Abstract

INTRODUCTIONThe success achieved in recent decades in improving the survival rates of children and adolescents with cancer has been largely attributed to combined treatment approaches, the intensification of cytotoxic chemotherapy, and enhanced supportive care.1 However, cancer‐ and treatment‐related toxicity remains a significant clinical problem in pediatric oncology. Clinically, symptoms experienced by children undergoing cancer treatment rarely occur in isolation,2 multiple symptoms can co‐occur and be related to each other, referred to as symptom clusters.3,4 Prevalent symptoms in children and adolescents throughout the process of diagnosis and cancer treatment include nausea and vomiting, fatigue, pain, mucositis, and anxiety.5‐12 Research evidence also suggests that these symptoms are inter‐correlated and can negatively influence patient outcomes.13‐17 Fatigue has been reported to be associated with psychological symptoms13 and pain14 in children with cancer. A higher level of anxiety was associated with a higher probability of mucositis,15 while mucositis was associated with pain.16 Previous study indicates that children with high symptom severity, including anxiety, fatigue, and pain were associated with poor functional outcomes.17 These multiple symptoms throughout their process of cancer diagnosis and treatment continue to be a challenge in supportive care for pediatric oncology. Nevertheless, the concepts of symptom clusters and self‐care3,18,19 offer insights