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Symptom Screening Linked to Care Pathways for Pediatric Patients With Cancer: A Randomized Clinical Trial
L Lee Dupuis1,2, Emily Vettese1, Allison C Grimes3
1Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
JAMA
|November 13, 2024
Summary
Routine symptom screening significantly improved symptom scores in pediatric cancer patients. This approach led to better symptom management but also increased emergency department visits.
Area of Science:
- Pediatric Oncology
- Symptom Management
- Clinical Trials
Background:
- Pediatric cancer patients frequently experience severe symptoms.
- The efficacy of routine symptom screening and management pathways is not well-established.
Purpose of the Study:
- To evaluate if thrice-weekly symptom screening with feedback and management care pathways improves symptom scores in pediatric cancer patients compared to usual care.
Main Methods:
- A cluster randomized trial involving 445 pediatric cancer patients (aged 8-18) across 20 US centers.
- Intervention group received thrice-weekly symptom screening, alerts, and care pathways; control group received usual care.
- Primary outcome: Symptom Screening in Pediatrics Tool (SSPedi) score at 8 weeks.
Main Results:
- Symptom screening group had significantly lower SSPedi scores at 8 weeks (adjusted mean difference: -3.8).
- 12 of 15 individual symptoms were significantly reduced in the screening group.
- No difference in fatigue or quality of life; however, the screening group had more emergency department visits (rate ratio: 1.72).
Conclusions:
- Symptom screening with feedback and management pathways improves symptom scores and interventions in pediatric cancer patients.
- Integration of symptom screening into routine clinical care is recommended.
- Increased emergency department visits warrant further investigation.
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