pediatric patients who are likely to exhibit psychosocial distress or are at high risk of depression. IMPLICATIONS FOR PRACTICE:: It is essential for nurses to be sensitive and knowledgeable about the therapy-related symptoms of cancer treatment and their effects on children and adolescents to promote the psychosocial well-being of these patients and enhance their quality of life.
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