Exploring core symptoms and interrelationships among symptoms in children with acute leukemia during chemotherapy: A network analysis.

PURPOSE: Children with acute leukemia have suffered from a considerable symptom burden during chemotherapy. However, few studies have focused on exploring the mechanisms among symptoms in children with acute leukemia. Our study aims to explore core symptoms and describe the interrelationships among symptoms in children with acute leukemia during chemotherapy. METHODS: From January 2021 to March 2023, 469 children with acute leukemia were recruited from 20 Chinese cities. The Memorial Symptom Assessment Scale 10-18 (MSAS 10-18) was used to evaluate the prevalence and severity of symptoms during chemotherapy. A network analysis was performed by the R software based on 31 symptoms. Centrality indices and density were used to explore core symptoms and describe interrelationships among symptoms in the network during chemotherapy. RESULTS: Worrying and feeling irritable were the central symptoms across the three centrality indices, including strength, closeness, and betweenness. Lack of energy was the most prevalent symptom; however, it was less central than other symptoms. The density of the "induction and remission" network significantly differed from other cycles' counterparts (p < 0.001). Global strength was greater in the " ≥ 8 years group " network than the " < 8 years group " network (p = 0.023). CONCLUSION: Network analysis provides a novel approach to identifying the core symptoms and understanding the interrelationships among symptoms. Our study indicates the need to assess emotional symptoms in children with acute leukemia during chemotherapy, especially during the induction and remission phases, as well as in older children. Future research is imperative to construct trajectories of dynamic symptom networks and centrality indices in longitudinal data to investigate the causal relationships among symptoms.

Identifying central symptom clusters and correlates in children with acute leukemia undergoing chemotherapy: a network analysis.

Background: Previous studies have examined symptom clusters in children with acute leukemia, yet a knowledge gap persists regarding central symptom clusters and their influencing factors. By identifying these central clusters and associated factors, healthcare providers can enhance their understanding and effective management of symptoms. Our study seeks to address this gap by identifying symptom clusters, exploring central clusters, and investigating the demographic and health-related factors associated with these clusters in children with acute leukemia undergoing chemotherapy. Methods: A total of 586 children with acute leukemia from January 2021 to April 2023 were recruited from China. They were investigated using Memorial Symptom Assessment Scale 10-18 during chemotherapy. The principal component analysis was used to identify the symptom clusters. An association network was conducted to describe the relationships among symptoms and clusters. A multiple linear model was used to investigate the associated factors for the severity of overall symptoms and each symptom cluster. Results: Five clusters were identified, including oral and skin cluster, somatic cluster, self-image disorder cluster, gastrointestinal cluster and psychological cluster. Gastrointestinal cluster was the most central symptom cluster. Age, sex, clinical classification, number of having chemotherapy and education degree and marital status of the primary caregiver are associated with the severity of these five symptom clusters. Conclusion: Our study highlights the importance of evaluating symptom clusters in children with acute leukemia during chemotherapy. Specifically, addressing gastrointestinal symptoms is crucial for effective symptom management and overall care.

[Quality of life of patients with arthritis in China].

OBJECTIVE: To evaluate the quality of life of arthritis patients in China. METHODS: Patients (n = 1 344) were selected by stratified random sampling according to the economic conditions and the ranking of hospitals, and asked to complete the arthritic self-reported questionnaire of quality of life. RESULTS: The scores of quality of life were not different between male arthritis and female arthritis in different age groups (P > 0.05). The lower scores of quality of life were reported more often among the women older than 65 years. Those of lower educational level and lower income got fewer scores. Compared to the married and unmarried patients, the divorcees and those who were bereft of their spouses gained low scores (t = 9.310, P = 0.001). Among different occupation groups, the labors and farmers also got lower scores than others (P < 0.05). On the other hand, if the arthritis with better physical conditions, it was more possible that the scores were higher, but to pressed pain index, there were no different scores shown between the second and third grade (mean difference = 4.910, P = 0.765), and to joint swell index, there are no different scores between either the 0 and 1 grade (mean difference = 16.308, P = 0.079) or the 2 and 3 grade (mean difference = 6.643, P = 0.533). CONCLUSION: To improve the quality of life of all arthritis patients, enhancing the quality of medical technology and enriching the medical knowledge are evidently necessary. However, it is also important to prefect social security system, to improve the country education and pay attention to life of elderly in order to improve the quality of life of all arthritis patients.