Symptom Trajectories of Adolescents During Hematopoietic Stem Cell Recovery

Abstract

Background Adolescents undergoing allogeneic hematopoietic stem cell transplantation (HSCT) experience multiple symptoms during and after the transplant. These symptoms can increase the need for medical care and reduce the quality of their life. However, little is known about symptom experiences specific to adolescents undergoing HSCT. Objective The primary aim was to describe symptom incidence, severity, and distress trajectories among adolescents from pre-HSCT through 90 days post-HSCT. A secondary aim was to examine the relationship between symptom trajectories and demographic and treatment factors. Methods A repeated-measures design was used for this prospective study. Demographic and treatment information was collected from the medical record. Symptoms were assessed with the Memorial Symptom Assessment Scale 10–18. Symptom trajectories were identified by latent class growth analysis with growth mixture modeling; logistic regression evaluated relationships of demographic and treatment characteristics on the latent classes of symptom trajectories. Results Two distinct latent class trajectories were identified for symptom incidence, severity, and distress. Symptom incidence declined, but symptom severity and distress remained stable. No significant relationships were noted among any demographic or treatment characteristics to any of the symptom trajectories. Conclusions Symptoms persist and remain severe and distressing throughout the first 90 days after HSCT, with pain and lack of energy among the highest in incidence, severity, and distress. Implications for Practice Awareness of symptom trajectories empowers nurses to assess for symptoms throughout the HSCT process and conduct meaningful symptom discussions with their patients.

Parent Caregiving Experiences and Posttraumatic Growth Following Pediatric Hematopoietic Stem Cell Transplant

“…Allogeneic hematopoietic stem cell transplant (HSCT) offers a lifesaving treatment for a growing number of children diagnosed with life-threatening and rare blood, immune, metabolic, and malignant diseases (Guilcher, 2016). Despite diverse utility and improving survivorship, HSCT poses significant child mortality and morbidity during both acute recovery and long-term survivorship (Battiwalla, Tichelli, et al, 2017;Rodgers et al, 2019). HSCT has a significant impact not only on the child's health and quality of life but also on parents' psychological and emotional functioning (Rodday et al, 2017).…”

Parental Posttraumatic Growth After Pediatric Hematopoietic Stem Cell Transplant

“…The preparative chemotherapy and potential adverse effects from the transplant may lead to life-threatening complications and may even result in children's deaths 1 . Following HSCT chemotherapy preparative conditioning, children endure distressing fatigue, mucositis related pain, nausea, vomiting, and appetite suppression, as well as risk of infection, bleeding, and graft-versus-host disease 2-4 . Children's adjustment to these physical changes and anxiety regarding the uncertainty of HSCT success impacts their quality of life during HSCT recovery 2,5 .…”

“…Following HSCT chemotherapy preparative conditioning, children endure distressing fatigue, mucositis related pain, nausea, vomiting, and appetite suppression, as well as risk of infection, bleeding, and graft-versus-host disease 2-4 . Children's adjustment to these physical changes and anxiety regarding the uncertainty of HSCT success impacts their quality of life during HSCT recovery 2,5 . Early integration of palliative care is needed to support parents navigating the physical and emotional toll of children's unpredictable HSCT recovery.…”

Acupressure to Reduce Treatment-Related Symptoms for Children With Cancer and Recipients of Hematopoietic Stem Cell Transplant: Protocol for a Randomized Controlled Trial

“…Despite advances in pharmacologic symptom management, most children with cancer 1,2 or receiving a hematopoietic stem cell transplant (HSCT) [3][4][5][6] suffer from multiple treatment-related symptoms including nausea, vomiting, 7 pain, 8 and fatigue. 3 Pharmacologic symptom management can be effective, but can have side effects that decrease quality of life.…”

“…9,10 Symptom distress is an important predictor of poor health-related quality of life among children treated for cancer 11 or receiving HSCT. 6,12 Severe symptoms can result in interruptions in planned treatment, dose reductions, or other therapy changes with the potential to compromise survival. 13,14 A systematic review documented frequent undertreated symptoms during oncology and HSCT treatment.…”