Symptoms in Children Receiving Treatment for Cancer—Part I: Fatigue, Sleep Disturbance, and Nausea/Vomiting

Mary C. Hooke, Lauri A. Linder

Research output: Contribution to journalReview articlepeer-review

63 Scopus citations


Children and adolescents with cancer often undergo intensive chemotherapy treatment to obtain remission and long-term survival. The pursuit of successful treatment outcomes may lead to high levels of symptom distress related to treatment side effects and toxicities. The Children’s Oncology Group Nursing Discipline held a State of the Science Symposium “Symptom Assessment During Childhood Cancer Treatment” in 2018 that included reviews of evidence regarding key symptoms. The purpose of this review is to summarize and synthesize the evidence presented about the prevalence, relationships, trajectories, and associated biomarkers of selected symptoms experienced by children and adolescents during cancer treatment. Five symptoms were selected, with the focus on fatigue, sleep disturbance, and nausea/vomiting and included in Part I of the review. Using Ovid-Medline, studies published between 2008 and 2018 that focused on these specific symptoms during active chemotherapy treatment were selected. Fatigue interferes with normal developmental activities and is associated with sleep disturbances, and its pattern changes within a cycle of chemotherapy as well as across the treatment trajectory. Sleep is disrupted by the hospital environment, treatment medications, and changes in normal childhood and schedules. Disturbances of sleep persist during treatment, preventing recovery from poor quality sleep. Although pharmacologic interventions have advanced for treatment of nausea and vomiting, children and adolescents continue to struggle with this symptom. Its trajectory changes with the intensity of treatment, and over half of the patients report that they experience nausea and/or vomiting. Future research is needed to advance identification of biologic risk factors for symptoms and test effectiveness of symptom-related interventions.

Original languageEnglish (US)
Pages (from-to)244-261
Number of pages18
JournalJournal of Pediatric Oncology Nursing
Issue number4
StatePublished - Jul 1 2019

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the National Cancer Institute R13CA232442 (PIs: Rodgers/Hockenberry) and National Clinical Trials Network (NCTN) Group Operations Center Grant U10CA180886 (PI: Adamson).

Publisher Copyright:
© 2019 by Association of Pediatric Hematology/Oncology Nurses.


  • fatigue
  • side effects of treatment
  • sleep
  • symptoms


Dive into the research topics of 'Symptoms in Children Receiving Treatment for Cancer—Part I: Fatigue, Sleep Disturbance, and Nausea/Vomiting'. Together they form a unique fingerprint.

Cite this