Family filial value on caring children with leukemia

OBJECTIVE: Family centered empowerment is a nursing intervention by increasing family filial value which consists of responsibility, respect, and family care. The purpose of this study was to explain the family filial value in treating leukemia children. METHOD: The design of this study was descriptive with a cross-sectional design. The population in this study were families with children suffering from leukemia who were treated at Dr. Soetomo Surabaya. A sample of 140 respondents were recruited by consecutive sampling technique. Data was collected by questionnaire. The independent variable is family filial value and the dependent variable is the family's ability to caring children with leukemia. Data were collected by questionnaire and analyzed with spearman correlation (∝<0.05). RESULT: Responsibility is the highest indicator of family filial value (16.4%). The results showed that there was an influence of family filial value (responsibility p = 0.000; r=0.520, respect p = 0.000; r=0.403 and care p = 0.000; r=0.297) on the family's ability to care for leukemia children. CONCLUSION: Filial value of the family can improve the family's ability to care for leukemic children that have an impact on children's health indicators

No disponible

Emotional symptoms and family functioning in caregivers of children with newly diagnosed leukemia/lymphomas and solid tumors: Short-term changes and related demographic factors.

BACKGROUND: Pediatric oncology diagnoses are distressing to caregivers. However, researchers have not investigated the impact that the type of cancer diagnosis has on caregiver anxiety, depression, distress, and family functioning. The purpose of this study was to longitudinally investigate the early trajectory of caregiver psychological symptoms of anxiety, depression, distress, and family functioning near diagnosis and 6 months later by cancer type, and to examine the demographic factors that may be associated with caregiver emotional and family functioning outcomes. METHODS: Caregivers (n = 122) of children with a recent diagnosis of leukemia/lymphoma or solid tumor completed self-report measures of psychological and family functioning (Hospital Anxiety and Depression Scale, Distress Thermometer, and Family Environment Scale). RESULTS: In general, caregivers endorsed elevated psychological symptoms at the time of diagnosis, which decreased 6 months later. Caregivers of children with solid tumors endorsed greater anxiety across time than caregivers of children with leukemia/lymphoma did. In addition to caring for a child with a solid tumor, female sex, non-White ethnicity, and non-English language spoken in the home were factors associated with anxious and depressive symptoms and poorer family functioning. CONCLUSION: When creating psychosocial interventions for families of children with cancer, the unique demands of solid tumor treatments, the caregiver's sex, and cultural characteristics must be considered to promote coping, resiliency, and problem-solving skills around the time of diagnosis, particularly in more vulnerable families.

The Roles of Nurses in Hematopoietic Cell Transplantation for the Treatment of Leukemia in Older Adults.

OBJECTIVE: To review and summarize nurses' roles in the care of the older adult undergoing an allogeneic hematopoietic cell transplant (HCT) for the treatment of leukemia. DATA SOURCES: Published literature indexed in PubMed, CINAHL, textbooks, and clinical expertise. CONCLUSION: Nurses are a vital component of the highly specialized care delivered before, during, and after an allogeneic HCT. IMPLICATIONS FOR NURSING PRACTICE: Nurses who are prepared for the complex HCT care trajectory will be able to optimally meet the complex needs of the older adult patient and their caregiver(s).

Recognition and management of leukaemia in children.

Leukaemia is the most common cancer in children. The presenting manifestations can be wide-ranging, from a relatively well child to life-threatening complications. Symptoms can be manifested in any of the bodily systems. Undertaking a thorough clinical assessment of the child, in addition to recognising and addressing parental concerns, is vital. Furthermore, recognising that children can commonly present with musculoskeletal or abdominal symptoms increases the diagnostic yield, thereby preventing missed or late diagnoses. Childhood cancer has a huge impact on the child and their family, both at diagnosis and in the long term; providing advice and signposting families to appropriate support groups is an important aspect of their management. Nurses play a vital role in managing children with cancers, starting from raising suspicion and identifying the child with leukaemia, ensuring that high-quality care is delivered throughout their treatment, managing complications, and providing support and information to children and their families. An illustrative case study is included to highlight some of the challenges that health professionals may encounter in their clinical practice.

Childhood Cancer Symptom Cluster: Leukemia and Health-Related Quality of Life.

OBJECTIVES: To examine the relationship of the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L) with health-related quality of life (HRQOL). SAMPLE & SETTING: 327 children receiving treatment for acute lymphoblastic leukemia from four pediatric oncology programs across the United States. METHODS & VARIABLES: Participants completed fatigue, sleep disturbance, pain, nausea, and depression symptom questionnaires at four time points; these symptoms comprised the CCSC-L. HRQOL was measured at the start of postinduction therapy and then at the start of maintenance therapy. Relationships between the CCSC-L and HRQOL scores were examined with longitudinal parallel-process modeling. RESULTS: The mean HRQOL significantly increased over time (p < 0.001). The CCSC-L had a significant negative association with HRQOL scores at the start of postinduction therapy (beta = -0.53, p < 0.005) and the start of maintenance therapy (beta = -0.33, p < 0.015). Participants with more severe symptoms in the CCSC-L over time had significantly lower HRQOL at the start of maintenance therapy (beta = -0.42, p < 0.005). IMPLICATIONS FOR NURSING: Nurses are pivotal in providing management strategies to minimize symptom severity that may improve HRQOL.

As demandas de aprendizagem dos familiares de crianças com leucemia para o cuidado domiciliar: contribuições para a construção de materiais educativos / As demandas de aprendizagem dos familiares de crianças com leucemia para o cuidado domiciliar: contribuições para a construção de materiais educativos

A criança com leucemia, quando no domicílio, requer cuidados especiais. Nesse contexto, os familiares deparam-se com demandas de cuidados que precisam ser apreendidas em função da condição clínica de sua criança. Este estudo teve como objetivos: descrever as demandas de aprendizagem dos familiares de crianças com leucemia para o cuidado domiciliar; e analisar os temas que os familiares julgaram significativos na composição de materiais educativos. Trata-se de uma pesquisa participante, de abordagem qualitativa, desenvolvida com oito familiares de crianças com leucemia. O cenário foi uma enfermaria de hematologia infantil localizada no estado do Rio de Janeiro. A coleta de dados foi realizada por meio de círculos de discussão, no período de maio a junho de 2018, após a aprovação do estudo pelo Comitê de Ética da UERJ e da unidade hospitalar onde se realizou a pesquisa. Para a análise de dados, foi utilizada a análise de conteúdo proposta por Bardin. Como resultados, emergiram três categorias: 1.ª Percepções de familiares de crianças com leucemia sobre a proposta de construção de materiais educativos para o cuidado domiciliar; 2.ª A importância da adequação do conteúdo do material educativo para compreensão dos familiares; e 3.ª Temas que geram muitas dúvidas ou dificuldades para os familiares. As participantes elucidaram a importância da construção de materiais educativos como instrumento de aprendizagem e de esclarecimento de dúvidas. Apontaram a relevância de estes apresentarem: imagens/gravuras; terem linguagem simples ­ e mais próxima das situações vivenciadas pelo público ­; conterem explicações sobre os alimentos indicados à criança nas diversas fases do tratamento da leucemia; terem orientações sobre como proteger o cateter durante o banho; e fornecerem esclarecimentos acerca da prescrição dos medicamentos que a criança deverá tomar em casa. Assim, o estudo aponta a importância da construção de materiais educativos a partir das demandas de cuidados da clientela. Contribuição para a Enfermagem: os materiais educativos podem proporcionar uma assistência segura, bem como ser uma fonte de esclarecimento de dúvidas dos familiares ao prestarem cuidados a sua criança quando no domicílio.

When in the home environment, the child with leukemia requires special care. In this context, the relatives are confronted with demands for care that need to be understood because of the clinical condition of their children. This study had the following objectives: to describe the learning demands of relatives of children with leukemia for home care and to analyze the topics that these relatives judged to be significant in the formulation of educational materials. This is a participatory research with a qualitative approach developed with eight relatives of children with leukemia. The research setting was a hematology pediatric ward located in the state of Rio de Janeiro. Data collection was performed by means of discussion groups, from May to June 2018, after approval of the study by the Ethics Committee of UERJ and by the hospital unit where the research was conducted. In order to analyze the collected data, we used the content analysis proposed by Bardin. As results, three categories emerged: 1 st ­ Perceptions of relatives of children with leukemia on the proposal for developing educational materials for home care; 2 nd ­ The importance of the suitability of the content of the educational material for helping the relatives to understand this topic; and 3 rd ­ Topics generators of many doubts or difficulties for the relatives. The participants elucidated the importance of the development of educational materials as an instrument for learning and clarification of doubts. Moreover, they highlighted the relevance of these images/drawings, due to having clear language and closer to the situations experienced by the public, explanations on what to provide the child with food during the various stages of the leukemia treatment, guidelines on how to protect the catheter during bath, besides clarifications on the prescription of medicines that the child should take at home. Accordingly, the study points out the importance of the development of educational materials based on the health care demands of customers. Contribution for Nursing: Educational materials may provide safe care, in addition to being a source of clarification of doubts of the relatives when caring for their children in the home environment.

Construção de uma cartilha educativa para familiares de crianças com leucemia para o cuidado domiciliar / Preparation of an educational booklet for relatives of children with leukemia for home care

A criança com leucemia é uma criança com necessidades especiais de saúde que requer cuidados especiais quando no domicílio, o que torna relevante preparar seu familiar para a realização desses cuidados. Objeto do estudo: a construção de uma cartilha voltada para os cuidados dos familiares à criança com leucemia quando no domicílio. Objetivos: Desenvolver material educativo dirigido a familiares de crianças com leucemia para o cuidado no domicílio, identificar junto a familiares e enfermeiros temas relacionados ao cuidado à criança com leucemia no domicílio; elaborar uma cartilha sobre os temas estabelecidos pelos familiares e enfermeiros para o cuidado da criança com leucemia no domicílio. Pesquisa qualitativa do tipo participativa, realizada em um hospital oncológico localizado no município do Rio de Janeiro/RJ. Participaram do estudo 6 familiares de criança com leucemia e 6 enfermeiros assistenciais. Os dados foram coletados nos meses de junho e julho de 2018, através de círculos de discussão e analisados pelo método de análise de conteúdo de Bardin. A construção da cartilha se deu através dos dados definidos no terceiro momento dos círculos de discussão e foi subsidiada pela literatura científica. A pesquisa foi aprovada pelos Pareceres: 2.549.848 e 2.627.369. A alimentação, o cateter venoso central, a imunidade e o medicamento estimulador da medula óssea concentram as principais dúvidas dos familiares no cuidado domiciliar à criança com leucemia e estão retratados nas quatro categorias a seguir: Alimentação: orientações sobre os alimentos permitidos, higiene e formas de preparo; O cateter venoso central como gerador de dúvidas dos familiares no cuidado à criança com leucemia; Os cuidados à criança com baixa imunidade e Manejo do medicamento estimulador da medula óssea. Optou-se por trazer os diferentes temas de cuidados em cartilhas seriadas, ou seja, cartilha volume 1, cartilha volume 2, etc. Entretanto, para este momento, apresentaremos os produtos referentes às categorias 1 e 2, cujos títulos são: Alimentação: orientações sobre os alimentos permitidos, higiene e formas de preparo e O cateter venoso central como gerador de dúvidas dos familiares no cuidado à criança com leucemia, respectivamente. Há uma série de dúvidas dos familiares sobre os cuidados domiciliares à criança com leucemia. Assim, este material educativo poderá saná-las, uma vez que permitirá aos enfermeiros orientar os familiares durante a internação da criança a partir deste instrumento educativo, servindo posteriormente como um guia para o desenvolvimento dos cuidados à criança no domicílio.

The child with leukemia is a child with special health needs requiring special care when it is in the home environment, which makes it important to train its relatives to perform these care actions. Study object: the preparation of a booklet focused on the care of relatives of children with leukemia in the home environment. Objectives: To develop an educational material for relatives of children with leukemia for home care; to identify with these relatives and nurses some topics related to the care of the child with leukemia in the home environment; and to elaborate a booklet on the topics established by these relatives and nurses for the care of the child with leukemia in the home environment. This is a qualitative research of the participatory type, which was conducted in an oncology hospital located in the city of Rio de Janeiro/RJ. This study was attended by six relatives of children with leukemia and six health care nurses. Data were collected in the months of June and July 2018, through discussion circles, and analyzed by the Bardin's content analysis method. The preparation of the booklet took place through the data defined in the third moment of the discussion circles and was supported by the scientific literature. The research was approved by means of the opinions: 2.549.848 and 2.627.369. Feeding, central venous catheter, immunity and bone marrow stimulating drugs concentrate the main doubts of relatives regarding the home care of the child with leukemia and are depicted in the following four categories: Feeding: guidelines on allowed foods, hygiene and preparation methods; The central venous catheter as a generator of doubts in the relatives regarding the care of children with leukemia; The care of the child with low immunity and The management of the bone marrow stimulating drugs. We choose to bring the different topics of care in serial booklets, i.e., booklet volume 1, booklet volume 2, etc. Nevertheless, at this stage, we will introduce the products referring to categories 1 and 2, whose titles are: Feeding: guidelines on allowed foods, hygiene and preparation methods and The central venous catheter as a generator of doubts in the relatives regarding the care of children with leukemia, respectively. There are a range of doubts from the relatives about the home care of the child with leukemia. Accordingly, this educational material may resolve such doubts, as it will enable nurses to guide the relatives during the hospitalization of their children, based on this educational instrument, which may subsequently be used as a guide for the development of child care at home.

Role of advanced nurse practitioners in the care pathway for children diagnosed with leukemia.

PURPOSE: The development of advanced nursing practices (ANP) can meet challenges presented by evolving needs of health care. We aimed at describing the approach taken to implement ANP in a pediatric oncology-hematology unit. METHOD: The Participatory, Evidence-informed, Patient-centered Process for Advanced practice was considered as a conceptual framework for the development, implementation and evaluation of the nursing role. Successive steps were taken for identifying patients and family needs, defining the health care priorities, and establishing a new health care model. RESULTS: The seven steps of the PEPPA framework were carried out over a year and contributed to the identification of the tasks and the role of the advanced nurse practitioner in the patient care pathway. The implementation of ANP was gradually achieved with the development of new evidenced-based health care procedures. The subsequent approval of a contract specification for advanced nurse practitioners facilitated the onset of a specific consultation, which facilitated a holistic approach. CONCLUSION: The impact of the implementation can be appreciated at different levels: i) the patient and his or her family, with improvement of communication and continuity of care; ii) the interdisciplinary team, with development of a dynamic and greater motivation of the health care providers; and iii) the profession, with a greater recognition of the competencies and conceptualization of the new role. An assessment of the process, the structure and the results should be carried out to validate the role of the advanced nurse practitioner throughout the long journey of a child with leukemia.

Perspectives on advance care planning in haematopoietic stem cell transplantation: a qualitative study.

BACKGROUND: Advance care planning (ACP) engagement and completion of advance directives remain low in patients undergoing haematopoietic stem cell transplantation, despite the high risk of treatment-related mortality. AIM: To understand the barriers to and facilitators of ACP in haematopoietic stem cell transplantation. METHODS: This qualitative study used interpretive description methodology. The researchers conducted audio-recorded semi-structured interviews with participants. The constant comparative method was used to analyse data. RESULTS: A total of six patients, five family members and eight clinicians participated in the study. Perceived barriers to ACP included: lack of time, lack of process, lack of understanding of disease/treatment and ACP, need to keep positive and prognostic uncertainty. Potential facilitators of ACP included: early and frequent discussion of ACP, incorporating ACP into routine care, involvement of the multidisciplinary team and framing discussions on ACP as positive. CONCLUSIONS: Haematopoietic stem cell transplantation poses unique challenges for patients, families and clinicians when it comes to ACP. Introducing advance care planning as part of standard care and providing ongoing facilitation of ACP, including discussion of disease and treatment expectations at the outset and when complications arise may assist patients and families in recognising how ACP can fit into and enhance their care.

Identifying the unmet supportive care needs, with concomitant influencing factors, in adult acute leukemia patients in China.

PURPOSE: To understand the supportive care needs (SCNs), with associated influencing factors, related to five unmet need dimensions in adult Acute Leukemia (AL) patients, in China. METHODS: This multi-center cross-sectional study enrolled 340 pathologically confirmed adult, Chinese AL patients who were requested to complete a self-reported questionnaire, detailing demographic information, general status and physical functions, and Supportive Care Needs Survey-Short Form 34 (SCNS-SF34), revealing their unmet SCNs. The variables were statistically analyzed. RESULTS: A total of 311 (91.4%) effective questionnaires were retrieved. Among the 5 dimensions, the health information dimension scored the highest, 47.72(43.18), followed by psychological dimension, 35.00(32.50), while the sexual need scored the lowest, 0.00(24.99). As per multiple stepwise regression analysis, marital status, treatment stages and Karnofsky Performance Status index (KPS) score significantly influenced the health information dimension, while the age and "whether the treatment was the initial one or not" influenced sexual need dimension. KPS score and income were the common factors influencing the rest of the three dimensions with treatment stage adding to two of them except "physiological and daily living needs" dimension. "Being informed about your test results as soon as possible", "Being informed about things you can do to help yourself to get well" and "Being informed about cancer which is under control or in remission" were the three highest scoring entries. CONCLUSIONS: The results of this study reveal the unmet SCN's, with its influencing factors, in AL patients, the understanding of which may be of assistance in designing/delivering effective clinical nursing intervention.

Health-Related Quality of Life of Nepalese Children With Leukemia Using Pediatric Quality of Life Inventory 4.0 Generic Core Scale.

Health-related quality of life (HRQOL) is an essential measure to consider when evaluating the full impact of illness in children diagnosed with leukemia. The purpose of the current study was to assess the overall HRQOL and specific functioning subscales of Nepalese children with leukemia using Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL 4.0), compare self-report with parent proxy report of HRQOL and to identify the determinants affecting HRQOL. After cultural linguistic validation of PedsQL, a descriptive cross-sectional study was conducted on 43 children with leukemia and their parents in B. P. Koirala Memorial Cancer Hospital, Bharatpur via interview schedule. Among the subscales of HRQOL both the child's self-report and parent proxy report scores were highest in social functioning and lowest in emotional functioning subscale. Intraclass correlation coefficient between proxy reports and self-reports were highest (0.828) in physical functioning and lowest (0.493) in social functioning subscales. Age group was significantly associated with the total score, physical functioning subscale, and emotional functioning subscale of only proxy scores. Leukemic children's age-specific needs should be addressed properly to improve their overall HRQOL.

Financial Assistance for Patients Who Relocate for Specialist Care in Hematology: Practical Findings to Inform Nursing Supportive Care.

AIMS: This article examines findings on the need for, awareness of, and critical time for referral to financial assistance for patients who have to relocate for specialist care for hematological malignancies. DESIGN: The study involved descriptive qualitative research based on in-depth interviews that were audio-recorded, transcribed verbatim, coded, and thematically analyzed. PARTICIPANTS: Forty-five hematology patients purposively selected from the client database of the Leukaemia Foundation of Queensland were interviewed for the study. RESULTS AND CONCLUSION: The findings indicate that there is a critical period at the initial point of diagnosis and start of treatment when patients are experiencing shock, confusion, and a sense of being overwhelmed by stress, fear, and uncertainty about the future. The stress can be exacerbated by the loss of work and a period of waiting to access income (e.g., from superannuation or approval to receive a pension). For some patients, this is a critical period when individuals need support and advice to avoid long-term financial problems. However, at this point in time, many individuals do not know how to access financial advice or assistance from leading cancer supportive care organizations. The findings have practical implications to inform the work by many nurses who provide psychosocial care to hematology patients.

Effects of Slow-Stroke Back Massage on Symptom Cluster in Adult Patients With Acute Leukemia: Supportive Care in Cancer Nursing.

BACKGROUND: Patients with acute leukemia usually experience pain, fatigue, and sleep disorders, which affect their quality of life. Massage therapy, as a nondrug approach, can be useful in controlling such problems. However, very few studies have been conducted on the effects of massage therapy on the complications of leukemia. OBJECTIVE: The aim of this study was to examine the effects of slow-stroke back massage (SSBM) on the symptom cluster in acute leukemia adult patients undergoing chemotherapy. METHODS: In this randomized controlled trial, 60 patients with acute leukemia were allocated randomly to either the intervention or control group. The intervention group received SSBM 3 times a week (every other day for 10 minutes) for 4 weeks. The pain, fatigue, and sleep disorder intensities were measured using the numeric rating scale. The sleep quality was measured using the Pittsburgh Sleep Quality Index. Statistical tests of χ, t test, and the repeated-measure analysis of variance were used for data analysis. RESULTS: Results showed that the SSBM intervention significantly reduced the progressive sleep disorder, pain, fatigue, and improved sleep quality over time. CONCLUSIONS: Slow-stroke back massage, as a simple, noninvasive, and cost-effective approach, along with routine nursing care, can be used to improve the symptom cluster of pain, fatigue, and sleep disorders in leukemia patients. IMPLICATIONS FOR PRACTICE: Oncology nurses can increase their knowledge regarding this symptom cluster and work to diminish the cluster components by using SSBM in adult leukemia patients.

THE MANY FACES OF CARING IN NURSING.

Nonverbal communication is essential with children. Nurses are challenged when answers to assessment questions include shoulder shrugs and descriptions of 'ouchies' and pain all over that feels 'bad.' Pediatric nursing requires creativity and eliciting expression of emotions nonverbally. One way our patients express themselves is through art therapy. The art therapist on our unit uses masks with children who choose not to express themselves with words. I chose to create a mask as sculpture to nonverbally share my values, feelings, and compassion, just like my pediatric patients. As I worked with the mask, many faces of nursing emerged.

[The role of the nurse and child health nurse in a haematology day hospital]. / Le rôle de l'infirmière et de la puéricultrice en hôpital de jour d'hématologie.

The paediatric haemato-oncology nurse and the child health nurse in a day hospital have specific technical skills and in-depth knowledge in order to be able to provide global care for children with leukaemia. Close collaboration between the different professionals working in this care unit is essential.

[Hospital at home care for children with leukaemia]. / L'hospitalisation à domicile de l'enfant atteint de leucémie.

The care pathway of a child with leukaemia is long and often difficult. The different professionals work together to ensure optimal care management. Hospital at home forms part of this pathway in partnership with the inhospital departments, the general practitioner and the day hospital. This link between the different professionals is assured by the hospital at home child health nurse coordinator.

Models of survivorship care provision in adult patients with haematological cancer: an integrative literature review.

PURPOSE: Increasing numbers of haematology cancer survivors warrants identification of the most effective model of survivorship care to survivors from a diverse range of haematological cancers with aggressive treatment regimens. This review aimed to identify models of survivorship care to support the needs of haematology cancer survivors. METHOD: An integrative literature review method utilised a search of electronic databases (CINAHL, Medline, PsycInfo, PubMed, EMBASE, PsycArticles, and Cochrane Library) for eligible articles (up to July 2014). Articles were included if they proposed or reported the use of a model of care for haematology cancer survivors. RESULTS: Fourteen articles were included in this review. Eight articles proposed and described models of care, and six reported the use of a range of survivorship models of care in haematology cancer survivors. No randomised controlled trials or literature reviews were found to have been undertaken specifically with this cohort of cancer survivors. There was variation in the models described and who provided the survivorship care. CONCLUSION: Due to the lack of studies evaluating the effectiveness of models of care, it is difficult to determine the best model of care for haematology cancer survivors. Many different models of care are being put into practice before robust research is conducted. Therefore, well-designed high-quality pragmatic randomised controlled trials are required to inform clinical practice.

The Effect of Perceived Parental Rearing Behaviors on Health-Related Quality of Life in Adolescents with Leukemia.

As the prognosis of childhood leukemia has dramatically improved, clinical interest has been growing in health-related quality of life in adolescents with leukemia. An important factor in adolescent quality of life is their perception of parental rearing behavior. The aim of this study was to explore how perceived parental rearing behaviors related to the quality of life of adolescents with leukemia. A descriptive, exploratory study was conducted among 106 adolescents with leukemia using the Recalled Parental Rearing Behavior and the Minneapolis-Manchester Quality of Life scales. Data were examined using descriptive, correlation, and path analyses. The coefficients of total effect of paternal and maternal emotional warmth on the quality of life of adolescents were 0.36 and 0.45, respectively. We found that paternal rejection/punishment behavior was significantly correlated with maternal rejection/punishment behavior (P < .00); paternal and maternal control/overprotection behavior were also significantly correlated with each other (P < .00). We found that perceived parental warmth has a moderate effect on the quality of life of adolescents, that quality of life was related to both paternal and maternal rearing behaviors, and that the mother's and father's rearing behaviors were correlated with each other. To improve the quality of life of adolescents with leukemia, the patient's care plan should aim to enhance positive parental rearing behaviors in both parents.

The influence of oxidative stress on symptom occurrence, severity, and distress during childhood leukemia treatment.

PURPOSE/OBJECTIVES: To explore the symptom trajectory during the first 16 months of childhood leukemia treatment and any associations with the oxidative stress pathway measured by cerebrospinal fluid (CSF) concentration of oxidized phosphatidylcholine (PC), the predominant glycerophospholipid in the brain and cell membranes. DESIGN: Prospective, longitudinal design. SETTING: Two cancer centers in the southwestern United States. SAMPLE: 36 children (aged 3-14 years) newly diagnosed with acute lymphoblastic leukemia. METHODS: Symptoms were measured using the Memorial Symptom Assessment Scale at six specific time points during treatment. Biochemical changes in oxidative stress were measured by oxidized PC in the CSF. MAIN RESEARCH VARIABLES: Childhood cancer symptoms, oxidized PC. FINDINGS: Significant differences were found in the number of symptoms experienced during the three phases of treatment. Symptom trajectory changes and influence of the oxidative stress pathway on symptom experiences were identified. CONCLUSIONS: Symptoms experienced during treatment for childhood leukemia are associated with increased oxidative stress. IMPLICATIONS FOR NURSING: Children with leukemia experience symptoms throughout treatment. Physiologic measures indicate the influence of oxidative stress on symptoms.