Correlation Study On Symptom Clusters And Quality Of Life In Children With Acute Leukemia During Chemotherapy

Objective:To investigate the frequency,severity,distress of symptoms and quality of life in children with acute leukemia during chemotherapy,investigate the classification and composition of potential symptom clusters in children,explore the influencing factors of the severity of symptom clusters in children.At the same time,the correlation between symptom clusters and quality of life during chemotherapy in children with acute leukemia was analyzed.Scientific and reliable theoretical evidence was presented to develop a scientific and effective symptom management strategy,alleviate or even eliminate the discomfort symptoms of children and improve their quality of life.Methods:This study used a convenient sampling method to conduct a cross-sectional survey of children with acute leukemia who underwent chemotherapy in the Department of Hematology,a university affiliated with Children’s Hospital from July 2017 to November 2018.A total of 184 valid questionnaires were obtained.The Survey tools included the general information questionnaire,the Memorial Symptom Assessment Scale 10-18(MSAS10-18)and Pediatric Quality of Life InventoryTM General Core Module(PedsQLTM4.0).The data was entered and statistically processed using SPSS 18.0 software.Descriptive analysis of the demographic characteristics and disease-related characteristics of patient,the incidence,frequency,severity and distress of the symptoms,and the current quality of life,such as mean,standard deviation,percentage,etc.Exploratory factor analysis was used to identify symptom clusters.The internal consistency of the symptom cluster was assessed by Cronbach’s a coefficients,and the correlation between the symptoms in the cluster was analyzed by Spearman correlation.Univariate analysis and multiple linear regression analysis were used to explore the factors affecting the severity of symptom clusters.The impact of symptom clusters on quality of life was analyzed by Spearman correlation analysis and multiple linear regression analysis.The difference was statistically significant at P<0.05.Results:1.Children with acute leukemia experienced(16.49±5.93)symptoms during chemotherapy,and the top five were lack of energy(89.7%),sweating(85.3%),lack of appetite(84.8%),change in the way food tastes(84.2%),nausea(81.5%);among them,there were twenty six symptoms with a incidence>20%.Symptom severity score was 1.18±0.40～2.15±0.66,the top five were lack of energy,sweating,hair loss,lack of appetite,"I don’t look like myself’.The proportion of children with symptoms ranging from frequent to almost continuous occurrence was 1.1%to 44.3%,the top five were lack of energy,sweating,lack of appetite,feeling irritable,and dry mouth.The proportion of symptoms ranging from more to a lot was 1.1%to 32.7%,the top five were lack of energy,sweating,lack of appetite,and hair loss,"I don’t look like myself".2.Exploratory factor analysis method resulted in six symptom clusters,namely gastrointestinal symptom cluster,emotional symptom cluster,nervous system symptom cluster,skin mucosal symptom cluster,self-image disorder symptom cluster and somatic symptom cluster.The total variance contribution rate of six symptom clusters was 72.020%,and the variance contribution rates of symptom clusters were 29.905%,12.180%,8.751%,8.138%,6.895%,and 6.151%,respectively.The Cronbach’s a coefficient of each symptom cluster was 0.904,0.877,0.916,0.958,0.761,and 0.824,respectively.Spearman correlation analysis showed a positive correlation between each symptom within six symptom clusters(r=0.275～0.912,all P=0.000<0.001).3.Univariate analysis of the severity of symptom clusters in children with acute leukemia showed gender,age,place of residence,highest grade completed,whether it was only child,chemotherapy phase,primary caregiver’s role,primary caregiver’s education level,primary caregiver’s occupation,family monthly income,reimbursement of symptom clusters score were significant difference(P<0.05).4.Multiple linear regression analysis of the severity of symptom clusters in children with acute leukemia showed that the chemotherapy phase was associated with the gastrointestinal symptom cluster,with 14.1%of the variation of the cluster explained by this variable.Factors influencing the emotional symptom cluster were gender,age and chemotherapy phase,which explained 23.6%of the variation of the cluster.The nervous system symptom cluster was affected by the chemotherapy phase,explaining 7.3%of the variation of the cluster.The self-image disorder symptom cluster was affected by gender,with 22.2%of the variation of the cluster explained by this variable.The influencing factors of the somatic symptom cluster were the place of residence and chemotherapy phase,which explained 15.8%of the variation of the cluster.5.The total quality of life of children with acute leukemia during chemotherapy was(67.97±11.03)points.The scores from high to low were social function(74.96± 12.47)points,emotional function(67.5± 16.61)points,and school function(59.97±16.45)points,physiological function(59.63± 17.30)points.6.The severity of symptom clusters in children with acute leukemia was negatively correlated with quality of life during chemotherapy.The correlation coefficient was-0.213 to-0.462.Gastrointestinal symptom cluster,emotional symptom cluster and somatic symptom cluster were effective predictors of quality of life in children with acute leukemia during chemotherapy.Conclusion:1.Children with acute leukemia experience various symptoms during chemotherapy.The incidence and severity of symptoms were always in high level,and the frequency,distress of symptoms were higher.The symptom burden of the patient was heavier.The medical staff should pay attention to the symptom assessment and symptom management of the child.2.Children with acute leukemia had six symptom clusters during chemotherapy,which were gastrointestinal symptom clduster,emotional symptom cluster,nervous system symptom cluster,skin mucosal symptom cluster,self-image disorder symptom cluster and somatic symptom cluster.During chemotherapy,children not only experienced the disturbance of single symptoms,but also experienced complex and severe symptoms at the same time,which provided a scientific theoretical basis for medical staff to further explore symptom management and control from the perspective of the symptom cluster,and enriched the related theories of symptom clusters of children with acute leukemia to a certain extent.3.The main influencing factors of symptom cluster in children with acute leukemia were gender,age,place of residence,whether it is only child,chemotherapy phase.Therefore,in the clinical symptom management,individualized intervention measures should be implemented according to the influencing factors of the symptom cluster to minimize the symptom trouble.4.The overall quality of life quality and the scores of each dimension were lower in children with acute leukemia.The average score of physiological function dimension was the lowest,and the average score of social function dimension was the highest.This suggests that medical staff should take active measures to alleviate the physical discomfort and pain of the child,and give them more emotional support and psychological counseling during the chemotherapy period.5.During chemotherapy,the symptom cluster of children with acute leukemia was negatively correlated with the quality of life,that is,the higher the severity of the symptom cluster,the worse the quality of life.This suggests that medical staff should pay attention to the prevention of children’s symptoms and formulate scientific and efficient symptom management,so as to relieve the burden of children’s symptoms and improve the quality of life of children to a certain extent.