Introduction
Methods
Protocol and registration
Search strategies and data sources
Eligibility criteria
Study selection
Data extraction and synthesis
Quality appraisal
Data analysis
Results
Search results
Characteristics of studies
Author, Year, and Country | Title | Design | Year of Data Retrieval | Sample Characteristics | Symptom Characteristics | Symptom(s) and Prevalence |
---|---|---|---|---|---|---|
Zupanec et al. 2010 [18] Canada | Sleep habits and fatigue of children receiving maintenance chemotherapy for ALL and their parents | Mixed methods – Cross-sectional design | 2008.09-2009.01 |
N = 64; 51 (79.69%) male
Age: 4–18 y (Mean age was not reported)
Diagnoses: ALL
Treatment state:
Had finished the first 3 courses of maintenance chemotherapy Risk state:
Standard risk (60.94%) High risk (29.69%) T-cell (9.38%) Race:
Caucasian (51.56%) Asian (25.00%) Multiracial (14.06%) Black (7.81%) Hispanic (1.56%) | Symptom focus:
Fatigue: FSA, FSP Sleep disturbance: CSHQ Reporting mode:
< 13 y: Parent proxy report ≧ 13 y: Children self-report Recall period: 1 week
| Sleep disturbance (85.94%) |
Bu et al. 2015 [28] China | Study of fatigue and related factors among children with acute lymphoblastic leukemia receiving chemotherapy in hospital (Chinese version) | Quantitative -Cross-sectional design | 2013.07-2014.01 |
N = 100; 65 (65.0%) male
Age: 2–15 y (6)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy Risk state and race were not reported
| Symptom focus:
Fatigue: PedsQLTMMFS (Parent) Pain: Wong-Baker Faces Scale Reporting mode:
Parents proxy-report Recall period:
The recall period was not reported | Sleep disturbance (6.15%) |
Ren et al. 2017 [19] China | Fatigue of children with acute lymphoblastic leukemia during chemotherapy and influencing factors (Chinese version) | Quantitative -Cross-sectional design | 2014.02-2016.08 |
N = 216; 102 (47.2%) male
Age: 5–15 y (Mean age was not reported)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy Risk state and race were not reported
| Symptom focus:
Fatigue: PedsQLTMMFS Other symptoms: MSAS10-18 Reporting mode:
5-8y: Parents proxy-report > 8: Children self-report Recall period: 1 week
| Fatigue (95.83%) |
Daniel et al. 2018 [20] USA | The relationship between child and caregiver sleep in acute lymphoblastic leukemia maintenance | Quantitative -Cross-sectional design | 2010.05-2014.10 |
N = 68 (The gender information was not reported)
Age: 3–12 y (Mean age was not reported)
Diagnoses: ALL
Treatment state:
Maintenance phase of chemotherapy Risk state:
Low (2.9%) Standard (63.2%) High (33.8%) Race:
Caucasian (76.5%) Asian (4.4%) Black or African American (7.4%) Other (2.7%) More than one race (8.8%) Hispanic/Latino (10.3%) | Symptom focus:
Sleep disturbance: CSHQ Reporting mode:
Parents proxy report Recall period: 1 week
| Sleep disturbance (67.65%) |
Fadhilah et al. 2019 [21] Indonesia | The Relationship between Activity Level and Fatigue in Indonesian Children with Acute Lymphocytic Leukemia in the Home Setting | Quantitative -Cross-sectional design | The year of data retrieval was not reported |
N = 45; 30 (66.7%) male
Age: 3–16 y (Mean age was not reported)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy Induction (13.3%) Consolidation (6.7%) Maintenance (53.3%) Remission (26.7%) Risk state:
Standard risk (62.2%) High risk (37.8%) The race was not reported
| Symptom focus:
Fatigue: Allen-Child Oncology Fatigue questionnaire Reporting mode:
Primary self-report, partially report with the help of parents Recall period:
The recall period was not reported | Fatigue (100%) |
Loves et al. 2019 [22] Canada | Taste changes in children with cancer and hematopoietic stem cell transplant recipients | Quantitative -Cross-sectional design | 2014.09-2017.06 |
N = 64 (The gender information was not reported)
Age: The tumour type of sample was mixed, and the mean age of children with ALL was not reported, but all the participants were between 8–18 years old (Mean age was not reported)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy The risk state and race were not reported
| Symptom focus:
Taste changes: SSPedi Reporting mode:
Children self-report Recall period:
The recall period was not reported | Taste changes (40.6%) |
Tomlinson et al. 2019 [23] Canada | Severely bothersome fatigue in children and adolescents with cancer and hematopoietic stem cell transplant recipients | Quantitative -Cross-sectional design | 2014.09-2017.06 |
N = 64 (The gender information was not reported)
Age: The tumour type of sample was mixed, and the mean age of children with ALL was not reported, but all the participants were between 8–18 years old (Mean age was not reported)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy The risk state and race were not reported
| Symptom focus:
Fatigue: SSPedi Reporting mode:
Children self-report Recall period:
The recall period was not reported | Fatigue (14.1%) |
Ma et al. 2019 [30] China | Analysis of the correlation between fatigue and discomfort symptoms in children with acute lymphoblastic Leukemia and its influencing factors (Chinese version) | Quantitative -Cross-sectional Design | 2017.01-2018.03 |
N = 68; 27 (39.7%) male
Age: 5–15 y (8.29)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy The risk state and race were not reported
| Symptom focus:
Fatigue: PedsQLTMMFS Other symptoms: MSAS 10–18 Reporting mode:
Primary self-report, partially reported with the help of parents Recall period: 1 week
| Fatigue (95.59%) |
Hyslop et al. 2021 [24] Canada | Feeling scared or worried self-report in children receiving cancer treatments using the Symptom Screening in Pediatrics Tool (SSPedi) | Quantitative -Cross-sectional design | 2014.09-2017.07 |
N = 64 (The gender information was not reported)
Age: The tumour type of sample was mixed, and the mean age of children with ALL was not reported, but all the participants were between 8–18 years old (Mean age was not reported)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy The risk state and race were not reported
| Symptom focus:
Feeling scared or worried: SSPedi Reporting mode:
Children self-report Recall period:
The recall period was not reported | Feeling scared or worried (40.77%) |
Zhou et al. 2021 [25] China | Cancer-related fatigue status and influencing factors in children with acute lymphoblastic leukemia (Chinese version) | Quantitative -Cross-sectional design | 2018.12-2019.09 |
N = 102; 62 (60.78%) male
Age: 5–18 y (Mean age was not reported)
Diagnoses: ALL
Treatment state:
Induction (41.18%) Consolidation (44.12%) Maintenance (14.70%) Risk state:
low risk (34.31%) Moderate risk (41.18%) High risk (24.51%) The race was not reported
| Symptom focus:
Fatigue: PedsQLTMMFS Reporting mode:
Children self-report Recall period: 1 month
| Fatigue (98.04%) |
Hockenberry et al. [29] 2014 USA | The influence of oxidative stress on symptom occurrence, severity, and distress during childhood Leukemia treatment | Quantitative - Prospective Longitudinal Design | The year of data retrieval was not reported |
N = 34; 17 (47.2%) male
Age: 3–15 y (7.36)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy The risk state was not reported
Race:
Caucasian (44.4%) Hispanic (41.7%) African American (5.6%) Native American (2.8%) Other (5.6%) | Symptom focus:
Multiple symptoms: MSAS10-18 Reporting mode:
3–7: Parents proxy report 8-15: Children self-report Data collection points:
T1-T6: Average of 45, 142, 241, 338, 424, and 510 days from diagnosis, respectively, spanning induction, post-induction, and during continuation therapy Recall period: 1 week
| Lack of energy (47.06%) Pain (41.18%) Feeling drowsy (29.41%) Nausea (41.18%) Cough (41.18%) Lack of appetite (44.12%) Feeling sad (29.41%) Feeling nervous (35.29%) Worrying (20.59%) Feeling irritable (47.06%) Itching (23.53%) Insomnia (29.41%) Hair loss (50.00%) Vomiting (23.53%) Weight loss (26.47%) Sweating (29.41%) Lack of concentration (38.24%) Diarrhea (14.71%) Skin changes (20.59%) Dyspnea (14.71%) Change in the way food tastes (41.18%) “I don’t look like myself” (17.65%) Mouth sores(20.59%) Constipation (17.65%) |
Kunin-Batson et al. 2016 [17] USA | Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study | Quantitative - Prospective Longitudinal Design | 2005–2009 | N = 159; 83 (52.2%) male Age: 2–9 y (Mean age was not reported)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy The risk state was not reported
Race:
White, non-Hispanic (67.9%) Black, non-Hispanic (6.9%) Hispanic (16.4%) Other (8.8%) | Symptom focus:
Anxiety and depression: BASC-2 Reporting mode:
Parents proxy report Data collection points:
T1: day 1 of consolidation therapy T2: the end of the delayed intensification T3: 6 months after the initiation of maintenance therapy T4: 3 months after the completion of therapy Recall period: 1 month
| Anxiety (24.8%) Depression (27.6%) |
McCarthy et al. 2016 [16] Australia | Are parenting behaviors associated with child sleep problems during treatment for acute lymphoblastic leukemia? | Quantitative- Cross-sectional & Case-control design | The year of data retrieval was not reported |
N = 43; 30 (69.77%) male
Age: 2–6 y (4.6)
Diagnoses: ALL
Treatment state:
During the maintenance phase of ALL treatment The risk state and race were not reported
| Symptom focus:
Sleep disturbance: TCSQ Reporting mode:
Parents proxy-report Recall period:
The recall period was not reported | Sleep disturbance (48.00%) |
Li et al. 2019 [31] China | Symptom clusters among children with acute lymphocytic leukemia during chemotherapy: a longitudinal study(Chinese version) | Quantitative - Prospective Longitudinal Design | 2017.07-2018.11 | N = 130; 85 (63.4%) male Age: 8–16 y (10.53)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy Risk state:
Low risk (20.15%) Moderate risk (45.93%) High risk (33.58%) The race was not reported
| Symptom focus:
Multiple symptoms: MSAS10-18 Reporting mode:
Children self-report Data collection points:
Four data collection points: T1: Before chemotherapy T2: induction T3: consolidation T4: maintenance of chemotherapy Recall period: 1 week
| Lack of energy (94.62%) Pain (68.46%) Headache (36.92%) Feeling drowsy (46.92%) Nausea (70.00%) Cough (53.08%) Lack of appetite (83.85%) Feeling sad (53.85%) Feeling nervous (66.15%) Worrying (64.62%) Feeling irritable (70.00%) Itching (23.85%) Insomnia (60.77%) Dry mouth (68.46%) Hair loss (53.85%) Vomiting (63.85%) Weight loss (67.69%) Dizziness (41.54%) Numbness/tingling in hands/feet (18.46%) Sweating (85.38%) Lack of concentration (51.54%) Diarrhea (7.69%) Skin changes (28.46%) Dyspnea (2.31%) Change in the way food tastes (83.85%) “I don’t look like myself” (53.85%) Mouth sores (24.62%) Constipation (60.77%) Swelling of arms/legs (5.38%) Problems with urination (1.54%) |
Steur et al. 2020 [15] Netherlands | High prevalence of parent-reported sleep problems in pediatric patients with acute lymphoblastic leukemia after induction therapy | Quantitative - Prospective Longitudinal Design | The year of data retrieval was not reported |
N = 113; 63 (55.8%) male
Age: 3–9 y (4.8)
Diagnoses: ALL
Treatment state:
Receiving chemotherapy Risk state:
Standard (26.55%) Medium (73.45%) The race was not reported
| Symptom focus:
Fatigue: PedsQL MFS-parent Sleep: Actigraphy, sleep diary Reporting mode:
Parents proxy-report Data collection points:
T1: After induction, T2: Between two hospital admissions Recall period: 1 week
| Sleep disturbance (12.10%) |
Irestorm et al., 2023 [27] Dutch | Fatigue trajectories during pediatric ALL therapy are associated with fatigue after treatment: a national longitudinal cohort study | Quantitative - Prospective Longitudinal Design | The year of data retrieval was not reported |
N = 92
Age: 2–18 y
Diagnoses: ALL
Treatment state:
Receiving chemotherapy Risk state:
Standard (25%) Medium (75%) The race was not reported
| Symptom focus:
Fatigue: PedsQL MFS-parent Reporting mode:
Parents proxy report Data collection points:
T0:5 months after diagnosis, T1: 12 months after diagnosis T2: 24 months after diagnosis Recall period: 1 week
| Fatigue (78.26%) |
Xi et al., 2023 China [26] | Analyzing sleep status in children with acute leukemia | Quantitative- Cross-sectional design | 2020 to 2022 | N = 173; 96 (55.5%) male Age: 0–18 y (6.86)
Diagnoses: ALL(n = 167)
Treatment state:
Receiving chemotherapy The risk state was not reported
The race was not reported
| Symptom focus:
Sleep disturbance: CSDS Reporting mode:
0–7: Parents proxy report 8-18: Children self-report Recall period: Not report
| Sleep disturbance (40.12%) |
Instruments | Symptoms |
---|---|
Multidimensional Fatigue Scale (PedsQL™ MFS) | Fatigue |
Fatigue Scale–Adolescent (FSA) | Fatigue |
Fatigue Scale–Parent (FSP) | Fatigue |
Allen-Child Oncology Fatigue questionnaire | Fatigue |
Children’s Sleep Habits Questionnaire (CSHQ) | Sleep Disturbance |
Tayside Children’s Sleep Questionnaire (TCSQ) | Sleep Disturbance |
Wong-Baker Faces Scale | Pain |
The Behavioral Assessment System for Children-2nd Edition (BASC-2) | Anxiety and depression |
Memorial Symptom Assessment Scale 10–18 (MSAS10-18) | Multiple symptoms |
Symptom Screening in Pediatrics Tool (SSPedi) | Multiple symptoms |
Methodological quality of included studies
Symptom prevalence
Symptoms |
k
|
n
| Prevalence (%) | Heterogeneity | ||||
---|---|---|---|---|---|---|---|---|
95% CI | Q | df(Q) |
I,%
| P | ||||
Fatigue | 6 | 796 | 91.0a
| 57.4–98.7 | 257.28 | 5 | 98.06% | 0.000 |
Lack of energy | 2 | 164 | 79.7a
| 17.4–98.7 | 33.097 | 1 | 96.98% | 0.000 |
Dry mouth | 1 | 89 | 68.5c
| 60.0-75.9 | ||||
Lack of appetite | 2 | 164 | 67.3a
| 24.5–92.9 | 20.14 | 1 | 95.04% | 0.000 |
Sweating | 2 | 164 | 61.3a
| 10.6–95.5 | 34.296 | 1 | 97.08% | 0.000 |
Feeling irritable | 2 | 164 | 60.0a
| 36.9–79.4 | 6.02 | 1 | 83.39% | 0.014 |
Change in the way food tastes | 3 | 437 | 57.7a
| 26.0-84.1 | 57.45 | 2 | 96.52% | 0.000 |
Nausea | 2 | 164 | 57a
| 29.0-81.1 | 9.171 | 1 | 89.10% | 0.002 |
Pain | 2 | 164 | 56.1a
| 29.7–79.5 | 8.155 | 1 | 87.74% | 0.004 |
Hair loss | 2 | 164 | 53a
| 45.4–60.6 | 0.16 | 1 | 0 | 0.689 |
Feeling nervous | 2 | 164 | 51.7a
| 23.5–78.9 | 9.99 | 1 | 89.99% | 0.002 |
Cough | 2 | 164 | 50.6b
| 43.0-58.3 | 1.512 | 1 | 33.87% | 0.219 |
Lack of concentration | 2 | 164 | 48.9b
| 41.2–56.5 | 1.89 | 1 | 46.95% | 0.17 |
Weight loss | 2 | 164 | 47.3a
| 13.8–83.4 | 16.65 | 1 | 94.00% | 0.000 |
Insomnia | 2 | 164 | 45.6a
| 18.8–75.2 | 9.91 | 1 | 89.91% | 0.002 |
Vomiting | 2 | 164 | 43.3a
| 12.1–80.9 | 15.52 | 1 | 93.56% | 0.000 |
Worrying | 3 | 451 | 42.5a
| 23.6–63.9 | 28.29 | 2 | 92.93% | 0.000 |
Feeling sad | 2 | 164 | 42.4a
| 21.2–66.7 | 6.141 | 1 | 83.72% | 0.013 |
Dizziness | 1 | 130 | 41.5c
| 33.4–50.2 | ||||
Sleep disturbance | 6 | 531 | 39.6a
| 18.1–65.1 | 110.53 | 5 | 95.48% | 0.000 |
Feeling drowsy | 2 | 164 | 39.5a
| 24.1–57.4 | 3.279 | 1 | 69.5·% | 0.07 |
Constipation | 2 | 164 | 37.6a
| 8.0-80.7 | 16.68 | 1 | 94.00% | 0.000 |
Headache | 1 | 130 | 36.9c
| 29.1–45.5 | ||||
“I don’t look like myself” | 2 | 164 | 34.5a
| 9.1–73.4 | 12.31 | 1 | 91.88% | 0.000 |
Depression | 1 | 159 | 27.6c
| 19.9–36.9 | ||||
Skin changes | 2 | 164 | 27b
| 20.7–34.3 | 0.84 | 1 | 0 | 0.359 |
Anxiety | 1 | 159 | 24.8c
| 17.4–33.9 | ||||
Itching | 2 | 164 | 23.8b
| 17.9–30.9 | 0.001 | 1 | 0 | 0.969 |
Mouth sores | 2 | 164 | 23.8b
| 17.9–30.9 | 0.24 | 1 | 0 | 0.624 |
Numbness/tingling in hands/feet | 1 | 130 | 18.5c
| 12.7–26.1 | ||||
Diarrhoea | 2 | 164 | 9.5b
| 5.8–15.2 | 1.54 | 1 | 35.15% | 0.214 |
Dyspnoea | 2 | 164 | 6.2a
| 0.9–31.5 | 6.86 | 1 | 85.43% | 0.009 |
Swelling of arms/legs | 1 | 130 | 5.4c
| 2.6–10.9 | ||||
Problems with urination | 1 | 130 | 1.5c
| 0.4–5.9 |