Key Symptoms Deteriorating Quality of Life and Daily Activities Before and After the First Chemotherapy for Hematologic Cancer

Abstract

Identifying the symptoms that most significantly deteriorate patient outcomes (i.e., quality of life [QoL] and daily activities) at specific treatment stages is important in caring for patients with hematologic cancer. Yet, few studies have examined symptom experiences and patient outcomes during the early phases of chemotherapy immediately after diagnosis. Hence, this study aimed to (a) evaluate symptom experience (prevalence, severity), QoL, and interference with daily activities before and 1 week after completing induction chemotherapy and (b) identify key symptoms affecting QoL and daily activities at each time point. The sample included 124 patients undergoing their first chemotherapy for hematologic cancer. We administered the Memorial Symptoms Assessment Scale, a single-item QoL scale, and the symptom-interference subscale of the Brief Pain Inventory. Statistical analyses included Wilcoxon rank-sum tests, Spearman’s rho, and multiple-regression analysis. No significant changes emerged in QoL or interference with daily activity scores from pre- to postchemotherapy, suggesting that the impact of chemotherapy on patient outcomes was not instant. However, two items in interference with daily activities worsened following treatment, possibly due to hospitalization: “relationships with others” (p = .03), and “sleep” (p = .001). At both time points, interference with daily activities was highest for “enjoyment of life.” Across time points, “lack of energy” most frequently and severely occurred. Symptom experience was strongly associated with interference in daily activities but not with QoL. Significant independent predictors of interference with daily activities were “being irritable” (β = .31, p < .001), “insomnia” (β = .18, p = .04), and “difficulty in concenting” (β = .18, p = .02) before chemotherapy; “difficulty in concentrating” (β = .30, p < .001), “worrying” (β = .30, p = .003), and “lack of energy” (β = .20, p = .02) 1 week after induction chemotherapy. In conclusion, psychological symptoms (e.g., lack of energy, difficulty in concentrating, being irritable, and worrying) were not only prevalent but also greatly influenced daily activities before and after treatment. Nurses should assess and manage these symptoms and be aware of pharmacological/nonpharmacological interventions to alleviate them. Interference in “enjoyment of life” is a notable patient outcome throughout treatment.