As pediatric cancer survival rates continue to improve, attention has shifted to quality of life and symptom management. While a majority of patients experience problematic symptoms during treatment, these symptoms usually go undocumented and untreated. In a secondary analysis of a cluster randomized trial, Yan et al investigated the factors associated with self-reported symptom burden in pediatric patients newly diagnosed with cancer. Their findings were reported in the JCO Oncology Practice.
Study Details
The study enrolled 430 patients from 20 sites in the United States between July 2021 and August 2023. Eligible patients were 8 to 18 years old (median age 14.8 years) and 58.6% were male. Participants were newly diagnosed with leukemia, lymphoma, solid tumors, or brain tumors. Enrollment occurred 28 days after treatment initiation or cancer diagnosis. The study sites were randomly assigned to routine symptom screening (n = 217 patients) or usual care (n = 213 patients). Symptom burden was measured at baseline, week 4, and week 8 using the Symptom Screening in Pediatrics Tool (SSPedi), with scores ranging from 0 (no bothersome symptoms) to 60 (worst bothersome symptoms). Intervention included thrice-weekly symptom screening with SSPedi, delivery of severely bothersome scores to healthcare teams, and implementation of locally adapted symptom management care pathways.
Key Results
The investigators found that SSPedi scores decreased significantly from baseline to weeks 4 and 8 (P < .0001). Patients at the intervention sites reported lower overall symptom burden compared with those at the control sites (P < .0001), and the benefit persisted across both follow-up time points.
Male patients consistently reported lower symptom burden than females, with an estimated difference of –3.3 points (95% confidence interval [CI] = –4.6 to –2.0; P < .0001). No significant differences were found by diagnosis type, although patients with solid tumors trended toward slightly lower burden than those with leukemia or lymphoma.
Sites with higher physician full-time equivalents per 100 new cancer diagnoses had a lower symptom burden (estimate –0.20; 95% CI = –0.5 to 0.0; P = .024). Once provider staffing and other variables were accounted for, variability in SSPedi scores between sites was eliminated, leading the authors to state, “the single explanatory variable with the largest impact on decreasing between-site variability was physician [full-time equivalent] per 100 new diagnoses.”
The authors concluded: “Total symptom burden was reduced by time, intervention (symptom screening and care pathways), and greater physician staffing ratio. Females had higher symptom burden. These data may inform programmatic implementation of routine symptom screening in pediatric patients with cancer.”
Adam P. Yan, MD, MBI, of Program in Child Health Evaluative Sciences and the Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was funded by the Canadian Institutes of Health Research and the National Institutes of Health. For full disclosures of all study authors, visit ascopubs.org.
