Care Pathway- and Guideline-Consistent Care in Pediatric Cancer Symptom Management

Area of Science:

• Pediatric Oncology
• Symptom Management
• Healthcare Quality Improvement

Background:

• Ten pediatric cancer treatment sites implemented symptom management care pathways based on clinical practice guidelines (CPGs).
• Assessing adherence to these pathways and CPGs is crucial for optimizing patient care.
• Understanding factors influencing consistent care delivery is essential for quality improvement.

Purpose of the Study:

• To determine the prevalence of care pathway- and CPG-consistent symptom management.
• To identify patient and symptom characteristics associated with consistent care delivery.

Main Methods:

• Analysis of 220 pediatric cancer patients (ages 8-18) enrolled within 4 weeks of diagnosis.
• Interventions for 15 symptoms were assessed 8 weeks post-enrollment for consistency with site pathways and CPGs.
• Statistical analysis explored associations between symptom type (observable vs. nonobservable) and patient characteristics with consistent care.

Main Results:

• Care pathway-consistent care prevalence was low, ranging from 0% to 52.3% across 15 symptoms (<27% for 14 symptoms).
• CPG-consistent care prevalence was below 50% for all symptoms.
• Consistent interventions were more frequent for observable symptoms (30% difference) and associated with age, race, ethnicity, and cancer type.

Conclusions:

• Adherence to pediatric cancer symptom management care pathways and CPGs is surprisingly uncommon.
• Observable symptoms and specific patient characteristics were associated with higher rates of consistent care.
• Further research is needed to enhance the delivery of consistent, guideline-based symptom management in pediatric oncology.