| ObjectiveTo preliminarily verify and demonstrate the health outcomes(symptom and functional status)reported by children with leukemia;To classify groups of children with leukemia who experience similar levels of symptom severity,and to characterize homogeneous subpopulation;To compare the functional impairments across class designation;To examine the various influences associated with symptom profile membership;To provide valuable guidance for clinicians achieving a specific multiple symptom management model,and to promote the development of the field of health outcomes of children with cancer as well as the improvement of pediatric cancer care.MethodsThis study is divided into two parts:1.The investigation of the health outcomes(symptom and functional status)reported by children with leukemiaThe investigation method was determined through methodology research and literature review.In a cross-sectional,single-site design,218 children with leukemia who were aged 8-17 from a children's hospital in Shanghai were included to investigate their symptoms and functional impairments prospectively.Data was collected using a general information questionnaire and the Chinese version of Pediatric PROMIS—child version(C-C-Ped-PROMIS),which included the Depressive Symptoms,Anger,Anxiety,Fatigue and Pain Interference,Peer Relationships,Physical Function-Mobility,Physical Functional-Upper Extremity eight short forms.The status of symptom and function domains of C-C-Ped-PROMIS were described and analyzed.2.A pilot heterogeneity test of children with leukemia experiencing multiple symptoms(1)The classification of children with leukemia experiencing multiple symptoms:Data was selected from 218 C-C-Ped-PROMIS in the field of symptom,which included the Depressive Symptoms,Anger,Anxiety,Fatigue and Pain Interference five short forms.Then,LPA was used to identify patterns of symptoms in children with leukemia.(2)The comparison of the functional impairments across class designation:According to the result of the classification,health outcomes differences were analyzed on the score of C-C-Ped-PROMIS in the field of function domains across class designation using Chi-squared test or non-parametric test.(3)The examination of various influences associated with symptom profile membership:Multinomial logistic model was conducted to examine factors associated with profile membership.Results1.The investigation of the health outcomes(symptom and functional status)reported by children with leukemiaThe mean domain scores of C-C-Ped-PROMIS range from 41.56 to 49.22,indicating that,in the field of symptom domains,the mean score were highest in the Depressive Symptoms short form,but lowest in the Anger short form,while in the field of function domains,the mean score were lowest in the Peer Relationships short form,but highest in the Physical Functional-Upper Extremity short form.Taking health outcomes of United States children population as a reference,except depressive symptoms(P=0.146),children-reported anger,anxiety,fatigue and pain interference were lower than the reference(P<0.05);The average level of peer relationships,physical function including mobility and upper extremity were lower than norm(P<0.05).2.A pilot heterogeneity test of children with leukemia experiencing multiple symptoms(1)The classification of children with leukemia experiencing multiple symptoms:The result of LPA indicate that the data best fit a three-profile model.Posterior assignment probabilities for profiles were 91.5%,97.0%and 96.8%,respectively.Given the estimated mean symptom scores for each subdomain according to class,on average,children in profile 1 had the lowest symptom severity(below 40)and children in profile 3 had the highest symptom severity(above50)conversely,while domain scores for profiles 2 fell between profiles 1 and 3(below but approach 50).Based on the pattern of the conditional probabilities in each latent class,we define profile 1,profile 2,profile 3 as "Mild Symptom Group","Less Severe Symptom Group" and "Severe Symptom Group",respectively."Mild Symptom Group" contained 42 children,19.3%of the total number of children;"Less Severe Symptom Group"contained 110 children,50.5%of the total and "Severe Symptom Group" contained 66 children,30.3%of the total.(2)The comparison of the functional impairments across class designation:The mean standardized scores of the Peer Relationships,Physical Function-Mobility,Physical Functional-Upper Extremity three short forms significantly vary(P<0.05 or P<0.01)by profiles.Further analysis found that children in "Severe Symptom Group" had on average worse physical functioning than those in other profiles(both P<0.05),while children in "Mild Symptom Group" had on average better peer relationship than those in "Severe Symptom Group"(P<0.05),conversely.(3)The examination of various influences associated with symptom profile membership:Three profiles had a significant effect of treatment status(P=0.005,P=0.017);"Mild Symptom Group" and"Severe Symptom Group" had a significant effect of guardian's education level(P=0.020).The result of the multinomial logistic model indicated that treatment status and guardian's education level both significantly predicted the child' s profile membership.Conclusion1.Children with leukemia are able to self-report multiple concurrent symptoms and functional impairments during the whole cancer treatment.C-C-Ped-PROMIS is with good clinical applicability.2.Children with leukemia undergoing multiple symptoms are empirically revealed to be a heterogeneous population.At least three subgroups of children were identified,in which who experience similar levels of cancer-related symptom bundle.3.There is a trend of functional impairments aggravate in children identified as experiencing higher symptom severity,but the research cannot provide adequate evidence to explain the relationship between symptoms and function.4.Treatment status and guardian's education level may have influence on the prediction of the child s profile membership,but the research was unable to develop a predictive model. |
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