Sentinel and Networked Symptoms During Remission Induction Chemotherapy in Acute Lymphoblastic Leukemia Children

Background Children with acute lymphoblastic leukemia experience various adverse symptoms during remission induction. Elucidating the interrelationships among symptoms can facilitate precise and efficacious symptom management. Objective This study aimed to elucidate symptom clusters and sentinel symptoms and to examine core and bridge symptoms within the symptom network in children with acute lymphoblastic leukemia during remission induction. Methods A cross-sectional survey of 226 children aged 8 to 16 years with a new diagnosis of acute lymphoblastic leukemia during remission induction chemotherapy was conducted using the Chinese version of the Memorial Symptom Assessment Scale 10-18. Symptom clusters and sentinel symptoms were identified using exploratory factor analysis and Apriori algorithm. Core and bridge symptoms were identified using network analysis. Results Five symptom clusters and sentinel symptoms were identified: gastrointestinal (constipation as the sentinel symptom), emotional (feeling sad as the sentinel symptom), and somatic (cough as the sentinel symptom); however, the sentinel symptoms of neurological and self-image impairment symptom clusters were not specified. In symptom network, feeling sad and nausea were core symptoms, whereas dizziness and lack of energy were the bridge symptoms. Conclusions The somatic symptom cluster should be prioritized for intervention during remission induction. Network analysis and sentinel symptom analysis must be extended to the symptom research in pediatric cancer to provide a scientific basis for symptom management. Implications for Practice Nurses should aim to identify and intervene with sentinel and networked symptoms to ensure that children are effectively supported during the remission induction, reducing symptom burden and improving quality of life.