Original Article

The Effect of Family-Centered Supportive Program on Chemotherapy-Induced Symptoms in Patients with Acute Lymphoblastic Leukemia


Acute lymphoblastic leukemia is a disease of the hematopoietic system and chemotherapy is recommended as the primary treatment.  As many chemotherapeutic agents have severe adverse effects, patients require to be supported by their family to deal with chemotherapy-related symptoms. This study attempted to investigate the effect of a family-centered supportive program on chemotherapy symptom control in patients with acute lymphoblastic leukemia.

Materials and Methods: Sixty-six patients with acute lymphoblastic leukemia undergoing chemotherapy along with their caregivers participated in this nonrandomized clinical trial. Patients in Shariati and Taleghani Hospital were assigned to the intervention (n=33) and control group (n=33), respectively. A survey of the family-centered supportive program was conducted via in-person and telephone up to 6 cycles of chemotherapy. The chemotherapy symptom assessment scale was administered to record the data during six cycles of chemotherapy treatment. The control group only received routine interventions. Data were analyzed using Chi-square and Mann–Whitney U tests.

Results: The results of the study indicated that there was a statistically significant difference in terms of the frequency of 9 chemotherapy-induced symptoms including nausea, shortness of breath, problems with the skin and nails, a sore/sensitive mouth or throat, anorexia, weight gain or loss, headache and sore/scratchy/dry eyes between the control and intervention group. There was also a statistically significant difference in the severity and level of discomfort of 19 chemotherapy-induced symptoms between the control and intervention group.

Conclusion: Family-centered supportive program can be considered as an approach to decrease the frequency, severity and discomfort level of chemotherapy-induced symptoms.


1. Blackburn LM, Brown S, Munyon A, et al. Leukostasis: Management to prevent crisis in acute leukemia. Clin J Oncol Nurs. 2017;21(6):E267-E71.
2. Soares Almeida AL, Campos de Azevedo I, de Souza Rego Pinto Carvalho D, et al. Clinical and epidemiological aspects of leukemias. Rev Cubana Hematol Inmunol Hemoter. 2017; 33(2): 1-14.
3. Inaba H, Greaves M, Mullighan CG. Acute lymphoblastic leukaemia. Lancet. 2013;381(9881):1943-55.
4. Sive JI, Buck G, Fielding A, et al. Outcomes in older adults with acute lymphoblastic leukaemia (ALL): results from the international MRC UKALL XII/ECOG2993 trial. Br J Haematol. 2012; 157(4):463-71.
5. Katz AJ, Chia VM, Schoonen WM, et al. Acute lymphoblastic leukemia: an assessment of international incidence, survival, and disease burden. Cancer Causes Control. 2015;26(11):1627-42.
6. Ghavamzadeh A, Alimoghaddam K, Ghaffari F, et al. Twenty Years of Experience on Stem Cell Transplantation in Iran. Iran Red Crescent Med J. 2013;15(2): 93–100.
7. Okhmat VA, klyasova GA, Parovichnikova EN, et al. Spectrum and epidemiology of infection complications in patients with acute myeloid leukemia during induction and consolidation chemotherapy. Gematologiya i Transfusiologiya. 2017;62(1):9-15.
8. Salles G, Barrett M, Foà R, et al. Rituximab in B-Cell Hematologic Malignancies: A Review of 20 Years of Clinical Experience. Adv Ther. 2017; 34(10):2232-2273.
9. Cardona A, Balouch A, Mohammed MA, et al. Efficacy of Chlorhexidine for the Prevention and Treatment of Oral Mucositis in Cancer Patients: A Systematic Review with Meta‐analyses. J Oral Pathol Med. 2017; 46(9): 680-688.
10. Tayyar Y, Jubair L, Fallaha S, et al. Critical risk-benefit assessment of the novel anti-cancer aurora a kinase inhibitor alisertib (MLN8237): A comprehensive review of the clinical data. Crit Rev Oncol Hematol. 2017;119(Supplement C):59-65.
11. Gougis P, Wassermann J, Spano JP, et al. Clinical pharmacology of anti-angiogenic drugs in oncology. Crit Rev Oncol Hematol. 2017;119:75-93.
12. Carneiro-Neto JN. Protocols for management of oral complications of chemotherapy and/or radiotherapy for oral cancer: Systematic review and meta-analysis current. Med Oral Patol Oral y Cir Bucal. 2017; 22(1):e15-e23.
13. Jitender S, Mahajan R, Rathore V, et al. Quality of life of cancer patients. J Exp Ther Oncol. 2018;12(3):217-221.
14. Buckley SA, Jimenez SD, Othus M, et al. Quality of life from the perspective of the patient with acute myeloid leukemia. Cancer. 2018;124(1):145-152.
15. Chagas TR, Borges DS, de Oliveira PF, et al. Oral fish oil positively influences nutritional-inflammatory risk in patients with haematological malignancies during chemotherapy with an impact on long-term survival: a randomised clinical trial. J Hum Nutr Diet. 2017; 30(6):681-692.
16. Mansouri P, Haghighi M, Beheshtipour N, et al. The Effect of Aloe Vera Solution on Chemotherapy-Induced Stomatitis in Clients with Lymphoma and Leukemia: A Randomized Controlled Clinical Trial. Int J Community Based Nurs Midwifery. 2016;4(2):119-26.
17. Blackburn L, Achor S, Allen B, et al. The effect of aromatherapy on insomnia and other common symptoms among patients with acute leukemia. Oncol Nurs Forum. 2017;44(4):E185-E193.
18. Zhang R, Yin J, Zhou Y. Effects of mindfulness-based psychological care on mood and sleep of leukemia patients in chemotherapy. Int J Nurs Sci. 2017;4(4):357-361.
19. Faller H, Brähler E, Härter M, et al. Unmet needs for information and psychosocial support in relation to quality of life and emotional distress: A comparison between gynecological and breast cancer patients. Patient Educ Couns. 2017;100(10):1934-1942.
20. Mayberry LS, Berg CA, Harper KJ, et al. The design, usability, and feasibility of a family-focused diabetes self-care support mHealth intervention for diverse, low-income adults with type 2 diabetes. J Diabetes Res. 2016;2016: 7586385.
21. Harper FWK, Eggly S , Crider B, et al. Patient- and Family-Centered Care as an approach to reducing disparities in asthma outcomes in urban African American children: A review of the literature. J Natl Med Assoc. 2015;107(2):4-17.
22. Sanaie N, Nejati S, Zolfaghari M, et al. The effect of family-centered empowerment in self efficacy and self-esteem in patients undergoing coronary bypass graft surgery. J Res Dev Nurs Midwifery. 2013;10(2):44-53.
23. Crespo C, Santos S, Canavarro MC, et al. Family routines and rituals in the context of chronic conditions: A review. Int J Psychol. 2013;48(5):729-46.
24. Rosland AM, Piette JD. Emerging models for mobilizing family support for chronic disease management: a structured review. Chronic Illn. 2010;6(1):7-21.
25. Chinh NTM, Thanasilp S, Preechawong S. The Effect of the Supportive Educative Nursing Program on Glycemic Control in Vietnamese Patients with Uncontrolled Type 2 Diabetes Mellitus: a Randomized Controlled Trial. J Health Res. 2017;31(3):233-239.
26. Armer JM, Shook RP, Schneider MK, et al. Enhancing Supportive-Educative Nursing Systems to Reduce Risk of Post-Breast Cancer Lymphedema. Self Care Depend Care Nurs. 2009;17(1):6-15.
27. Waenkaew K, Kerdmongkol P, Amnatsatsue K. Effects of a Supportive Educative Nursing Program on Knowledge and Self-care Behaviors of Older Adults with Heart Failure. Journal of Public Health. 2017;47(1):105-14.
28. Mollaoğlu M, Erdoğan G. Effect on symptom control of structured information given to patients receiving chemotherapy. Eur J Oncol Nurs. 2014;18(1):78-84.
29. Şahin ZA, Ergüney S. Effect on symptom management education receiving patients of chemotherapy. J Cancer Educ. 2016;31(1):101-7.
30. Mousavi SM, Gouya MM, Ramazani R, et al. Cancer incidence and mortality in Iran. Ann Oncol. 2009;20(3):556-63.
31. Dalvand H, Rassafiani M, Bagheri H. Family Centered Approach: A literature the review. J Mod Rehabil. 2014;8(1):1-9.
32. Epley P, Summers JA, Turnbull A. Characteristics and trends in family-centered conceptualizations. J Fam Soc Work. 2010;13(3):269-285.
33. Brown V, Sitzia J, Richardson A, et al. The development of the Chemotherapy Symptom Assessment Scale (C-SAS): a scale for the routine clinical assessment of the symptom experiences of patients receiving cytotoxic chemotherapy. Int J Nurs Stud. 2001;38(5):497-510.
34. Cohen J. Statistical power analysis for the behavioral sciences, 2nd ed , New York, Hillsdale , Lawrence Erlbaum Associates, 1988.
35. Alboughobeish SZ, Asadizaker M, Rokhafrooz D, et al. The effect of mobile-based patiente ducation on nausea and vomiting of patients undergoing chemotherapy. Biomed Res. 2017;28(19):8172-8.
36. Ince Y, Usta YY. The Effect on Nausea and Vomiting of Structured Education Given to Male Lung Cancer Patients Receiving Chemotherapy. J Canc Educ. 2020;35(4):788-795.
37. Williams SA, Schreier AM. The role of education in managing fatigue, anxiety, and sleep disorders in women undergoing chemotherapy for breast cancer. Appl Nurs Res. 2005;18(3):138-47.
38. Chen SF, Wang HH, Yang HY, et al. Effect of relaxation with guided imagery on the physical and psychological symptoms of breast cancer patients undergoing chemotherapy. Iran Red Crescent Med J. 2015; 17(11):e31277.
39. Syrjala KL, Jensen MP, Mendoza ME, et al. Psychological and behavioral approaches to cancer pain management. J Clin Oncol. 2014;32(16):1703.
40. Aranda S, Jefford M, Yates P, et al. Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: results from a randomised, controlled trial. Ann Oncol. 2011;23(1):222-231.
41. Withidpanyawong U, Lerkiatbundit S, Saengcharoen W. Family-based intervention by pharmacists for type 2 diabetes: A randomised controlled trial. Patient Educ Couns .2019;102(1):85-92.
42. Mazanec SR, Miano S, Baer L, et al. A family-centered intervention for the transition to living with multiple myeloma as a chronic illness: A pilot study. Appl Nurs Res
43. Hasanpour-Dehkordi A, Khaledi-Far A, Khaledi-Far B, et al. The effect of family training and support on the quality of life and cost of hospital readmissions in congestive heart failure patients in Iran. Appl Nurs Res. 2016; 31:165-9.
44. Grondin F, Bourgault P, Bolduc N. Intervention Focused on the Patient and Family for Better Postoperative Pain Relief. Pain Manag Nurs. 2014; 15(1):76-86.
45. Kumar A. Vincristine and vinblastine: a review. IJMPS. 2016;691):23-30.
IssueVol 15 No 1 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijhoscr.v15i1.5248
Acute lymphoblastic leukemia; Chemotherapy; Family-centered supportive program; Support

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Sayadi L, Varaei S, Babazadeh Zanjani M. The Effect of Family-Centered Supportive Program on Chemotherapy-Induced Symptoms in Patients with Acute Lymphoblastic Leukemia. Int J Hematol Oncol Stem Cell Res. 15(1):35-50.