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Establishing consensus on defining the physically vulnerable child with cancer: a protocol for an international
Sarah L Grimshaw1,2, Rachel Conyers3,2, Elvira C van Dalen4
1Cancer Therapies Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia sarah.grimshaw@mcri.edu.au.
Insights
This study aims to define physical vulnerability in children with cancer, adapting adult models to identify early signs and improve outcomes for pediatric cancer survivors. Early intervention is key for better long-term health.
Area of Science:
- Paediatric Oncology
- Clinical Assessment
- Survivorship Care
Background:
- Childhood cancer survivors face increased long-term health risks.
- Minimizing treatment toxicity is crucial for improving patient outcomes.
- Existing physical vulnerability models (sarcopenia, frailty) are adult-based and need adaptation for pediatric cancer.
Purpose of the Study:
- To establish a consensus definition of physical vulnerability in children with cancer.
- To adapt adult-based sarcopenia and frailty phenotypes for the pediatric oncology context.
- To identify early signs of physical vulnerability for timely intervention.
Main Methods:
- Utilizing a Delphi consensus approach guided by oncology healthcare professionals.
- Conducting a scoping review of existing sarcopenia and frailty assessments in pediatric populations.
- Engaging international experts, clinicians, and researchers in four Delphi rounds to achieve 80% consensus.
- Validating results through focus groups with Delphi panelists, patients, and families.
Main Results:
- Consensus on a definition for physical vulnerability in pediatric cancer patients is being established.
- The study will provide a framework for identifying physically vulnerable children with cancer.
- Adaptation of adult sarcopenia and frailty criteria for pediatric application is underway.
Conclusions:
- A validated, consensus-based definition of physical vulnerability in pediatric cancer is needed.
- This definition will facilitate early identification and intervention for vulnerable children.
- Improved understanding of physical vulnerability can enhance survivorship care and long-term outcomes.
Introduction:
Childhood cancer survivors have an increased risk of lifetime morbidity and mortality. To improve outcomes, the physical impact of treatment toxicity must be minimised in the acute phase. Using a framework to identify early signs of physical vulnerability could provide an avenue for early intervention. Yet, existing models of physical vulnerability (sarcopenia and frailty) are adult-based definitions and require adaptation as they do not reflect the unique pathophysiology of paediatric cancer. Using phenotypes of sarcopenia and frailty as base, this study aims to establish a consensus definition of the physically vulnerable child with cancer.
Methods And Analysis:
A Delphi consensus approach is guided by a project team of four specialised oncology healthcare professionals. Five stages include defining the problem area, selecting panel members, conducting four Delphi rounds, establishing closing criteria and validation of results. A focus group of international experts will meet to define the problem area, in addition to a scoping review to collate existing definitions and assessments of sarcopenia and frailty within paediatric contexts. Delphi panel members will include multinational clinicians with >5 years' experience in the acute paediatric setting, and researchers specialising in sarcopenia and/or frailty in paediatric cancer. Delphi rounds will aim to achieve consensus on how to define physical vulnerability in children with cancer. Consensus will be considered achieved when 80% or more of panellists agree. A series of focus groups with select members of the Delphi panel, and families, children, and adolescents affected by paediatric cancer will be held to validate results.
Ethics And Dissemination:
The study has ethics approval through the Royal Children's Hospital Human Ethics Committee (number 3707). Results from this study will be published in peer-reviewed academic journals and disseminated via scientific conference(s) and key stakeholders.
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