Symptoms in Children Receiving Treatment for Cancer—Part I: Fatigue, Sleep Disturbance, and Nausea/Vomiting

Abstract

Children and adolescents with cancer often undergo intensive chemotherapy treatment to obtain remission and long-term survival. The pursuit of successful treatment outcomes may lead to high levels of symptom distress related to treatment side effects and toxicities. The Children’s Oncology Group Nursing Discipline held a State of the Science Symposium “Symptom Assessment During Childhood Cancer Treatment” in 2018 that included reviews of evidence regarding key symptoms. The purpose of this review is to summarize and synthesize the evidence presented about the prevalence, relationships, trajectories, and associated biomarkers of selected symptoms experienced by children and adolescents during cancer treatment. Five symptoms were selected, with the focus on fatigue, sleep disturbance, and nausea/vomiting and included in Part I of the review. Using Ovid-Medline, studies published between 2008 and 2018 that focused on these specific symptoms during active chemotherapy treatment were selected. Fatigue interferes with normal developmental activities and is associated with sleep disturbances, and its pattern changes within a cycle of chemotherapy as well as across the treatment trajectory. Sleep is disrupted by the hospital environment, treatment medications, and changes in normal childhood and schedules. Disturbances of sleep persist during treatment, preventing recovery from poor quality sleep. Although pharmacologic interventions have advanced for treatment of nausea and vomiting, children and adolescents continue to struggle with this symptom. Its trajectory changes with the intensity of treatment, and over half of the patients report that they experience nausea and/or vomiting. Future research is needed to advance identification of biologic risk factors for symptoms and test effectiveness of symptom-related interventions.

Symptoms in Children Receiving Treatment for Cancer—Part II: Pain, Sadness, and Symptom Clusters

“…A detailed description of the search strategy has been reported in the first article in this two-part summary of symptoms (Hooke & Linder, 2019). Inclusion criteria were studies and systematic reviews published between January 2008 and May 2018, with a primary focus on symptom assessment among children and adolescents receiving treatment for cancer.…”

“…This article is the second of a two-part summary (see also, Part I: Hooke & Linder, 2019) of the current evidence addressing the assessment of symptoms frequently reported by children and adolescents receiving treatment for cancer. Data presented in these articles were presented at the COG Nursing Discipline State of the Science Symposium: Symptom Assessment During Childhood Cancer Treatment in October 2018 (R13CA232442).…”

“…An understanding of symptom assessment in children with cancer is foundational to the work of the Children's Oncology Group (COG) Nursing Discipline, which has focused its research aims on key knowledge gaps that include understanding illness-related distress (Landier, Leonard, & Ruccione, 2013). This focus is aligned with the organizing framework for the COG Nursing Discipline (Hooke & Linder, 2019), which aims to appreciate how children and their families sustain or regain optimal health in the context of serious illness, and is based on Prevalence of Pain. Although causes of pain varied across the cancer treatment continuum, pain was consistently among the most prevalent symptoms reported by children, adolescents, and their parents (Baggott et al, 2009;Erickson et al, 2013;Kestler & LoBiondo-Wood, 2012).…”

Clinical validity of the PROMIS pediatric sleep short forms in children receiving treatment for cancer

“…In response to recent calls for the systematic study of sleep 10 and symptom burden 20,21 in pediatric cancer, the current study assessed the reliability and clinical validity of the PROMIS pediatric sleep scales…”

A call to action for expanded sleep research in pediatric oncology: A position paper on behalf of the International Psycho‐Oncology Society Pediatrics Special Interest Group

“…Accurate assessment of children's sleep patterns and habits as well as a clear understanding of risk factors (eg, gender, age, cancer diagnosis, type of cancer treatment) and when sleep problems are likely to develop are crucial to achieve the ultimate goal of improving sleep and its associated outcomes in children with cancer. However, much of the existing literature on child sleep includes cross‐sectional, single‐center studies with small samples, despite families and providers indicating that this is a priority area for research and clinical practice . Adult oncology research has better integrated sleep as a meaningful outcome and correlate of medical and psychosocial outcomes.…”