title: Anxiety, pain, and nausea during the treatment of standard-risk childhood acute lymphoblastic leukemia: A prospective, longitudinal study from the Children's Oncology Group.
abstract: BACKGROUND
  This prospective study describes the procedure-related anxiety, treatment-related anxiety, pain, and nausea experienced by children with standard-risk acute lymphoblastic leukemia (ALL) during the first year of treatment.
  
  
  METHODS
  This study was undertaken at 31 Children's Oncology Group (COG) sites. Eligible children who were 2 to 9.99 years old were enrolled in a COG trial for patients with newly diagnosed standard-risk ALL from 2005 to 2009. Parents completed a demographic survey at the baseline and the Pediatric Quality of Life Inventory 3.0 Cancer Module (proxy version) and the General Functioning Scale of the Family Assessment Device 1, 6, and 12 months after the diagnosis. The association between patient-related (age, sex, ethnicity, and treatment), parent-related (marital status and education), and family-related factors (functioning, income, and size) and symptom scores was evaluated.
  
  
  RESULTS
  The mean scores for procedure-related anxiety, treatment-related anxiety, and pain improved during the first year of treatment (P < .0389). The mean nausea score was poorer 6 months after the diagnosis in comparison with the other assessments (P = .0085). A younger age at diagnosis was associated with significantly worse procedure-related anxiety (P = .004). An older age (P = .0002) and assignment to the intensified consolidation study arm (P = .02) were associated with significantly worse nausea.
  
  
  CONCLUSIONS
  Children with ALL experienced decreasing treatment-related anxiety, procedure-related anxiety, and pain during the first year of treatment. In comparison with scores at 1 and 12 months, nausea was worse 6 months after the diagnosis. Minimization of procedure-related anxiety in younger children and improved nausea control in older children and those receiving more intensified treatment should be prioritized.
authors.affiliation: Department of Pharmacy, Research Institute, Hospital for Sick Children, Toronto, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
authors.forename: L Lee
authors.initials: LL
authors.lastname: Dupuis
authors.affiliation: Department of Biostatistics, Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Lu
authors.affiliation: School of Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Hannah-Rose
authors.initials: HR
authors.lastname: Mitchell
authors.affiliation: Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada.
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
authors.affiliation: Department of Biostatistics, Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Devidas
authors.affiliation: HARP Pharma Consulting, Mystic, Connecticut.
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Mattano
authors.affiliation: Perlmutter Cancer Center, Langone Medical Center, New York University, New York, New York.
authors.forename: William L
authors.initials: WL
authors.lastname: Carroll
authors.affiliation: Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Naomi
authors.initials: N
authors.lastname: Winick
authors.affiliation: Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hunger
authors.affiliation: Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Kelly W
authors.initials: KW
authors.lastname: Maloney
authors.affiliation: Section of Pediatric Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Nina S
authors.initials: NS
authors.lastname: Kadan-Lottick
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology*; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D060830:Consolidation Chemotherapy / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D008137:Longitudinal Studies; D060046:Maintenance Chemotherapy / Q000379:methods; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009325:Nausea / Q000139:chemically induced* / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology / Q000209:etiology*; D010290:Parents; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000523:psychology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D003561:Cytarabine; D011092:Polyethylene Glycols; D014750:Vincristine; C042705:pegaspargase; D003907:Dexamethasone; D003520:Cyclophosphamide; D015122:Mercaptopurine; D001215:Asparaginase; D008727:Methotrexate
keywords: anxiety; childhood acute lymphoblastic leukemia; nausea; pain