Symptom clusters in postchemotherapy neutropenic fever in hematological malignancy: associations among sickness behavior symptom cluster, inflammatory biomarkers of procalcitonin and C-reactive protein, and febrile measures
Symptom clusters in postchemotherapy neutropenic fever in hematological malignancy: associations among sickness behavior symptom cluster, inflammatory biomarkers of procalcitonin and C-reactive protein, and febrile measures
Context: Little research has been conducted to investigate symptom clusters in postchemotherapy neutropenic fever (NF), their relationships with inflammatory biomarkers, and febrile outcome measures in patients with hematological malignancy, a population with high febrile rates incurring considerable costs to the health care system. Objectives: The aim of the present study was to investigate these. Methods: One hundred four NF episodes were observed in patients with hematological malignancy who were enrolled in the study. Patient-reported symptoms were recorded using the M.D. Anderson Symptom Inventory. Inflammatory biomarkers of procalcitonin (PCT) and C-reactive protein (CRP), vital signs, blood specimens for cultures, blood cell counts, and biochemistry were also collected. Serious complications from NF were reviewed from medical records if documented. Exploratory factor analysis and Spearman's rank correlation were used in the data analysis. Results: Three symptom clusters—sickness behavior, chemotherapy neurotoxicity, and emesis—were identified by exploratory factor analysis. The factor score of the sickness behavior cluster was significantly correlated with CRP (P < 0.05), PCT (P < 0.01), and the highest (P < 0.05) and maximum increased in (P < 001) temperatures at the onset (first day) of neutropenic fever. Conclusion: This study identified symptom clusters of sickness behavior, chemotherapy neurotoxicity, and emesis and highlighted significant associations between sickness behavior cluster, PCT, CRP, and febrile temperatures at the onset of postchemotherapy NF. These areas have lacked exploration in previous research. Monitoring and analyzing patient-reported sickness behavior symptoms, PCT, CRP, and temperature data would provide significant complementary data for the management and surveillance of postchemotherapy NF in hematological malignancy.
C-reactive protein, hematological malignancy, M.D. Anderson Symptom Inventory, postchemotherapy neutropenic fever, procalcitonin, Sickness behavior symptom cluster
1204-1211
Chan, Choi Wan
a4105841-4f14-4335-990b-20eab20f28dd
Lee, Paul Hong
02620eab-ae7f-4a1c-bad1-8a50e7e48951
Molassiotis, Alex
f4f18817-07cb-48ca-a51e-9504aa886a79
Lee, Harold Kwok Kuen
e775a227-b942-4fe6-9b6f-0a21a0a3c3df
1 June 2020
Chan, Choi Wan
a4105841-4f14-4335-990b-20eab20f28dd
Lee, Paul Hong
02620eab-ae7f-4a1c-bad1-8a50e7e48951
Molassiotis, Alex
f4f18817-07cb-48ca-a51e-9504aa886a79
Lee, Harold Kwok Kuen
e775a227-b942-4fe6-9b6f-0a21a0a3c3df
Chan, Choi Wan, Lee, Paul Hong, Molassiotis, Alex and Lee, Harold Kwok Kuen
(2020)
Symptom clusters in postchemotherapy neutropenic fever in hematological malignancy: associations among sickness behavior symptom cluster, inflammatory biomarkers of procalcitonin and C-reactive protein, and febrile measures.
Journal of Pain and Symptom Management, 59 (6), .
(doi:10.1016/j.jpainsymman.2019.12.372).
Abstract
Context: Little research has been conducted to investigate symptom clusters in postchemotherapy neutropenic fever (NF), their relationships with inflammatory biomarkers, and febrile outcome measures in patients with hematological malignancy, a population with high febrile rates incurring considerable costs to the health care system. Objectives: The aim of the present study was to investigate these. Methods: One hundred four NF episodes were observed in patients with hematological malignancy who were enrolled in the study. Patient-reported symptoms were recorded using the M.D. Anderson Symptom Inventory. Inflammatory biomarkers of procalcitonin (PCT) and C-reactive protein (CRP), vital signs, blood specimens for cultures, blood cell counts, and biochemistry were also collected. Serious complications from NF were reviewed from medical records if documented. Exploratory factor analysis and Spearman's rank correlation were used in the data analysis. Results: Three symptom clusters—sickness behavior, chemotherapy neurotoxicity, and emesis—were identified by exploratory factor analysis. The factor score of the sickness behavior cluster was significantly correlated with CRP (P < 0.05), PCT (P < 0.01), and the highest (P < 0.05) and maximum increased in (P < 001) temperatures at the onset (first day) of neutropenic fever. Conclusion: This study identified symptom clusters of sickness behavior, chemotherapy neurotoxicity, and emesis and highlighted significant associations between sickness behavior cluster, PCT, CRP, and febrile temperatures at the onset of postchemotherapy NF. These areas have lacked exploration in previous research. Monitoring and analyzing patient-reported sickness behavior symptoms, PCT, CRP, and temperature data would provide significant complementary data for the management and surveillance of postchemotherapy NF in hematological malignancy.
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More information
Accepted/In Press date: 20 December 2019
Published date: 1 June 2020
Additional Information:
Funding Information:
The authors have no conflicts of interest to declare. This research was supported by The Hong Kong Polytechnic University Block Grant (1-ZE81). The authors give thanks to the Chief of Services, Dr. Law, staff of the hematological unit, and staff of the Medical Record Office for the facilitation of patient recruitment and medical record review. The authors are also grateful to Jackie Cheung, Isaac Cheng, Cindy Kwan, Sally Chan, Suki Ho, Lorelei Ip, and Carmen Ip for their assistance in data collection and to the patients whose participation made this research possible.
Publisher Copyright:
© 2019 American Academy of Hospice and Palliative Medicine
Keywords:
C-reactive protein, hematological malignancy, M.D. Anderson Symptom Inventory, postchemotherapy neutropenic fever, procalcitonin, Sickness behavior symptom cluster
Identifiers
Local EPrints ID: 475029
URI: http://eprints.soton.ac.uk/id/eprint/475029
ISSN: 0885-3924
PURE UUID: 44bc2dbb-911c-498e-8df7-15f6e5d91192
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Date deposited: 09 Mar 2023 17:32
Last modified: 06 Jun 2024 02:15
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Author:
Choi Wan Chan
Author:
Paul Hong Lee
Author:
Alex Molassiotis
Author:
Harold Kwok Kuen Lee
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