April 2010

Document Type


Degree Name



Oregon Health & Science University


Background: In recent years, childhood cancer in Thailand has become a more curable disease with aggressive treatment. Symptoms related to cancer treatment, however, have a significant impact on children’s quality of life. The problematic symptoms of young children undergoing chemotherapy for cancer have been little studied due to the children’s inability to self-report. There is an urgent need to examine symptoms related to cancer treatment in children aged 1 to 5 years old. Purposes: This study described mothers’ perceptions of symptoms and symptom management in their young children during three days of chemotherapy treatment for cancer. In addition, the relationships among maternal sensitivity, maternal parenting stress, and mothers’ perceptions of their children’s symptoms were explored. Methods: This study was a prospective and descriptive study. Fifty Thai mothers and their children were recruited at the Queen Sirikit National Institute of Child Health in Bangkok, Thailand between January and June 2009. The questionnaires for mothers included demographic data, a 3-day symptom dairy, a maternal sensitivity questionnaire, and a parenting stress index. Children wore an actiwatch for 3 days to validate mothers’ reports of trouble sleeping. Results: The modified MSAS assessed the prevalence, frequency, intensity, and distress of 9 symptoms the day before chemotherapy (Time1, T1 (baseline)) and 3 days after receiving chemotherapy treatment. Change of appetite was reported as the most prevalent symptom for the six time points. The results for the repeated measures ANOVA indicated a significant time effect with means increasing from time 1 (baseline) to time 2 (morning day 1), and then decreasing at each subsequent time period. Symptom frequency, intensity, and distress were rated by Thai mothers as less than found in previous studies. Majority of mothers used vigilant caring and distraction to manage several symptoms of their young children. Higher parenting stress index scores were related to higher post-chemotherapy symptom scores. However, children’s sleep times from actiwatch were consistent with mothers’ report of trouble sleeping. Discussion: Young children with cancer undergoing chemotherapy did not encounter isolated symptoms but rather multiple symptoms. Young children experienced greater symptoms the first day of chemotherapy and then symptoms decreased progressively at each subsequent time period. Symptoms associated with chemotherapy side effects or post procedure may have received minimal attention by mothers. In contrast, symptoms related to contextual stimuli such as the insertions of needles or lumbar puncture allowed mothers to make reasonable assessments. Thai culture and hospital environment in this study may have influenced mothers’ perceptions of symptoms in their young children leading them to report lower prevalence, intensity, and distress than those in the western culture. Thai mothers have great a concern about young children eating. The traditional interpretation of maternal-child interaction might not be appropriate for mothers of children with cancer. Perhaps they observed their children more closely due to the life threatening cancer and effectively reported their children’s symptoms. Finally, the findings indicated that mothers are appropriate as reporters of their children’s symptoms. Nonetheless, several factors should be considered when considering the accuracy of mothers’ reports, such as their knowledge of chemotherapy side effects, stress, parenting styles, culture, and the meaning of diagnosis.




School of Nursing



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