title: Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide.
abstract: OBJECTIVE
  To examine the influence of the proposed symptom cluster of fatigue, nausea and vomiting, and sleep disturbances on clinical outcomes defined as behavior changes, depression, and performance status in children and adolescents before and after receiving cisplatin, doxorubicin, or ifosfamide chemotherapy.
  
  
  METHODS
  A prospective, descriptive, within-group, before-and-after-chemotherapy design was used.
  
  
  METHODS
  Two major childhood cancer treatment hospitals in the United States.
  
  
  METHODS
  67 patients aged 7-18 years who were receiving chemotherapy courses of cisplatin, doxorubicin, or ifosfamide.
  
  
  METHODS
  Fatigue, depression, behavior, and performance assessments were completed on the first day of cisplatin, doxorubicin, or ifosfamide therapy and one week later. Patients wore a wrist actigraph on the nondominant hand during the course of therapy and for 48 hours after discharge from the hospital. Nausea and vomiting were measured every 24 hours during the course of therapy and for 48 hours after discharge. A linear mixed model was used to evaluate the influence of the symptom cluster. Regression analysis was used to examine the associations between performance status and the symptom cluster. Principal component analysis with varimax rotation was used to produce the correlation of sleep symptoms.
  
  
  METHODS
  Fatigue, nausea and vomiting, sleep disturbances, behavior, depression, and performance.
  
  
  RESULTS
  Adolescents with the cluster of increased fatigue and sleep disturbances experienced more depressive symptoms and behavior changes. Children with higher levels of fatigue had increased depressive symptoms. The more fatigue parents perceived in their children or adolescents, the more behavior and emotional difficulties were reported.
  
  
  CONCLUSIONS
  Fatigue, sleep disturbance, and nausea and vomiting, when clustered, impacted depressive symptoms and behavior changes in adolescents after chemotherapy. In children, fatigue alone impacted depressive symptoms and behavior changes.
  
  
  CONCLUSIONS
  Symptom clusters can have a significant impact on children's and adolescents' quality of life during cancer treatment. Early recognition and intervention for these symptoms are an important nursing role.
authors.affiliation: Department of Pediatrics, Section of Hematology/Oncology, Texas Children's Cancer Center at Texas Children's Hospital, Houston, USA. mjhocken@txccc.org
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Hockenberry
authors.forename: Mary C
authors.initials: MC
authors.lastname: Hooke
authors.forename: Maryann
authors.initials: M
authors.lastname: Gregurich
authors.forename: Kathy
authors.initials: K
authors.lastname: McCarthy
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sambuco
authors.forename: Kevin
authors.initials: K
authors.lastname: Krull
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000187:drug effects; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001294:Attitude to Health; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002945:Cisplatin / Q000009:adverse effects*; D016000:Cluster Analysis; D003863:Depression / Q000139:chemically induced / Q000175:diagnosis; D004317:Doxorubicin / Q000009:adverse effects*; D005221:Fatigue / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects*; D017567:Karnofsky Performance Status; D016014:Linear Models; D008297:Male; D009325:Nausea / Q000139:chemically induced / Q000175:diagnosis; D015404:Nursing Methodology Research; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000139:chemically induced / Q000175:diagnosis; D011795:Surveys and Questionnaires; D014481:United States; D014839:Vomiting / Q000139:chemically induced / Q000175:diagnosis
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide