Page 64 - Encyclopedia of Nursing Research

CAnCER In CHILDREn n 31

treatment-related nausea and vomiting, and As survival for childhood cancer con-
emotion-related symptoms (Hockenberry, tinues to improve, nursing investigations
2004). To evaluate the status of the current are focusing on survivorship issues and C
research on symptom management in indi- quality of life after the diagnosis and treat-
viduals with cancer, the national Institutes ment of cancer. A review of childhood can-
of Health (2002) held a State of the Science cer survivor studies showed that childhood
on Symptom Management in Cancer: Pain, cancer survivors who underwent radiation
Depression, and Fatigue. The review of exist- therapy reported more psychological dis-
ing research revealed that efforts to man- tress, those who underwent chemotherapy
age symptoms of cancer and its treatments treatment with anthracyclines or alkylating
have not kept pace with new advances in the agents experienced more physical impair-
causes and cures for cancer. ments, and those who had limb-sparing
Priority areas of symptom management procedures reported more anxiety and more
research include longitudinal and multidi- functional impairment than those who had
mensional studies to evaluate symptom dis- an amputation (Zelter et al., 2009). Childhood
tress, patient and parent studies to identify cancer survivor studies have also docu-
expectations of cancer-related symptoms, mented the adverse effects of central nervous
evaluation of pain management effective- system treatment on cognitive, academic,
ness, and evaluation of the presence of symp- and psychosocial functioning. Interventions
tom clusters (Hockenberry, 2004). Hedstrom designed to minimize the adverse effects
et al. (2003) discovered that the most common of central nervous system therapy are now
causes of distress in a group of 121 children being conducted.
with cancer were treatment-related pain, nau- Docherty (2003) completed a review of
sea, and fatigue. Woodgate and Degner (2003) the published literature on symptom experi-
evaluated expectations about childhood can- ences of children and adolescents with cancer.
cer symptoms in a group of 39 children and This review revealed no longitudinal symp-
their family members and found that these tom management study designs, limited use
individuals expected to experience suffering of conceptual models or theories, frequent
as part of the cancer treatment. The families adaptation of adult instruments as symptom
felt that unrelieved or uncontrolled symp- measures, and no attention to the impact of
toms were necessary for cure. Studies evalu- these symptoms on the children’s lives.
ating pain management now focus on various It is evident from the recent childhood
pharmacological and nonpharmacological cancer literature that there is still much to be
interventions; however, longitudinal studies gained from continued research. The impor-
evaluating the effectiveness of pain interven- tance of striving for symptom relief in chil-
tions over time are lacking. A relatively new dren cannot be overemphasized. Recognition
area of symptom assessment research is the and acknowledgment of the beliefs and expec-
evaluation of symptom clusters and research tations of children and their parents regard-
efforts are initially focusing on identifying ing cancer-related symptoms (Woodgate &
clinically significant symptom clusters and Degner, 2003) should continue to be a major
their prevalence rates (Miaskowski, Dodd, & research focus. Longitudinal studies evalu-
Lee, 2004). A recent study of 67 children and ating the trajectory of symptom occurrence
adolescents receiving chemotherapy found and symptom management over time are
that when fatigue, sleep disturbance, nau- not found. Continued exploration of the most
sea, and vomiting were present, depressive effective management and coping strategies
symptoms and behavior changes occurred should be pursued for children experiencing
among the adolescents after chemotherapy all types of cancer or treatment-related symp-
treatment (Hockenberry et al., 2010). toms. Finally, utilization of research findings