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A Pilot Exploration of Symptom Trajectories in Adolescents With Cancer During Chemotherapy

Ameringer, Suzanne PhD, RN; Elswick, R. K. Jr PhD; Shockey, Debra P. MS, RN, CPNP; Dillon, Robyn MSW, LCSW, C-ACYFSW

doi: 10.1097/NCC.0b013e318250da1a

Background: Chemotherapy is frequently administered in repetitive cycles. Adolescents with cancer have multiple symptoms related to chemotherapy, but knowledge of symptom trajectories across a cycle is limited. Examining trajectories over a cycle may reveal key periods to manage symptoms.

Objectives: The aims of this pilot were to describe the trajectory of symptoms (pain, sleep, appetite, nausea, fatigue) and biological and behavioral variables (anxiety, stress, hematologic function) across 1 cycle and examine relationships between variables.

Methods: Nine adolescents with cancer within 6 months of diagnosis participated. Data were collected by surveys, chart review, and biologic measures on days 1 and 2 of the cycle, 1 week later (nadir), and day 1 of the following cycle. To evaluate the trajectory, a simple random-effects repeated-measures analysis was computed.

Results: The significant trajectories were fatigue (P = .003), difficulty sleeping (P = .032), and nausea (P = .04). Most of the adolescents reported some anticipatory anxiety about receiving chemotherapy. Significant correlations between symptoms and biobehavioral variables included anticipatory anxiety and nausea (r = .86, P = .003), trait anxiety and fatigue (r = −0.82, P < .001), and stress and pain (r = 0.78, P = .039).

Conclusions: Multiple symptoms were experienced across the cycle. Three symptoms displayed significant trajectories indicating that patterns of symptoms may be anticipated.

Implications for Practice: Pilot findings suggest that monitoring symptoms, stress, and anxiety across a cycle is important, not only during chemotherapy administration, but also prior to being admitted for chemotherapy.

Author Affiliations: School of Nursing (Drs Ameringer and Elswick) and Division of Pediatric Hematology/Oncology (Mss Shockey and Dillon), Virginia Commonwealth University Health Systems, Richmond.

This work was supported in part by a grant from the National Institute ofNursing Research (P20 NR008988, “Biobehavioral Research in Critical Health Experiences,” N. McCain, principal investigator).

The authors have no conflicts of interest to disclose.

Correspondence: Suzanne Ameringer, PhD, RN, School of Nursing, Virginia Commonwealth University, 1100 E Leigh St, Richmond, VA 23219 (

Accepted for publication February 16, 2012.

© 2013 Lippincott Williams & Wilkins, Inc.