Multiple Symptoms and Their Influences on Health-Related Quality of Life in Adolescents with Hematologic Malignancies Undergoing Chemotherapy

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Piyarat Samantarath
Kanaungnit Pongthavornkamol
Karin Olson
Aurawamon Sriyuktasuth
Kleebsabai Sanpakit


             An understanding of symptom experiences is essential to improve patient outcomes. This cross-sectional, predictive correlation study investigated the symptom experiences and predictive abilities on health-related quality of life in 94 Thai adolescents with hematologic malignancies undergoing chemotherapy at the Division of Pediatric Hematology and Oncology at three tertiary care hospitals in Bangkok. The Theory of Unpleasant Symptoms was used as the conceptual framework. Data were collected through a Demographic and Medical Record Form, the Modified Memorial Symptom Assessment Scale, and the Pediatric Quality of Life Inventory.

               The findings demonstrated that participants experienced several symptoms. The most prevalent were pain, nausea/vomiting, lack of appetite, worrying and hair loss. In addition, feeling sad, hair loss, and sleeping difficulty significantly influenced health-related quality of life and explained 33.2% of variances. The findings support the evidence of concurrent multiple symptoms. The implications for nursing practice are that nurses should attend to the symptoms of sadness, hair loss and sleeping difficulty in this patient group, and design interventions to manage these symptoms to improve their quality of life during chemotherapy treatment.





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Samantarath P, Pongthavornkamol K, Olson K, Sriyuktasuth A, Sanpakit K. Multiple Symptoms and Their Influences on Health-Related Quality of Life in Adolescents with Hematologic Malignancies Undergoing Chemotherapy. PRIJNR [Internet]. 2018 Sep. 28 [cited 2022 Dec. 9];22(4):319-31. Available from:
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1. Burkhamer J, Kriebel D, Clapp R. The increasing toll of adolescent cancer incidence in the US. PLoS ONE. 2017;12(2):e0172986. PubMed PMID: PMC5325567.

2. Stiller CA. International patterns of cancer incidence in adolescents. Cancer Treatment Reviews. 2007;33 (7):631-45.

3. Imsamran W, Chaiwerawattana A, Wiangnon S, Pongnikorn D, Suwanrungrung K, Sangrajrang S, Buasom R. Cancer in Thailand Vol.VIII, 2010-2012. Thailand: National Cancer Institute; 2015.

4. The Thai Pediatric Oncology Group, The Thai Society of Hematology, The Thai National Health Security office. National protocol for the treatment of childhood cancers 2014. Bangkok: M Print Cooperation; 2014.

5. Place AE, Frederick NN, Sallan SE. Therapeutic approaches to haematological malignancies in adolescents and young adults. British Journal of Haematology. 2014;164 (1):3-14.

6. Baggott C, Dodd M, Kennedy C, Marina N, Miaskowski C. Multiple symptoms in pediatric oncology patients: A systematic review. Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses. 2009;26(6):325-39.

7. Erickson JM, MacPherson CF, Ameringer S, Baggott C, Linder L, Stegenga K. Symptoms and symptom clusters in adolescents receiving cancer treatment: A review of the literature. International Journal of Nursing Studies.; 2013; 50(6): 847-69

8. Kestler SA, LoBiondo-Wood G. Review of symptom experiences in children and adolescents with cancer. Cancer Nursing. 2012;35(2):E31-49. PubMed PMID: 21760492. Epub 2011/07/16. eng.

9. Buckner TW, Wang J, DeWalt DA, Jacobs S, Reeve BB, Hinds PS. Patterns of symptoms and functional impairments in children with cancer. Pediatric Blood Cancer. 2014; 61(7):1282-8.

10. Taylor RM, Pearce S, Gibson F, Fern L, Whelan J. Developing a conceptual model of teenage and young adult experiences of cancer through meta-synthesis. Int J Nurs Stud. 2013; 50(6): 832-46

11. Tiwaree C, Kantawng S, Wonghongkul T, Lertwatthanawilat W. Predicting Factors of Uncertainty in Illness Among Children with Leukemia Undergoing Chemotherapy [Internet]. Pacific Rim International Journal of Nursing Research. 2016;20(1):33-4. Available from: //www.

12. Baggott CR, Dodd M, Kennedy C, Marina N, Matthay KK, Cooper B, et al. An evaluation of the factors that affect the health-related quality of life of children following myelosuppressive chemotherapy. Supportive Care in Cancer. 2011; (3):353-61.

13. Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P. The PedsQL in pediatric cancer: Reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, multidimensional Fatigue Scale, and Cancer Module. Cancer. 2002;94(7):2090-106.

14. Lenz ER, Pugh LC, Milligan RA, Gift A, Suppe F. The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science. 1997; 19(3):14-27.

15. Lenz R, Gift A, Pugh C, & Milligan A. Unpleasant symptoms. In Peterson J, Bredow S, editors. Middle range theories: Application to nursing research Philadelphia: Lippincott Williams & Wilkins; 2013., pp. 69-81.

16. Gedaly-Duff V, Lee KA, Nail LM, Nicholson HS, Johnson KP. Pain, sleep disturbance, and fatigue in children with leukemia and their parents: A pilot study. Oncology Nursing Forum. 2006;33(3):641-6.

17. Sanford SD, Okuma JO, Jianmin PAN, Deo Kumar S, West N, Farr L, et al. Gender differences in sleep, fatigue, and daytime activity in a pediatric oncology sample receiving dexamethasone. Journal of Pediatric Psychology. 2008;33(3):298-306.

18. Zupanec S, Jones H, Stremler R. Sleep habits and fatigue of children receiving maintenance chemotherapy for ALL and their parents. Journal of Pediatric Oncology Nursing. 2010;27(4):217-28.

19. Hinds PS, Hockenberry MJ, Gattuso JS, Srivastava DK, Tong X, Jones H, et al. Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia. Cancer. 2007;15 110(10):2321-30.

20. Kuntana K, Soomlek S, Treevanich A. Unpleasant symptoms and symptom management among children with acute lymphoblastic leukemia undergoing chemotherapy. Journal of Nursing and Health Care. 2005;23(2):17-27 [in Thai].

21. Docherty SL, Sandelowski M, Preisser JS. Three months in the symptom life of a teenage girl undergoing treatment for cancer (English). Research in nursing & health. 2006 01/2006;29(4):294-310.

22. Gordijn MS, van Litsenburg RR, Gemke RJ, Huisman J, Bierings MB, Hoogerbrugge PM, et al. Sleep, fatigue, depression, and quality of life in survivors of childhood acute lymphoblastic leukemia. Pediatric Blood & Cancer. 2013;60(3):479-85.

23. Momani TeG, Mandrell BN, Gattuso JS, West NK, Taylor SL, Hinds PS. Children’s Perspective on Health-Related Quality of Life During Active Treatment for Acute Lymphoblastic Leukemia. Cancer Nursing. 2015;38(1): 50-9.

24. Algren C. Family-centered care of the child during illness and hospitalization. In Hockenberry MJ, Wilson D. , Wong’s nursing care of infants and children (10th ed.). St. Louis: Mosby Elsevier;2015, pp. 1046–1082.

25. Linder LA. Developmental diversity in symptom research involving children and adolescents with cancer. J Pediatr Nurs. 2008;23(4):296-309.

26. Arslan FT, Basbakkal Z, Kantar M. Quality of life and chemotherapy-related symptoms of Turkish cancer children undergoing chemotherapy. Asian Pacific journal of cancer prevention : APJCP. 2013;14(3):1761-8. PubMed PMID: 23679270. Epub 2013/05/18. eng.

27. Williams PD, Williams AR, Kelly KP, Dobos C, Gieseking A, Connor R, et al. A symptom checklist for children with cancer: the therapy-related symptom checklist -- children. Cancer Nursing. 2012;35(2):89-98.

28. Johnson, A. Adolescents receiving chemotherapy: Sleep, symptoms, and quality of Life [Doctoral Dissertation]. Portland: Oregon Health & Science University; 2008. [cited 2017 June 30]. Available from http://digital

29. Manitta V, Zordan R, Cole-Sinclair M, Nandurkar H, Philip J. The symptom burden of patients with hematological malignancy: A cross-sectional observational study. Journal of Pain & Symptom Management. 2011; 42(3):432-42.

30. Suedee N., Pongthavornkamol, K. , Sriyuktasuth, A., & Siritanaratkul, N. Symptom experiences and their influences on functional status in hematological malignancy patients receiving chemotherapy. Journal of Nursing Science. 2015; 33(2):29-40[in Thai].

31. Zimmermann C, Yuen D, Mischitelle A, Minden MD, Brandwein JM, Schimmer A, et al. Symptom burden and supportive care in patients with acute leukemia. Leukemia research. 2013;37(7):10.1016/j.leukres.2013.02. 009. PubMed PMID: PMC3808347.

32. Pongsing Y, Thai mothers’ reports of symptoms in young children receiving chemotherapy. [Dissertation]. Portland: Oregon Health & Science University. 2010. [cited 2017 June 30]. Available from http://digitalcommons.ohsu. edu/etd.

33. Collins JJ, Devine TD, Dick GS, Johnson EA, Kilham HA, Pinkerton CR, et al. The measurement of symptoms in young children with cancer: The validation of the Memorial Symptom Assessment Scale in children aged 7-12. Journal of Pain & Symptom Management. 2002;23(1):10-6.

34. Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E, et al. The Memorial Symptom Assessment Scale: An instrument for the evaluation of symptom prevalence, characteristics and distress. European Journal of Cancer. 1994;30(9):1326-36.

35. Sritipsukho P, Wisai M, Thavorncharoensap M. Reliability and validity of the Thai version of the Pediatric Quality of Life Inventory 4.0. Quality of Life Research : An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2013;22(3):551-7.

36. World Health Organization. Persisting pain in children package: WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. [Switzerland]: World Health Organization; 2012 [cited 2018 Jan 28]. Available from: http://apps.who. int/iris/bitstream/10665/44540/1/978924154 8120_Guidelines.pdf

37. Maloney AM. Gastrointestinal tract. In: Tomlinson D, Kline N. Pediatric oncology nursing: Advanced clinical handbook. New York: Springer; 2010, pp. 354-375.

38. Holdsworth MT, Raisch DW, Frost J. Acute and delayed nausea and emesis control in pediatric oncology patients. Cancer. 2006;106(4):931-40. PubMed PMID: 16404740. Epub 2006/01/13. eng.

39. National Institute of Mental Health. Depression. 2016 [updated 2016 October; cited 2018 Jan 20]. Available from depression/index.shtml

40. Enskar K, von Essen L. Physical problems and psychosocial function in children with cancer. Paediatric Nursing. 2008;20(3):37-41.