Regular Screening of Pediatric Cancer Patients May Help Improve Symptom Management
While advancements in pediatric cancer care have greatly improved remission and survival rates, children still endure many symptoms that cause discomfort and reduce quality of life. Traditionally, these symptoms are reported by clinicians assessing the child, deciding what symptoms are present and noting how severe they are—but many studies have documented that this approach fails to detect bothersome symptoms in many children.
A group of pediatric cancer physician-researchers published the results of a clinical trial that explored how direct child-report of symptoms linked to care pathways can improve medical management of patients during cancer treatment. The study, published in JAMA, involves 445 newly diagnosed patients ages 8 to 18 from 20 pediatric cancer centers across the U.S., including Children’s Hospital Los Angeles. Clinical trial collaborators David R. Freyer, DO, MS, and Etan Orgel, MD, MS, led the research at CHLA.
“We’re thrilled to collaborate with other national leaders in pediatric cancer care to measure how new care protocols may improve health outcomes for our young patients,” says Dr. Orgel, Director of CHLA's Medical Supportive Care Service within the Survivorship and Supportive Care Program.
Principal investigators of the clinical trial had previously developed the Symptom Screening in Pediatrics Tool (SSPedi). The SSPedi enables children to report for themselves whether they are experiencing any of 16 symptoms and their severity. Total symptom scores can range from 0-60, with higher scores indicating more bothersome symptoms. In this trial, SSPedi reports were completed by children electronically and the results could be linked to care pathways, or sets of expert recommendations for treating symptoms.
Twenty pediatric care centers participated in the study. Sites were randomized such that 10 care centers offered symptom screening with SSPedi three times a week with results linked to care pathways, while the other 10 used SSPedi but treated symptoms according to the usual standard of care. Patients at care centers where SSPedi results were linked to care pathways reported significantly better total SSPedi scores and less severe individual symptoms over the 8-week study period.
These results indicate the value of both direct-reporting of symptoms by even young children using SSPedi, and linking symptom results to care pathways to help clinicians know how to treat symptoms quickly and effectively when they occur.
Dr. Freyer, oncologist and Director of CHLA’s Survivorship and Supportive Care Program, notes that the study suggests this approach may be a major improvement over traditional ways children are assessed and treated.
“We’re committed to the continued advancement of clinical care processes for our patients in oncology,” adds Dr. Freyer. “Improving our methods of gathering symptom feedback leads to better symptom management and more personalized interventions.”
