Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide.
Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide.
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DOI：
10.1188/10.onf.e16-e27
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发表时间：
2010-01-01
影响因子：
1.9
通讯作者：
Krull, Kevin
中科院分区：
文献类型：
--
作者：
Hockenberry, Marilyn J;Hooke, Mary C;Krull, Kevin
目的/目的：研究疲劳、恶心、呕吐和睡眠障碍的症状群对儿童和青少年接受顺铂、阿霉素或异环磷酰胺化疗前后行为改变、抑郁和表现状态的临床结果的影响。设计：采用前瞻性、描述性、组内、化疗前后设计。地点：美国两家主要的儿童癌症治疗医院。样本：67例7-18岁接受顺铂、阿霉素或异环磷酰胺化疗疗程的患者。方法：在顺铂、阿霉素或异环磷酰胺治疗的第一天和一周后完成疲劳、抑郁、行为和表现评估。在治疗过程中以及出院后48小时，患者在非惯用手佩戴手腕活动记录仪。在治疗期间和出院后48小时内每24小时测量一次恶心和呕吐。采用线性混合模型评价症状聚类的影响。使用回归分析来检验绩效状态与症状聚类之间的关联。采用主成分分析和最大旋转分析得出睡眠症状的相关性。主要研究变量：疲劳、恶心和呕吐、睡眠障碍、行为、抑郁和表现。研究发现：伴随疲劳和睡眠障碍增加的青少年经历了更多的抑郁症状和行为改变。疲劳程度越高的儿童抑郁症状越严重。父母在他们的孩子或青少年中感受到的疲劳越多，报告的行为和情感困难就越多。结论：疲劳、睡眠障碍、恶心和呕吐聚集在一起时影响化疗后青少年的抑郁症状和行为改变。在儿童中，仅疲劳就会影响抑郁症状和行为改变。对护理的启示：症状群对癌症治疗期间儿童和青少年的生活质量有显著影响。早期识别和干预这些症状是重要的护理作用。
PURPOSE/OBJECTIVES: To examine the influence of the proposed symptom cluster of fatigue, nausea and vomiting, and sleep disturbances on clinical outcomes defined as behavior changes, depression, and performance status in children and adolescents before and after receiving cisplatin, doxorubicin, or ifosfamide chemotherapy.DESIGN: A prospective, descriptive, within-group, before-and-after-chemotherapy design was used.SETTING: Two major childhood cancer treatment hospitals in the United States.SAMPLE: 67 patients aged 7-18 years who were receiving chemotherapy courses of cisplatin, doxorubicin, or ifosfamide.METHODS: Fatigue, depression, behavior, and performance assessments were completed on the first day of cisplatin, doxorubicin, or ifosfamide therapy and one week later. Patients wore a wrist actigraph on the nondominant hand during the course of therapy and for 48 hours after discharge from the hospital. Nausea and vomiting were measured every 24 hours during the course of therapy and for 48 hours after discharge. A linear mixed model was used to evaluate the influence of the symptom cluster. Regression analysis was used to examine the associations between performance status and the symptom cluster. Principal component analysis with varimax rotation was used to produce the correlation of sleep symptoms.MAIN RESEARCH VARIABLES: Fatigue, nausea and vomiting, sleep disturbances, behavior, depression, and performance.FINDINGS: Adolescents with the cluster of increased fatigue and sleep disturbances experienced more depressive symptoms and behavior changes. Children with higher levels of fatigue had increased depressive symptoms. The more fatigue parents perceived in their children or adolescents, the more behavior and emotional difficulties were reported.CONCLUSIONS: Fatigue, sleep disturbance, and nausea and vomiting, when clustered, impacted depressive symptoms and behavior changes in adolescents after chemotherapy. In children, fatigue alone impacted depressive symptoms and behavior changes.IMPLICATIONS FOR NURSING: Symptom clusters can have a significant impact on children's and adolescents' quality of life during cancer treatment. Early recognition and intervention for these symptoms are an important nursing role.