Analyzing the Symptom Clusters Among Children With Acute Lymphoblastic Leukemia During Chemotherapy Based on Electronic Nursing Records

Yuxin Wang; Hongxia Xie; Hao Jiang; Meijia Chen; Liya Ren; Chaoqun Dong

doi:10.1097/NCC.0000000000001287

Analyzing the Symptom Clusters Among Children With Acute Lymphoblastic Leukemia During Chemotherapy Based on Electronic Nursing Records

Cancer Nurs. 2023 Oct 9. doi: 10.1097/NCC.0000000000001287. Online ahead of print.

Authors

Yuxin Wang¹, Hongxia Xie, Hao Jiang, Meijia Chen, Liya Ren, Chaoqun Dong

Affiliation

¹ Author Affiliations: School of Nursing, Wenzhou Medical University (Ms Wang, Mr Jiang, Mss Chen and Ren, and Dr Dong); and School of Computer and Computing Science, Hangzhou City University (Ms Xie), China.

PMID: 37815240
DOI: 10.1097/NCC.0000000000001287

Abstract

Background: Children with acute lymphoblastic leukemia often experience various physical and psychological symptoms during chemotherapy. Previous studies have used predetermined symptom inventories to analyze the complex relationships between these symptoms, which has certain limitations.

Objective: The aim of this study was to explore the dynamic changes in symptom clusters among children with acute lymphoblastic leukemia during chemotherapy using electronic nursing records.

Methods: Electronic nursing records for 2021 (N = 14 490) were obtained from a pediatric hematology department. A natural language processing tool was used to identify the presence of 46 symptoms in 3 chemotherapy phases of induction, consolidation, and maintenance. Incidence of symptom documentation was calculated by notes and patients, and principal component analysis and cluster analysis were performed for symptoms with an incidence above 15%.

Results: The most common symptoms included bleeding, cough, and vomiting. The number of symptom clusters in each chemotherapy period was 7, 6, and 4, respectively. There were upper gastrointestinal, respiratory system, lower gastrointestinal, skin-related, psychological, self-image disorder, and other discomfort symptom clusters in the induction period. Notably, the upper gastrointestinal, respiratory system, lower gastrointestinal, and skin-related symptom clusters persisted through the consolidation and maintenance periods. Neurological and other discomfort symptom clusters were observed during the consolidation period.

Conclusion: Symptom clusters of children with acute lymphoblastic leukemia at various stages of chemotherapy showed a certain level of stability and dynamics, informing healthcare providers in developing continuous symptom management.

Implications for practice: Medical staff should explore targeted intervention programs based on characteristics of symptom clusters at different chemotherapy stages, to improve the efficiency of symptom management and alleviate the symptom burden of children.