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Less restrictions in daily life: a clinical practice guideline for children with cancer
Debbie C Stavleu1,2, Renée L Mulder2, Demi M Kruimer2
1University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology/Hematology, University of Groningen, Groningen, The Netherlands.
Insights
This clinical practice guideline provides evidence-based recommendations for social restrictions in children with cancer, aiming to improve their quality of life. It addresses daily activities like school, sports, and public transport use.
Area of Science:
- Pediatric Oncology
- Clinical Practice Guidelines
- Quality of Life Research
Background:
- Current clinical practice often lacks evidence-based recommendations for social restrictions in children with cancer.
- Social restrictions (e.g., school, sports, swimming) can significantly impair the quality of life for pediatric cancer patients.
- There is a critical need for evidence-based guidance to support clinicians, children, and parents.
Purpose of the Study:
- To develop a clinical practice guideline for clinicians, children, and parents regarding social restrictions in daily life for children with cancer.
- To provide evidence-based recommendations to mitigate the negative impact of restrictions on quality of life.
- To establish clear guidance for managing daily activities during cancer treatment.
Main Methods:
- A multidisciplinary panel of 21 professionals and patient representatives was assembled.
- A systematic literature review using GRADE methodology was conducted for evidence appraisal.
- Multiple meetings were held to formulate recommendations based on evidence and expert consensus.
Main Results:
- Fourteen recommendations were formulated, impacting current Dutch clinical policy and practice.
- The guideline covers restrictions related to swimming, pets, zoos, sports, school attendance, and public transport.
- The evidence base included six studies with 758 children, supplemented by adult oncology guidelines and expert opinion due to limited pediatric data.
Conclusions:
- The guideline provides evidence-based and expert-opinion-based recommendations for social restrictions in pediatric cancer patients.
- It offers crucial guidance for clinicians, children, and parents to enhance the quality of life.
- The recommendations aim to standardize and improve the management of daily life restrictions during cancer treatment.
Purpose:
In current clinical practice, recommendations regarding restrictions in daily life for children with cancer are often lacking or not evidence-based. Critically reviewing the evidence and formulating recommendations are therefore of great importance as social restrictions (e.g., swimming, school attendance, sports) can impair the quality of life of these children severely. Therefore, our aim was to develop a clinical practice guideline for clinicians, children, and their parents regarding social restrictions in children with cancer.
Methods:
A comprehensive multidisciplinary panel was assembled, comprising 21 professionals and patient representatives. A systematic literature review was performed, including dual appraisal of all citations. The GRADE methodology was used to extract, summarize, and assess the evidence. Multiple in-person meetings were held to rank outcomes, discuss evidence, complete evidence-to-decision frameworks, and formulate recommendations. Final recommendations were unanimously supported by all panel members.
Results:
Six studies, including 758 children, formed the evidence base for the recommendations. Given the scarcity of the available evidence and various designs of studies in children with cancer, additional evidence was extracted from adult oncology guidelines, and shared expert opinions were utilized. In total, 14 recommendations were formulated of which multiple result in changes in current policy and standard of practice in the Netherlands. Topics covered in this guideline are swimming, having pets, visiting the zoo or farm, performing sports or high-velocity events, attending school or kindergarten, and use of public transport. This guideline is not intended to provide recommendations for patients after end of treatment, for palliative care settings, or for children undergoing a stem cell transplantation.
Conclusions:
In this clinical practice guideline, we provide recommendations regarding restrictions in daily life in children with cancer. These include evidence-based recommendations and, in the absence of sufficient evidence, recommendations based on expert evidence. With these recommendations, we provide guidance for clinicians, children, and parents and contribute to improving quality of life for children with cancer.
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