The principal toxicity for children who receive vincristine for the treatment of acute lymphocytic leukemia (ALL) is peripheral neuropathy, with symptoms that negatively affect physical function and may require the reduction or withdrawal of chemotherapy; even though cumulative dosing has not been shown to increase peripheral neuropathy. This population not only has to deal with the physical challenges of cancer but also can have psychosocial and cognitive effects from treatment. Utilizing secondary analysis, the purpose of this dissertation is to examine peripheral neuropathy (PN) trajectory during the second year of ALL treatment which has not been investigated in children receiving vincristine. Describing these symptom patterns in children carries the potential to guide future targeted nursing interventions. The Symptom Management Model will conceptually guide this three-manuscript dissertation to describe the patients' experience and the development of PN over year two of treatment.Chapter 2 (manuscript 1) examined the state of the science relative to valid and reliable assessment tools for measuring VIPN in pediatric patients receiving chemotherapy through a review of the literature. The results of the scoping review identified two valid and reliable measures (i.e., Ped-mTNS, mTNS©-PV), with one tool better suited for children (mTNS©-PV).Chapter 3 (manuscript 2) and Chapter 4 (manuscript 3) involve a secondary analysis using data collected from an observational, longitudinal, prospective, multi-center study, entitled The Advance Trial, funded by the National Cancer Institute. Chapter 3 (manuscript 2) characterizes the changes in VIPN in a retrospective sample of 77 children with ALL using the cumulative score of the modified TNS©-PV (1-20; higher = more severe) monthly at 12, 15, 18, 21, and 24 months and identifies which nerve pathway contributes to a higher VIPN cumulative score using the subscales of the modified TNS©-PV at the aforementioned time points. These results provide evidence that VIPN is persistent during the second year of ALL treatment and that the sensory/motor pathway is affected the most.Utilizing the same aforementioned data set, Chapter 4 (manuscript 3) examines whether the patient characteristics and treatment characteristics (i.e., race, sex, age, VIPN at 12 months) are associated with VIPN severity at 24 months based on the modified TNS©-PV cumulative score. The modified TNSÓ-PV scores were not correlated with age, sex, race or VIPN at 12 months. Female sex and VIPN at 12 months are associated with VIPN at 24 months as an interaction. Early identification of patients at risk for severe VIPN will enable nurses to proactively screen and monitor patients for peripheral neuropathy as well as recommend interventions to improve this population's functional status.Results from this three-manuscript dissertation add to the growing body of evidence showing a high incidence of PN in children, specifically sensory/motor neuropathy, that does not resolve during the second year of ALL treatment. Proactive assessment and early interventions directed toward children at risk to improve their physical function should be investigated. Studies in larger samples are needed to validate these findings. Patient and provider education is vital to prevent injuries and other complications of PN as well as to improve a patient's quality of life and physical functioning. Future research should focus on examining the psychosocial and cognitive disabilities resulting from PN, examining differences in symptom presentation and functioning between boys and girls with PN, and finding more effective means of treatment.
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