Physical, Psychological and Social Symptoms, Activity and Education of Children and Adolescents with Acute Lymphoblastic Leukemia Receiving Maintenance Chemotherapy

Hee Sung Yoon; Kwang Sung Kim; Sun Hee Choi; So Eun Choi; Kyoung A Kim; Kyoung Eon Kim

doi:10.5388/aon.2016.16.4.169

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Yoon, Kim, Choi, Choi, Kim, and Kim: Physical, Psychological and Social Symptoms, Activity and Education of Children and Adolescents with Acute Lymphoblastic Leukemia Receiving Maintenance Chemotherapy

Original Article

Asian Oncology Nursing 2016; 16(4): 169-175.

Published online: 31 December 2016

DOI: https://doi.org/10.5388/aon.2016.16.4.169

Physical, Psychological and Social Symptoms, Activity and Education of Children and Adolescents with Acute Lymphoblastic Leukemia Receiving Maintenance Chemotherapy

Hee Sung Yoon¹, Kwang Sung Kim¹, Sun Hee Choi¹, So Eun Choi², Kyoung A Kim¹, Kyoung Eon Kim¹

¹BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

²Department of Nursing, Mokpo National University, Muan, Korea.

Address reprint requests to: Kim, Kwang Sung. Catholic University, Seoul St. Mary's Hospital,505 Banpo-dong,Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-2786, Fax: +82-2-2258-2780, bm.coor@catholic.ac.kr

Received 19 September 2016 Revised 27 October 2016 Accepted 30 November 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was to identify the physical, psychological and social symptoms of ALL (acute lymphoblastic leukemia) children and adolescents receiving maintenance chemotherapy to build a basic data set to produce effective nursing intervention and ultimately help their early return to school and social adaptation.

Methods

Fifty ALL children and adolescents between 4 and 18, who were receiving maintenance chemotherapy were surveyed on days 2, 7, and 28. For younger children, between the age of 4 and the 3rd year in elementary school, their primary caregivers answered the survey and those between the 4th year in elementary school and the age of 18 answered the survey themselves.

Results

During maintenance chemotherapy, ALL children and adolescents experience diverse physical, psychological and social symptoms. On days 7 and 28, physical and social symptoms were greater than physical symptoms. Physical symptoms were greatest on day 2 and the most psychological and social symptoms were observed on day 7. During the maintenance chemotherapy period, 40% of the children and adolescents could not attend regular educational institutions.

Conclusion

Since each point in the maintenance chemotherapy period shows different symptomatic characteristics, nursing intervention can be provided appropriately for each specific point to help the patients' social adaptation and early return to school.

Keywords: Acute Lymphoblastic Leukemia, Symptom Assessment, Chemotherapy

Figures and Tables

Fig. 1

Design of study.

Table 1

General Characteristics & Laboratory Finding (N=50)

Characteristics	Categories	n (%) or M±SD
Gender	Male	34 (68.0)
Gender	Female	16 (32.0)
Care giver	Parents	47 (94.0)
	Grand parents	2 (4.0)
	Others	1 (2.0)
ALL risk feature	Low risk	14 (28.0)
	Standard risk	14 (28.0)
	High risk	13 (26.0)
	Very high risk	9 (18.0)
Cycle of chemotherapy	2	8 (16.0)
	3	4 (8.0)
	4	6 (12.0)
	5	11 (22.0)
	6	4 (8.0)
	7	9 (18.0)
	8	8 (16.0)
ECOG	0	41 (82.0)
	1	8 (16.0)
	2	1 (2.0)
Other medications	No	44 (88.0)
Other medications	Yes	6 (12.0)
Other treatment	No	48 (96.0)
Other treatment	Yes	2 (4.0)
Laboratory finding	WBC (10^{^9}/L)	3,407.4±1,636.0
	Hemoglobin (g/dL)	11.6±1.0
	Platelet (10^{^9}/L)	252.7±71.6
	SGOT (U/L)	26.1±12.2
	SGPT (U/L)	25.7±27.3

ECOG= Eastern Cooperative Oncology Group; WBC= White blood count; SGOT= Serum glutamic oxaloacetic transaminase; SGPT= Serum glutamic pyruvic transaminase.

Table 2

Physical & Psychosocial Symptom during Maintenance Chemotherapy (N=50)

Day	Strength	Presence	Strength	Discomfort
Day	Strength	n (%)	M±SD	M±SD
2^ndday	Nausea	28 (56.0)	1.64±1.80	1.66±1.85
	Vomiting	23 (46.0)	1.36±1.75	1.38±1.81
	Taste change	19 (38.0)	1.06±1.54	0.94±1.43
	Itching	19 (38.0)	0.98±1.50	1.00±1.57
	Screaming and throwing a fit. If you don’t go as your mind	19 (38.0)	0.96±1.49	0.88±1.36
7^th day	Sulky & irritable	26 (52.0)	1.46±1.68	1.28±1.62
	Screaming and throwing a fit. If you don’t go as your mind	23 (46.0)	1.32±1.70	1.14±1.62
	Itching	21 (42.0)	1.14±1.44	1.06±1.42
	Headstrong & sullen	15 (30.0)	0.86±1.57	0.72±1.44
	Difficulty sleeping	11 (22.0)	0.60±1.26	0.56±1.23
28^th day	Sulky & irritable	16 (32.0)	0.78±1.32	0.68±1.30
	Cough	16 (32.0)	0.76±1.30	0.66±0.20
	Screaming and throwing a fit. If you don’t go as your mind	12 (24.0)	0.58±1.29	0.48±1.12
	Headstrong & sullen	11 (22.0)	0.52±1.23	0.48±1.21
	Lack of energy	9 (18.0)	0.44±0.97	0.30±0.70

Table 3

Activity and Education (N=50)

Categories	Categories	n (%) or M±SD
Education	Nursery school	3 (6.0)
	Kindergarden	11 (22.0)
	Elementary school	11 (22.0)
	Middle school	1 (2.0)
	High school	4 (8.0)
	Alternative school	3 (6.0)
	Cyber school	5 (10.0)
	None	12 (24.0)
Attendance (times/week)	5	29 (58.0)
	3~4	1 (2.0)
	none	20 (40.0)
School meals	Yes	29 (58.0)
	Not applicapable	20 (40.0)
	Others	1 (2.0)
Activities (min/day)	Sleeping	561.6±59.7
	Watching TV	155.0±111.5
	Internet	102.6±128.1
	Conversation	116.6±85.1
	Out door activities	65.4±43.8

Table 4

The Difference between Physical Symptom and Psychosocial Symptom (N=50)

Variables	Physical symptom	Psychosocial symptom	Difference (Psychosocial-Physical)	t	p
Variables	M±SD	M±SD	M±SD	t	p
2^nd day	0.20±0.13	0.21±0.23	0.01±0.24	0.28	.775
7^th day	0.14±0.15	0.24±0.25	0.10±0.25	2.73	.008
28^th day	0.09±0.10	0.14±0.18	0.05±0.15	2.21	.031

Table 5

Physical and Psychosocial Symptom during Maintenance Chemotherapy (N=50)

Variables	2nd day	7th day	28th day	F	p
Variables	M±SD	M±SD	M±SD	F	p
Physical symptom	0.20±0.13	0.14±0.15^*	0.09±0.10^*†	21.12	<.001
Psychosocial symptom	0.21±0.23	0.24±0.25	0.14±0.18^†	5.18	.007

^*Bonferroni test, comparison between day 2 and each time; ^†Bonferroni test, comparison between day 7 and day 28.

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