title: A pilot exploration of symptom trajectories in adolescents with cancer during chemotherapy.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Nursing, Virginia Commonwealth University Health Systems, Richmond, VA 23219, USA. swameringer@vcu.edu
authors.forename: Suzanne
authors.initials: S
authors.lastname: Ameringer
authors.forename: R K
authors.initials: RK
authors.lastname: Elswick
authors.forename: Debra P
authors.initials: DP
authors.lastname: Shockey
authors.forename: Robyn
authors.initials: R
authors.lastname: Dillon
mesh_terms: D000293:Adolescent; D000681:Amylases / Q000032:analysis; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology*; D002908:Chronic Disease; D064420:Drug-Related Side Effects and Adverse Reactions; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009325:Nausea / Q000209:etiology*; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D010146:Pain / Q000209:etiology*; D010865:Pilot Projects; D012463:Saliva / Q000737:chemistry; D012720:Severity of Illness Index; D012890:Sleep / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000681:Amylases