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Symptom Trajectories of Adolescents During Hematopoietic Stem Cell Recovery

Rodgers, Cheryl, PhD, RN, CPNP, CPON†; Highberger, Marika, MSN, RN, CPNP; Powers, Kimberly, MA, CPNP; Voigt, Katherine, MS, PA-C; Douglas, Christian, DrPH

doi: 10.1097/NCC.0000000000000643
Article: PDF Only

Background Adolescents undergoing allogeneic hematopoietic stem cell transplantation (HSCT) experience multiple symptoms during and after the transplant. These symptoms can increase the need for medical care and reduce the quality of their life. However, little is known about symptom experiences specific to adolescents undergoing HSCT.

Objective The primary aim was to describe symptom incidence, severity, and distress trajectories among adolescents from pre-HSCT through 90 days post-HSCT. A secondary aim was to examine the relationship between symptom trajectories and demographic and treatment factors.

Methods A repeated-measures design was used for this prospective study. Demographic and treatment information was collected from the medical record. Symptoms were assessed with the Memorial Symptom Assessment Scale 10–18. Symptom trajectories were identified by latent class growth analysis with growth mixture modeling; logistic regression evaluated relationships of demographic and treatment characteristics on the latent classes of symptom trajectories.

Results Two distinct latent class trajectories were identified for symptom incidence, severity, and distress. Symptom incidence declined, but symptom severity and distress remained stable. No significant relationships were noted among any demographic or treatment characteristics to any of the symptom trajectories.

Conclusions Symptoms persist and remain severe and distressing throughout the first 90 days after HSCT, with pain and lack of energy among the highest in incidence, severity, and distress.

Implications for Practice Awareness of symptom trajectories empowers nurses to assess for symptoms throughout the HSCT process and conduct meaningful symptom discussions with their patients.

Author Affiliations: Duke University School of Nursing, Durham, North Carolina (Drs Rodgers and Douglas); Baylor College of Medicine, Houston, Texas (Ms Highberger); and Ann & Robert H. Lurie Children's Hospital of Chicago (Ms Powers); and Northwestern Medical Group, Lake Forest (Ms Voigt), Illinois.

This study was funded by an Alex's Lemonade Stand Foundation Nursing Grant.

The authors have no conflicts of interest to disclose.

Correspondence: Christian Douglas, DrPH, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 (


Accepted for publication June 12, 2018.

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