Symptom Clusters, Physical Activity, and Quality of Life: A Latent Class Analysis of Children During Maintenance Therapy for Leukemia.

Journal Article (Journal Article)


Children undergoing treatment for acute lymphocytic leukemia (ALL) report co-occurring symptoms of fatigue, sleep disturbances, and depression as a symptom cluster. Physical activity (PA) may influence symptom severity and quality of life (QOL).


This study examined changes in symptoms and QOL during ALL maintenance in children categorized by symptom cluster and explored the influence of PA and symptoms on QOL.


Self-report of fatigue, sleep disturbance, and depression; QOL; and PA were measured at the beginning and end of maintenance in 42 children aged 3 to 18 years with ALL. Children were categorized into symptom cluster groups based on measurements at the beginning of maintenance.


Two latent classes of symptom clusters (low and high) were identified with significant differences between groups in symptoms at both the beginning and end maintenance (P < .01). Each group's symptom levels did not change during maintenance. Quality-of-life was different between groups at both time points (P < .01) and did not improve. Children with low symptoms and high PA at the beginning of maintenance had better QOL as treatment ended compared with the physically active high-symptom group and the inactive high-symptom group (P < .01).


Children with higher symptoms did not experience an improvement with time. Symptom and PA levels may influence QOL at the end of treatment.

Implications for practice

Maintenance therapy is a long time (1.5 years) in a child's life. Symptom assessment is needed early in maintenance; interventions are needed for children with high levels.

Full Text

Duke Authors

Cited Authors

  • Hooke, MC; Mathiason, MA; Blommer, A; Hutter, J; Mitby, P; Taylor, O; Scheurer, ME; Kunin-Batson, AS; Pan, W; Hockenberry, MJ

Published Date

  • March 2022

Published In

Volume / Issue

  • 45 / 2

Start / End Page

  • 113 - 119

PubMed ID

  • 34387237

Pubmed Central ID

  • PMC8831653

Electronic International Standard Serial Number (EISSN)

  • 1538-9804

International Standard Serial Number (ISSN)

  • 0162-220X

Digital Object Identifier (DOI)

  • 10.1097/ncc.0000000000000963


  • eng