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Symptom Clusters and Influencing Factors in Children With Acute Leukemia During Chemotherapy

Li, Rongrong, MSN, RN; Ma, Jinling, MSN, RN; Chan, Yuying, MSN, RN; Yang, Qi, MSN, RN; Zhang, Chunxu, MSN, RN

doi: 10.1097/NCC.0000000000000716
Article: PDF Only

Background: Acute leukemia is the most common malignancy in childhood. Identification of symptom clusters and their influencing factors in children with acute leukemia may improve the management of symptoms.

Objective: The aims of this study were to investigate symptom clusters in children with acute leukemia during chemotherapy and analyze the factors influencing their severity.

Methods: A cross-sectional survey was administered to 159 Chinese children with acute leukemia during chemotherapy. A demographic questionnaire and the Memorial Symptom Assessment Scale 10-18 were completed by the patients and their parents. Exploratory factor analysis was used to identify symptom clusters. Univariate analyses and multiple linear regression analyses were performed to analyze the factors affecting symptom clusters.

Results: Six clusters were identified, including gastrointestinal cluster, emotional cluster, head-related cluster, self-image disorder cluster, skin itching/irritation cluster, and somatic cluster. Factors influencing the severity of symptom clusters included age, gender, stage of chemotherapy, and medical reimbursement.

Conclusions: There are multiple symptom clusters in children with acute leukemia during chemotherapy. Medical care staff should manage symptoms from the perspective of symptom cluster and carry out personalized interventions according to factors influencing these clusters.

Implications for Practice: The ability to predict symptom clusters in children with acute leukemia undergoing chemotherapy may assist with optimal clinical decision making in order to alleviate the symptom burden and improve children’s quality of life.

Author Affiliations: Department of Hematology (Mss Li, Ma, and Yang), Discipline Supervision Office (Ms Chan), and Intensive Care Unit (Ms Zhang), Children's Hospital Affiliated to Soochow University, Suzhou, China.

R.L. and J.M. contributed equally to this work and should be regarded as co–first authors.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Yuying Chan, MSN, RN, Discipline Supervision Office, Children's Hospital Affiliated to Soochow University, No. 92 Zhongnan Road, Suzhou 215025, China (

Accepted for publication February 27, 2019.

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