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Symptom Screening for Hospitalized Pediatric Patients With Cancer: A Randomized Clinical Trial
L Lee Dupuis1,2,3, Donna L Johnston4, David Dix5
1Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Daily symptom screening using the Symptom Screening in Pediatrics Tool (SSPedi) significantly reduced symptom burden in pediatric cancer patients. This approach improved total symptom scores compared to standard care, enhancing patient treatment experiences.
Area of Science:
- Oncology
- Clinical Trials
- Pediatric Healthcare
Background:
- Pediatric cancer patients often experience severe symptoms during treatment.
- Effective symptom management is crucial for improving quality of life in these patients.
Purpose of the Study:
- To evaluate if daily symptom screening and reporting via the Symptom Screening in Pediatrics Tool (SSPedi) reduces symptom burden in pediatric cancer patients.
- To compare the effectiveness of daily symptom screening against usual care in a hospital or clinic setting.
Main Methods:
- A randomized clinical trial involving pediatric cancer patients (aged 8-18) requiring daily hospital or clinic visits for at least 5 days.
- Participants were assigned to either daily SSPedi screening with reports to the healthcare team or usual care.
- Data analysis included comparing day 5 total SSPedi scores using multiple linear regression and analyzing secondary outcomes with proportional odds models.
Main Results:
- Daily symptom screening significantly improved total symptom burden scores on day 5 compared to usual care (adjusted mean difference: -2.5).
- Symptom screening reduced the likelihood of higher individual symptom scores, with 8 of 15 symptoms showing statistically significant reductions.
- While pain and quality of life scores did not differ significantly, symptom documentation and intervention rates increased with the screening protocol.
Conclusions:
- Daily symptom screening using the SSPedi tool is effective in reducing overall symptom burden for pediatric cancer patients.
- This intervention improves symptom management and documentation, contributing to better patient care during treatment.
- The findings support the integration of systematic symptom screening into routine care for pediatric oncology patients.
Importance:
Pediatric patients with cancer experience severely bothersome symptoms during treatment. It was hypothesized that symptom screening and provision of symptom reports to the health care team would reduce symptom burden in pediatric patients with cancer.
Objective:
To determine if daily symptom screening and provision of symptom reports to the health care team was associated with lower total symptom burden as measured by the Symptom Screening in Pediatrics Tool (SSPedi) compared to usual care among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days.
Design, Setting, And Participants:
This randomized clinical trial enrolled participants from July 2018 to September 2023 from 8 Canadian tertiary care centers that diagnose and treat pediatric patients with cancer. Patients aged 8 to 18 years with cancer expected to be in a hospital or clinic daily for at least 5 consecutive days were eligible for inclusion. Participants were randomized to intervention (n = 176) vs control (n = 169) groups. Data were analyzed from November 2023 to December 2023.
Intervention:
Intervention participants completed the SSPedi once daily for 5 days. Printed symptom reports were provided daily to the health care team, and email alerts were distributed for severely bothersome symptoms. Control participants received usual care.
Main Outcomes And Measures:
The primary outcome was self-reported total SSPedi score on day 5. Secondary outcomes were individual SSPedi symptoms, pain, quality of life, symptom documentation, and intervention provision. The primary analysis compared the day 5 total SSPedi scores between randomized groups using a multiple linear regression model. For the secondary analysis comparing individual SSPedi symptom scores, the odds ratio for the intervention was estimated using a proportional odds model. Pain and quality of life were analyzed using the same approach as the primary outcome. Fisher exact test was used to compare symptom documentation, any intervention, and symptom-specific intervention between groups.
Results:
A total of 345 participants were enrolled; median (range) participant age was 13.8 (8.0-18.8) years, and 150 participants (43.5%) were female. Day 5 SSPedi score was significantly better with symptom screening compared to usual care (adjusted mean difference, -2.5; 95% CI, -3.8 to -1.2). Symptom screening reduced the odds of higher individual symptom scores; 8 of 15 symptom reductions were statistically significant. There were no significant differences in pain or quality of life scores between groups. Five symptoms were documented or treated significantly more often with symptom screening than usual care.
Conclusions And Relevance:
In this randomized clinical trial, among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days, symptom screening with SSPedi improved total symptom scores compared to usual care.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03593525.
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