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

Ten pediatric cancer treatment sites previously implemented site-specific symptom management care pathways for 15 symptoms, which were based upon clinical practice guidelines (CPGs). The primary objective of this analysis was to describe the prevalence of care pathway- and CPG-consistent care for symptom management. The secondary objective was to identify factors associated with care pathway-consistent care.

Participants were patients age 8-18 years diagnosed with cancer within the previous 4 weeks. We identified any intervention to manage each of 15 symptoms during a 3-day period 8 weeks after enrollment. We determined whether the intervention appeared in that site's care pathway and whether it was recommended in the CPG. We determined whether type of symptom (observable v nonobservable) or patient characteristics were associated with care pathway-consistent care.

Two hundred twenty participants were analyzed. The prevalence of care pathway-consistent care for each symptom ranged from 0% (problems thinking, body or face changes, and diarrhea) to 52.3% (throwing up) and was <27% for 14 of 15 symptoms. Similarly, the prevalence of CPG-consistent care was <50% across all symptoms. Participants received significantly more care pathway-consistent interventions for observable symptoms compared with nonobservable symptoms (difference 30% [95% CI, 3 to 54]). Factors associated with receipt of at least one care pathway-consistent intervention were age group, race, ethnicity, and cancer type.

Care pathway- and CPG-consistent care were surprisingly uncommon. Care pathway-consistent interventions were more common for observable than nonobservable symptoms and were associated with patient characteristics. Future work should identify approaches to improve care pathway-consistent care delivery.