A pilot exploration of symptom trajectories in adolescents with cancer during chemotherapy

Abstract

Background: Chemotherapy is frequently administered in repetitive cycles. Adolescents with cancer have multiple symptoms related to chemotherapy, but knowledge of symptom trajectories across a cycle is limited. Examining trajectories over a cycle may reveal key periods to manage symptoms.

Objectives: The aims of this pilot were to describe the trajectory of symptoms (pain, sleep, appetite, nausea, fatigue) and biological and behavioral variables (anxiety, stress, hematologic function) across 1 cycle and examine relationships between variables.

Methods: Nine adolescents with cancer within 6 months of diagnosis participated. Data were collected by surveys, chart review, and biologic measures on days 1 and 2 of the cycle, 1 week later (nadir), and day 1 of the following cycle. To evaluate the trajectory, a simple random-effects repeated-measures analysis was computed.

Results: The significant trajectories were fatigue (P = .003), difficulty sleeping (P = .032), and nausea (P = .04). Most of the adolescents reported some anticipatory anxiety about receiving chemotherapy. Significant correlations between symptoms and biobehavioral variables included anticipatory anxiety and nausea (r = .86, P = .003), trait anxiety and fatigue (r = -0.82, P < .001), and stress and pain (r = 0.78, P = .039).

Conclusions: Multiple symptoms were experienced across the cycle. Three symptoms displayed significant trajectories indicating that patterns of symptoms may be anticipated.

Implications for practice: Pilot findings suggest that monitoring symptoms, stress, and anxiety across a cycle is important, not only during chemotherapy administration, but also prior to being admitted for chemotherapy.

Figure 1. Profile Plot of Severity of Pain by Diagnosis over Time

Individual ratings of severity of pain at each time point. VAS indicates Visual Analog Scale. The solid line represents the mean severity scores of pain and the error bars represent ± 1 standard error. The trajectory of pain was not significant indicating mean pain severity scores did not change over time.

Figure 2. Profile Plot of Severity of Difficulty Sleeping by Diagnosis over Time

Individual ratings of severity of difficulty sleeping at each time point. VAS indicates Visual Analog Scale. The solid line represents the mean severity scores of difficulty sleeping and the error bars represent ± 1 standard error. The trajectory of difficulty sleeping was significant indicating mean scores changed over time.

Figure 3. Profile Plot of Severity of Appetite Loss by Diagnosis over Time

Individual ratings of severity of appetite loss at each time point. VAS indicates Visual Analog Scale. The solid line represents the mean severity scores of appetite loss and the error bars represent ± 1 standard error. The trajectory of appetite loss was not significant indicating mean scores did not change over time.

Figure 4. Profile Plot of Severity of Nausea by Diagnosis over Time

Individual ratings of severity of nausea at each time point. VAS indicates Visual Analog Scale. The solid line represents the mean severity scores of nausea and the error bars represent ± 1 standard error. The trajectory of nausea was significant indicating mean scores changed over time.

Figure 5. Profile Plot of Severity of Fatigue by Diagnosis over Time

Individual ratings of severity of fatigue at each time point. VAS indicates Visual Analog Scale. The solid line represents the mean severity scores of fatigue and the error bars represent ± 1 standard error. The trajectory of nausea was significant indicating mean scores changed over time.