Latent profile analysis of multiple symptom distress in children and adolescents with cancer and its effect on their physical activity

Abstract

Abstract:

Objective ·To describe the level of multiple symptom distress and physical activity in children and adolescents with cancer, analyze symptom distress profiles, and explicit the relationship between latent profiles and physical activity. Methods ·From November 2021 to March 2023, the convenient sample method was used to recruit children and adolescents with cancer aged 10－18 years old, who had been treated for more than 1 month in the Departments of Hematology/Oncology, Shanghai Children′s Medical Center and Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine. The questionnaires, including General Information Questionnaire, Memorial Symptom Assessment Scale 10-18 (MSAS 10-18) and Modified Chinese Version of Children′s Leisure Time Activities Study Survey (CLASS-C), were used. Latent profile analysis was used to identify whether the level of multiple symptom distress in children and adolescents with cancer was population heterogeneity and its explicit characteristics. Whether there were differences in physical activity levels among different profiles of symptom distress was also analyzed. Results ·A total of 165 valid questionnaires were collected, with an effective response rate of 91.7%. The symptom distress scores of the top five occurrence rates of symptoms in children and adolescents with cancer were lack of energy with a median of 1 (1, 2) point, nausea 1 (1, 2) point, lack of appetite 2 (2, 3) points, sweat 1 (1, 2) point, and pain 1 (1, 2) point. The physical activity level of the patients was mainly light, with a median of 2 530.00 (1 577.50, 3 721.00) min/week, and moderate to vigorous physical activity was relatively lower [70.00 (10.00, 197.50) min/week]. The patients with cancer could be divided into two latent profiles: "high fatigue-high nausea-high hair loss-high sleepy" and "high fatigue-low nausea-low vomiting-low sleepy", which were named as high symptom distress (n=47, 30.6%) and low symptom distress (n=118, 69.4%) separately. Multivariate Logistic regression analysis showed that patients with acute lymphoblastic leukemia were more likely to be classified as high symptom distress group, and outpatients in the latest hospital visit were more likely to classified as low symptom distress group (both P<0.05). In addition, patients with high symptom distress had a higher level of light physical activity (P<0.05), and had a lower level of moderate to vigorous physical activity, but the difference was not statistically significant. Conclusion ·There is population heterogeneity in the multiple symptom distress in children and adolescents with cancer. Disease type (acute leukemia) and the way of the latest hospital visit (through outpatient department) are the predictors of symptoms profiles of patients with cancer. Patients who experience high symptom distress have higher level of light physical activity, and perhaps lower level of moderate to vigorous physical activity.

Key words: symptom distress, cancer, child, adolescent, physical activity, latent class analysis

CLC Number:

R473.73

LIU Yanyan, YANG Tiantian, SHEN Nanping, HE Mengxue, ZHANG Hongyan. Latent profile analysis of multiple symptom distress in children and adolescents with cancer and its effect on their physical activity[J]. Journal of Shanghai Jiao Tong University (Medical Science).

Figures/Tables 7

TrendMD

References 37

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Characteristic	n (%)
Gender
Male	108 (65.5)
Female	57 (34.5)
Age
10‒14 years old	136 (82.4)
15‒18 years old	29 (17.6)
Caregiver
Father	47 (28.5)
Mother	118 (71.5)
Education level of caregiver
Primary middle school and lower	56 (33.9)
High school/college degree	61 (37.0)
Bachelor degree and above	48 (29.1)
Family monthly income
<2 000 yuan	13 (7.9)
2 001‒5 000 yuan	36 (21.8)
5 001‒8 000 yuan	44 (26.7)
8 001‒10 000 yuan	34 (20.6)
>10 000 yuan	38 (23.0)
Type of disease
Acute lymphoblastic leukemia	50 (30.3)
Other leukemia	13 (7.9)
Brain tumor	43 (26.1)
Lymphoma	16 (9.7)
Others	43 (26.1)
Risk group
Low	40 (24.2)
Middle	78 (47.3)
High	47 (28.5)
Latest visit in hospital
Outpatient	70 (42.4)
Inpatient	95 (57.6)
Treatment
Chemotherapy/Radiotherapy/Operation	68 (41.2)
Chemotherapy＋Radiotherapy	53 (32.1)
(Chemotherapy/Radiotherapy)＋Operation	17 (10.3)
Chemotherapy＋Radiotherapy＋Operation	27 (16.4)
Other health problem
No	154 (93.3)
Yes	11 (6.7)
Anemia
No	112 (67.9)
Yes	53 (32.1)

Characteristic	n (%)
Gender
Male	108 (65.5)
Female	57 (34.5)
Age
10‒14 years old	136 (82.4)
15‒18 years old	29 (17.6)
Caregiver
Father	47 (28.5)
Mother	118 (71.5)
Education level of caregiver
Primary middle school and lower	56 (33.9)
High school/college degree	61 (37.0)
Bachelor degree and above	48 (29.1)
Family monthly income
<2 000 yuan	13 (7.9)
2 001‒5 000 yuan	36 (21.8)
5 001‒8 000 yuan	44 (26.7)
8 001‒10 000 yuan	34 (20.6)
>10 000 yuan	38 (23.0)
Type of disease
Acute lymphoblastic leukemia	50 (30.3)
Other leukemia	13 (7.9)
Brain tumor	43 (26.1)
Lymphoma	16 (9.7)
Others	43 (26.1)
Risk group
Low	40 (24.2)
Middle	78 (47.3)
High	47 (28.5)
Latest visit in hospital
Outpatient	70 (42.4)
Inpatient	95 (57.6)
Treatment
Chemotherapy/Radiotherapy/Operation	68 (41.2)
Chemotherapy＋Radiotherapy	53 (32.1)
(Chemotherapy/Radiotherapy)＋Operation	17 (10.3)
Chemotherapy＋Radiotherapy＋Operation	27 (16.4)
Other health problem
No	154 (93.3)
Yes	11 (6.7)
Anemia
No	112 (67.9)
Yes	53 (32.1)

Symptom	Number of occurrence	Incidence /%	Distress score/point
Lack of energy	143	86.7	1 (1, 2)
Nausea	127	77.0	1 (1, 2)
Lack of appetite	116	70.3	2 (2, 3)
Sweat	108	65.5	1 (1, 2)
Pain	107	64.8	1 (1, 2)
Sleepy	90	54.5	1 (1, 2)
Difficuly in concentrating	90	54.5	1 (1, 1)
Hair loss	85	51.5	2 (1, 3)
Cough	83	50.3	1 (1, 2)
Vomiting	81	49.1	1 (1, 2)
Dry mouth	80	48.5	1 (1, 2)
Weight loss	80	48.5	1 (1, 2)

Symptom	Number of occurrence	Incidence /%	Distress score/point
Lack of energy	143	86.7	1 (1, 2)
Nausea	127	77.0	1 (1, 2)
Lack of appetite	116	70.3	2 (2, 3)
Sweat	108	65.5	1 (1, 2)
Pain	107	64.8	1 (1, 2)
Sleepy	90	54.5	1 (1, 2)
Difficuly in concentrating	90	54.5	1 (1, 1)
Hair loss	85	51.5	2 (1, 3)
Cough	83	50.3	1 (1, 2)
Vomiting	81	49.1	1 (1, 2)
Dry mouth	80	48.5	1 (1, 2)
Weight loss	80	48.5	1 (1, 2)

Model	AIC	BIC	aBIC	P value			Entropy
Model	AIC	BIC	aBIC	LMRT	aLMRT	BLRT	Entropy
1	5 187.082	5 261.625	5 185.641	－	－	－	－
2	4 992.976	5 107.896	4 990.754	0.008	0.008	0.000	0.828
3	4 949.732	5 105.030	4 946.729	0.413	0.418	0.000	0.862
4	4 887.739	5 083.413	4 883.955	0.173	0.178	0.000	0.875
5	4 874.649	5 110.701	4 870.085	0.519	0.522	0.040	0.889