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Symptom Characteristics Among Hospitalized Children and Adolescents With Cancer

Linder, Lauri A. PhD, APRN, CPON; Al-Qaaydeh, Sharifa MS, RN; Donaldson, Gary PhD

doi: 10.1097/NCC.0000000000000469

Background: Studies addressing physical and psychosocial symptoms among hospitalized children and adolescents with cancer are limited. Understanding commonly occurring symptoms and their associated characteristics across the hospitalization is needed to guide symptom management strategies.

Objective: This study described the symptom experience of hospitalized children and adolescents with cancer. The study explored the frequencies of individual symptoms and the severity, duration, and associated distress of symptoms during the course of the hospitalization.

Methods: Participants completed the Memorial Symptom Assessment Scale 7–12 during each 12-hour shift of the 3-day/3-night data collection period.

Results: Participants were 50 children and adolescents (mean age, 12.6 years; range, 7.1–18.6 years) receiving inpatient chemotherapy. Participants reported a mean of 2.75 symptoms at each assessment point and a mean of 5.42 different symptoms during their hospitalization. Mixed model analyses identified a significant fixed effect for study day, with participants reporting fewer symptoms (F = 8.4, P < .01), less symptom severity (F = 5.81, P < .01), and shorter duration (F = 6.67, P < .01) on day 3 relative to days 1 and 2. A fixed effect for study day was not present for symptom distress.

Conclusions: Children and adolescents receiving inpatient chemotherapy experience multiple physical and psychosocial symptoms of moderate or greater severity and duration throughout the course of their hospitalization. Symptoms of greatest severity may not be those that are most distressing to the patient.

Implications for Practice: Ongoing assessment that incorporates the multidimensional nature of symptoms is needed. Prioritizing interventions for symptoms that are most distressing to the patient may support a more meaningful, patient-centric approach to care.

Author Affiliations: College of Nursing (Dr Linder and Ms Al-Qaaydeh) and Department of Anesthesiology (Dr Donaldson) University of Utah; and Cancer, Blood, and Transplant Service, Primary Children’s Hospital (Dr Linder), Salt Lake City, Utah.

This study was supported by Alex’s Lemonade Stand Foundation Independent Nurse Researcher Grant (Linder, PI; Donaldson, co-I).

Dr Linder has the following past relationships to disclose:

• Elsevier Publishing: received $400 for serving as a textbook chapter author in “Cancer in children and adolescents.” In McCance KL & Huether SE (Eds.), Understanding Pathophysiology (6th ed.).

• Hospital for Sick Children, Toronto, ON—Garron Family Cancer Centre Visiting Scholar Program in Celebration of Canadian Oncology Nurses Day, April 2016: received a $500 honorarium for serving as a visiting nurse scholar at the Hospital for Sick Children in Toronto, ON.

• Oncology Nursing Society, Fall 2014: $400 honorarium for contributions to an online course—Central Line-Associated Bloodstream Infections; section author: Common Causative Organisms, Prevention Strategies, Treatment Protocols, Oncology Population Challenges.

Correspondence: Lauri A. Linder, PhD, APRN, CPON, College of Nursing, University of Utah, 10 S 2000 E, Salt Lake City, UT 84112 (

Accepted for publication November 29, 2016.

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