The TRSC-C and Childhood Leukemia in Thailand and the USA: Symptom Occurrence/Severity and Care Strategies for Symptom Relief.

Background: Treatments f or Acute Lymphoblastic L eukemia (A.L.L.) cause significant side effects in children. Symptom alleviation affects treatment adherence and success. Purposes: Examine i n t wo co untries, during can cer t reatments, b y p arent report: (a) symptom occurrence and severity on the Therapy-Related Symptom Checklist for Ch ildren (TRSC-C); a nd ( b) s trategies to r elieve s ymptoms re- ported on t he S ymptom Alleviation: S elf-Care M ethods (S ASCM) t ool. Bo th tools have good psychometric properties. Methods: A secondary analysis of d ata from a l arger study. Samples: USA 51 children, mean age 7.9 yrs; 45% male; 86% on chemotherapy; and Thailand 63 children, mean age 7.7 yrs; 79% male; 81% on chemotherapy. Parents rated on the 30-item TRSC-C: scale "0"None; "1" A bit; "2"Quite a b it"; "3" A lot; "4", A whole lot). On the SASCM, descriptive and content analyses were done. Findings: A. % Symptom occurrence: 19 symptoms out of 30 were report- ed to occur in 40%-84% of the USA children; among Thais, 16 of 30 symptoms were reported to occur in 41%-92% of the children. Top 5 reported symptoms were: ( USA) f eeling s luggish, hair lo ss, n ausea, a ppetite l oss, ir ritable; ( Thai- land) hair loss, nausea, fever, weight loss, vomiting. Symptom severities (top 5) were: (USA) feeling sluggish, hair loss, appetite loss, irritable, nausea; (Thai- land) hair loss, fever, nausea, appetite loss, irritable. B. Top symptom allevia- tion categories were: (USA) p rescribed and over-the-counter medications and mind/body control (comfort measures, massage); (Thailand) mind/body control (comfort child, pray), and diet/nutrition/lifestyle change (rest, soft diet). Conclusion: The TR SC-C f acilitates identification, m onitoring, and m an- agement o f s ymptoms. L arge p ercentages o f p atients r eport m any symptoms listed on the TRSC-C. Oncology instruments that mention fewer than 10 symp- toms will under-document symptom concerns of patients. Implications: More studies on the applications of the TRSC-C and SASCM in different cultures and countries are needed. Use of electronic tools for storage and acces s o f s ymptom r eports b y p atients/parents m ay i mprove pa tient- clinician communications and adherence to treatment.