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Skrabal Ross X, Condon P, Yates P, Walker R, Herbert A, Bradford N. Feasibility of Weekly Electronic Patient- and Proxy-Reported Outcome Measures in Pediatric Oncology. Cancer Nurs 2024; 47:E318-E326. [PMID: 37232526 DOI: 10.1097/ncc.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Electronic patient-reported outcome measures (ePROMs) benefit adult cancer care, but their use in pediatric cancer care is limited. OBJECTIVES To explore the feasibility of collecting weekly ePROMs from pediatric cancer patients and/or their caregivers and to describe children's levels of symptom burden, distress, and cancer-related quality of life. METHODS A prospective and longitudinal cohort study was undertaken at one tertiary children's cancer center. Children (2-18 years)/caregivers completed ePROMs with validated measures for distress, symptom burden, and cancer-related quality of life weekly for 8 weeks. RESULTS Seventy children/caregivers participated in the study, and 69% completed ePROMs at all 8 weeks. Distress and cancer-related quality of life significantly improved over time. However, at week 8, almost half of the participants still reported high levels of distress. Symptom burden decreased over time, with the youngest and the oldest age groups (2-3 and 13-18 years) reporting the highest number of symptoms with severe burden. CONCLUSIONS Weekly collection of ePROMs in pediatric cancer care is feasible. Although distress, quality of life, and symptom burden improve over time, there is a need for timely assessment and interventions to improve symptoms, high levels of distress, and issues that negatively affect quality of life. IMPLICATIONS FOR PRACTICE Nurses are ideally placed to intervene, assess, and monitor symptoms and to provide symptom management advice to pediatric cancer patients and caregivers. Findings from this study may inform the design of models of pediatric cancer care to improve communication with the healthcare team and patient experience of care.
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Affiliation(s)
- Xiomara Skrabal Ross
- Author Affiliations: Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation (Drs Skrabal Ross, Yates, and Bradford), and Centre for Children's Health Research (Dr Skrabal Ross, Mrs Condon, Mr Walker, Mr Herbert, and Dr Bradford), Queensland University of Technology, and Oncology Service Group, Queensland Children's Hospital (Mrs Condon, Mr Walker, and Mr Herbert), Children's Health Queensland, South Brisbane, Australia
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Mueller S, Fangusaro J, Thomas AO, Jacques TS, Bandopadhayay P, de Blank P, Packer RJ, Fouladi M, van Meeteren AS, Jones D, Perry A, Nakano Y, Hargrave D, Riedl D, Robison NJ, Partanen M, Fisher MJ, Witt O. Consensus framework for conducting phase I/II clinical trials for children, adolescents, and young adults with pediatric low-grade glioma: Guidelines established by the International Pediatric Low-Grade Glioma Coalition Clinical Trial Working Group. Neuro Oncol 2024; 26:407-416. [PMID: 38146999 PMCID: PMC10912006 DOI: 10.1093/neuonc/noad227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Within the last few decades, we have witnessed tremendous advancements in the study of pediatric low-grade gliomas (pLGG), leading to a much-improved understanding of their molecular underpinnings. Consequently, we have achieved successful milestones in developing and implementing targeted therapeutic agents for treating these tumors. However, the community continues to face many unknowns when it comes to the most effective clinical implementation of these novel targeted inhibitors or combinations thereof. Questions encompassing optimal dosing strategies, treatment duration, methods for assessing clinical efficacy, and the identification of predictive biomarkers remain unresolved. Here, we offer the consensus of the international pLGG coalition (iPLGGc) clinical trial working group on these important topics and comment on clinical trial design and endpoint rationale. Throughout, we seek to standardize the global approach to early clinical trials (phase I and II) for pLGG, leading to more consistently interpretable results as well as enhancing the pace of novel therapy development and encouraging an increased focus on functional endpoints as well and quality of life for children faced with this disease.
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Affiliation(s)
- Sabine Mueller
- Department of Neurology, Neurological Surgery and Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Pediatrics, University Children’s Hospital, University of Zurich, Zürich, Switzerland
| | - Jason Fangusaro
- Department of Hematology and Oncology, Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA
| | - Arzu Onar Thomas
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Thomas S Jacques
- UCL Great Ormond Street Institute of Child Health and Histopathology Department, Developmental Biology and Cancer Programme, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pratiti Bandopadhayay
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Peter de Blank
- Department of Pediatrics, University of Cincinnati Medical Center and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Roger J Packer
- Brain Tumor Institute, Washington DC, USA
- Gilbert Family Neurofibromatosis Institute, Washington DC, USA
- Center for Neuroscience and Behavioral Medicine, Children’s National Hospital, Washington, District of Columbia, USA
| | - Maryam Fouladi
- Pediatric Brain Tumor Program, Division of Hematology, Oncology, and Bone Marrow Transplant, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | | | - David Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Arie Perry
- Departments of Pathology and Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Yoshiko Nakano
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Darren Hargrave
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - David Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Nathan J Robison
- Division of Hematology and Oncology, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marita Partanen
- Department of Research, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Michael J Fisher
- Division of Oncology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olaf Witt
- Hopp Children’s Cancer Center (KiTZ), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ) and University Hospital, Heidelberg, Germany
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Ruan H, Sun J, Zhao K, He M, Yuan C, Fu L, Shen N. Subjective Toxicity Profiles of Children With Cancer During Treatment: A Latent Class Analysis. Cancer Nurs 2024; 47:E1-E9. [PMID: 36881644 DOI: 10.1097/ncc.0000000000001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Children and adolescents may experience a variety of subjective adverse events (AEs) caused by cancer treatment. The identification of distinct groups of patients is crucial for guiding symptomatic AE management interventions to prevent AEs from worsening. OBJECTIVE The aim of this study was to identify subgroups of children with cancer experiencing similar patterns of subjective toxicities and evaluate differences among these subgroups in demographic and clinical characteristics. METHODS A cross-sectional survey was conducted of 356 children in China with malignancies who received chemotherapy within the past 7 days using the pediatric Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. A latent class analysis (LCA) was conducted to identify subgroups of patients with distinct profiles of symptomatic AE occurrence. RESULTS Nausea (54.5%), anorexia (53.4%), and headache (39.3%) were the top 3 AEs children experienced. Nearly all participants (97.8%) experienced ≥1 core AEs, and 30.3% experienced ≥5 AEs. The LCA results identified 3 subgroups ("high gastrotoxicity and low neurotoxicity" [53.2%], "moderate gastrotoxicity and high neurotoxicity" [23.6%], and "high gastrotoxicity and high neurotoxicity" [22.8%]). The subgroups were differentiated by monthly family per-capita income, time since diagnosis, and Karnofsky Performance Status score. CONCLUSIONS Children experienced multiple subjective toxicities during chemotherapy, especially gastrotoxicity and neurotoxicity. Heterogeneity was found in the LCA in the patients' toxicities. The prevalence of toxicities could be distinguished by the children's characteristics. IMPLICATIONS FOR PRACTICE The results showing different subgroups in our study may assist clinical staff in focusing on patients with higher toxicities to provide effective interventions.
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Affiliation(s)
- Haishan Ruan
- Author Affiliations: Department of Hematology and Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Ms Ruan and Ms He); School of Nursing, Shanghai Jiao Tong University, Shanghai, China (Ms Zhao); Department of Nursing, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Ms Sun and Ms Shen); School of Nursing, Fudan University, Shanghai, China (Dr Yuan); Fujian Children's Hospital, Fujian, China (Ms Fu)
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Hetzer B, Meryk A, Kropshofer G, Salvador C, Riedl D, Lehmann J, Rumpold G, Haid A, Schneeberger-Carta V, Holzner B, Crazzolara R. Integration of Daily Patient-Reported Outcome Measures in Pediatric Stem Cell Transplantation. Transplant Cell Ther 2023; 29:776.e1-776.e7. [PMID: 37741458 DOI: 10.1016/j.jtct.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023]
Abstract
Patients' reports of their health status are increasingly used in hematopoietic stem cell transplantation (SCT) to better understand the negative impact on symptom burden and quality of life. Little is known regarding the implementation in routine clinical care, particularly how it can be used to improve supportive care. We sought to the evaluate feasibility of capturing daily patient-reported outcomes (PROs) in the acute phase of SCT to measure physical and psychosocial symptom burden. In this single-center prospective observational study, we assessed daily PRO from conditioning to neutrophil engraftment in children (age 1 to 18 year) who underwent allogeneic or autologous SCT for malignant and nonmalignant disease. The most common acute adverse effects of chemotherapy (pain, nausea, loss of appetite, sleep disturbance, and physical performance impairment) were reported daily via ePROtect, a web-based program designed to integrate health responses. From February 2021 to March 2023, 20 children undergoing allogeneic (allo-) SCT (n = 11) or autologous (auto-) SCT (n = 9) and their proxies consented to participation, all of whom were included in this analysis. A total of 359 PRO questionnaires were completed, corresponding to a median daily completion rate of 72.7% (interquartile range, 60.4% to 83.6%). After conditioning, pain perception anticipated the rise of infectious parameters and the development of mucositis, thus initiating supportive treatment. Patients reported the strongest symptom burden at a median of 8.5 days post-transplantation. At 4 weeks post-transplantation, baseline values were restored for all symptoms. There were no significant differences between auto-SCT and allo-SCT, except for nausea and loss of appetite after administration of antithymocyte globulin in allo-SCT. This study empirically documents the daily health status of children undergoing SCT and proposes an attractive modus operandi on how continuous feedback on health-related symptoms can be integrated into daily clinical practice.
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Affiliation(s)
- Benjamin Hetzer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Meryk
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Salvador
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria; Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Jens Lehmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandra Haid
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.
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Taramasco C, Rimassa C, Noël R, Bravo Storm ML, Sánchez C. Co-design of a Mobile App for Engaging Breast Cancer Patients in Reporting Health Experiences: Qualitative Case Study. J Med Internet Res 2023; 25:e45968. [PMID: 38010791 PMCID: PMC10714266 DOI: 10.2196/45968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/30/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The World Health Organization recommends incorporating patient-reported experience measures and patient-reported outcome measures to ensure care processes. New technologies, such as mobile apps, could help report and monitor patients' adverse effects and doubts during treatment. However, engaging patients in the daily use of mobile apps is a challenge that must be addressed in accordance with the needs of people. OBJECTIVE We present a qualitative case study documenting the process of identifying the information needs of breast cancer patients and health care professionals during the treatment process in a Chilean cancer institution. The study aims to identify patients' information requirements for integration into a mobile app that accompanies patients throughout their treatment while also providing features for reporting adverse symptoms. METHODS We conducted focus groups with breast cancer patients who were undergoing chemotherapy (n=3) or who completed chemotherapy between 3 months and 1 year (n=1). We also surveyed health care professionals (n=9) who were involved in patient care and who belonged to the oncology committee of the cancer center where the study took place. Content analysis was applied to the responses to categorize the information needs and the means to satisfy them. A user interface was designed according to the findings of the focus groups and was assessed by 3 trained information system and user interaction design experts from 2 countries, using heuristic evaluation guidelines for mobile apps. RESULTS Patients' information needs were classified into 4 areas: an overview of the disease, information on treatment and day-to-day affairs, assistance on the normality and abnormality of symptoms during treatment, and symptoms relevant to report. Health care professionals required patients to be provided with information on the administrative and financial process. We noted that the active involvement of the following 4 main actors is required to satisfy the information needs: patients, caregivers, social network moderators, and health professionals. Seven usability guidelines were extracted from the heuristic evaluation recommendations. CONCLUSIONS A mobile app that seeks to accompany breast cancer patients to report symptoms requires the involvement of multiple participants to handle the reports and day-to-day information needs. User interfaces must be designed with consideration of the patient's social conventions and the emotional load of the disease information.
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Affiliation(s)
- Carla Taramasco
- Instituto de Tecnologías para la Innovación en Salud y Bienestar, Facultad de Ingeniería, Universidad Andrés Bello, Viña del Mar, Chile
- Centro para la Prevención y el Control del Cáncer, Santiago, Chile
| | - Carla Rimassa
- Instituto de Tecnologías para la Innovación en Salud y Bienestar, Facultad de Ingeniería, Universidad Andrés Bello, Viña del Mar, Chile
- Facultad de Medicina, Escuela de Fonoaudiología, Campus San Felipe, Universidad de Valparaíso, San Felipe, Chile
| | - René Noël
- Escuela de Ingeniería Informática, Facultad de Ingeniería, Universidad de Valparaíso, Valparaíso, Chile
| | - María Loreto Bravo Storm
- Departamento de Hematología y Oncología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - César Sánchez
- Departamento de Hematología y Oncología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Lacerda A, Martínez MA, Dumont B, Leiss U, Kokkinou G, Scheinemann K, Craig F. Embracing paediatric palliative care in paediatric oncology from diagnosis onwards. Pediatr Blood Cancer 2023; 70:e30561. [PMID: 37430425 DOI: 10.1002/pbc.30561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
Paediatric palliative care aims to support children and young people with life-limiting or life-threatening conditions, and their families, from the time of diagnosis. Early integration within oncology has been recognised as having benefits for all involved, whatever the outcome may be. Through improved communication and advance care planning, it enables user-centred care, where concerns about quality of life, preferences and values are given the same relevance as cutting-edge therapy. Challenges to the integration of palliative care within paediatric oncology include raising awareness and providing education, whilst searching for the best care model and adapting to an ever-changing therapeutic scenario.
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Affiliation(s)
- Ana Lacerda
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- European Association for Palliative Care Children and Young People Reference Group, Vilvoorde, Belgium
- Department of Paediatrics, Portuguese Institute of Oncology, Lisbon, Portugal
| | - María Avilés Martínez
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Paediatric Palliative Care Unit, Niño Jesús Children's University Hospital, Madrid, Spain
- Department of Nursing, Autonomous University of Madrid, Madrid, Spain
| | - Benoît Dumont
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Paediatric Hematology and Oncology Institute, Léon Bérard Cancer Center, Lyon, France
| | - Ulrike Leiss
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georgia Kokkinou
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Floga - Parents Association of Children with Cancer, Athens, Greece
- Childhood Cancer International Europe, Vienna, Austria
| | - Katrin Scheinemann
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Division of Oncology-Haematology, Department of Paediatrics, Kantonsspital Aarau, Aarau, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Paediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Finella Craig
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- European Association for Palliative Care Children and Young People Reference Group, Vilvoorde, Belgium
- Louis Dundas Paediatric Palliative Care Centre, Great Ormond Street Hospital, London, UK
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Riedl D, Lehmann J, Rothmund M, Dejaco D, Grote V, Fischer MJ, Rumpold G, Holzner B, Licht T. Usability of Electronic Patient-Reported Outcome Measures for Older Patients With Cancer: Secondary Analysis of Data from an Observational Single Center Study. J Med Internet Res 2023; 25:e49476. [PMID: 37733409 PMCID: PMC10557001 DOI: 10.2196/49476] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Patient-reported outcomes are considered the gold standard for assessing subjective health status in oncology patients. Electronic assessment of patient-reported outcomes (ePRO) has become increasingly popular in recent years in both clinical trials and practice. However, there is limited evidence on how well older patients with cancer can complete ePRO assessments. OBJECTIVE We aimed to investigate how well adult patients with cancer of different age ranges could complete ePRO assessments at home and in a treatment facility and to identify factors associated with the ability to complete questionnaires electronically. METHODS This retrospective longitudinal single-center study involved survivors of cancer who participated in inpatient rehabilitation. Patients completed ePRO assessments before rehabilitation at home (T1) and after rehabilitation at the facility (T2). We analyzed the rate of patients who could complete the ePRO assessment at T1 and T2, the proportion of patients who required assistance, and the time it took patients to complete standardized questionnaires. Multivariate logistic regression analyses were conducted to identify predictors of ePRO completion rate and the need for assistance. RESULTS Between 2017 and 2022, a total of 5571 patients were included in this study. Patients had a mean age of 60.3 (SD 12.2) years (range 18 to 93 years), and 1135 (20.3%) of them were classified as geriatric patients (>70 years). While more than 90% (5060/5571) of all patients completed the ePRO assessment, fewer patients in the age group of >70 years (924/1135, 81.4% at T1 vs 963/1135, 84.8% at T2) completed the assessment. Approximately 19% (1056/5571) of patients reported a need for assistance with the ePRO assessment at home, compared to 6.8% (304/4483) at the institution. Patients older than 70 years had a significantly higher need for assistance than those in younger age groups. Moreover, a gender difference was observed, with older women reporting a higher need for assistance than men (71-80 years: women requiring assistance 215/482, 44.6% vs men 96/350, 27.4%; P<.001 and >80 years: women 102/141, 72.3% vs men 57/112, 50.9%; P<.001). On average, patients needed 4.9 (SD 3.20) minutes to remotely complete a 30-item questionnaire (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire) and patients in the older age groups took significantly longer compared to younger age groups. Lower age and higher physical functioning were the clearest predictors for both the ePRO completion rate and the need for assistance in the multivariate regression analysis. CONCLUSIONS This study's results indicate that ePRO assessment is feasible in older individuals with cancer, but older patients may require assistance (eg, from relatives) to complete home-based assessments. It may be more feasible to conduct assessments in-house in this population. Additionally, it is crucial to carefully consider which resources are necessary and available to support patients in using ePRO devices.
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Affiliation(s)
- David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jens Lehmann
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Rothmund
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Daniel Dejaco
- Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Michael J Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- Vamed Rehabilitation Center Kitzbühel, Kitzbühel, Austria
| | - Gerhard Rumpold
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
- Evaluation Software Development (ESD), Innsbruck, Austria
| | - Bernhard Holzner
- Evaluation Software Development (ESD), Innsbruck, Austria
- University Hospital of Psychiatry I, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Licht
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- Oncological Rehabilitation Center, Sankt Veit im Pongau, Austria
- Paracelsus Medical University, Salzburg, Austria
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Lai JS, Jensen SE, Peipert JD, Mitchell SA, Garcia SF, Cella D, Goldman S, Lenzen A. Using IT to Improve Outcomes for Children Living With Cancer (SyMon-SAYS): Protocol for a Single-Institution Waitlist Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50993. [PMID: 37682593 PMCID: PMC10517385 DOI: 10.2196/50993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Children and adolescents with cancer may experience multiple disease- and treatment-related symptoms that negatively affect health-related quality of life. Routine symptom surveillance thus constitutes an important component of supportive care in pediatric oncology. The Symptom Monitoring and Systematic Assessment and Reporting System in Young Survivors (SyMon-SAYS) system will administer, score, interpret, and display the results of symptom assessments captured weekly using patient-reported outcomes presented via the electronic health record (EHR) portal between clinic visits in oncology ambulatory settings, when patients are likely to be more symptomatic. This study is testing a digital system for routine symptom surveillance that includes EHR-based reports to clinicians and alerts for severe symptoms. OBJECTIVE In this randomized trial, we are examining the effects of the SyMon-SAYS system on perceived barriers to symptom management, self-efficacy, and symptom severity. Better self-management and timely clinical intervention to address symptoms promote adherence to treatment plans, strengthen child and parent self-efficacy, improve interactions between children, parents, and their clinical providers, and optimize clinical outcomes. METHODS The SyMon-SAYS system is integrated into the EHR to streamline the presentation of symptom scores and delivery of alerts for severe symptoms to clinicians using EHR (Epic) messaging functionalities. Children (aged 8 to 17 years) complete the weekly symptom assessment and review the symptom report by logging into the patient portal (Epic MyChart). This single-institution waitlist randomized controlled trial is recruiting 200 children (aged 8-17 years) with cancer and their parents, guardians, or caregivers. Participating dyads are randomly assigned to receive the intervention over 16 weeks (Group A: 16-week SyMon-SAYS intervention; Group B: 8-week usual care and then an 8-week SyMon-SAYS intervention). Analyses will (1) evaluate the efficacy of SyMon-SAYS at week 8 and the maintenance of those effects at week 16; (2) evaluate factors associated with those efficacy outcomes, including contextual factors, adherence to the SyMon-SAYS intervention, demographic characteristics, and clinical factors; and (3) evaluate predictors of adherence to the SyMon-SAYS intervention and preference of SyMon-SAYS versus usual care. RESULTS Data collection is currently in progress. We hypothesize that at 8 weeks, those receiving the SyMon-SAYS intervention will report decreased parent-perceived barriers to managing their children's symptoms, increased parent and child self-efficacy, decreased child symptom burden, and ultimately better child health-related quality of life, compared to waitlist controls. Feasibility, acceptability, and engagement from the perspectives of the children with cancer, their parents, and their clinicians will be examined using mixed methods. CONCLUSIONS We anticipate that this system will facilitate prompt identification of problematic symptoms. Additionally, we hypothesize that with the availability of graphical symptom reports over time, and timely provider responses, children or parents will become better informed and take an active role in managing their symptoms, which will further improve clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04789720; https://clinicaltrials.gov/study/NCT04789720. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50993.
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Affiliation(s)
- Jin-Shei Lai
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Sally E Jensen
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - John Devin Peipert
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - Sofia F Garcia
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - David Cella
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Stewart Goldman
- Department of Child Health, College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, United States
- Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Alicia Lenzen
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
- Division of Hematology, Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Meryk A, Kropshofer G, Hetzer B, Riedl D, Lehmann J, Rumpold G, Haid A, Schneeberger-Carta V, Salvador C, Rabensteiner E, Rothmund MS, Holzner B, Crazzolara R. Disagreement between mothers' and fathers' rating of health-related quality of life in children with cancer. Qual Life Res 2023; 32:1683-1691. [PMID: 36635414 PMCID: PMC9836339 DOI: 10.1007/s11136-023-03341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE Serial assessment of health condition based on self-report made by children and their proxies has consistently shown a lack of congruence. The study explored the discrepancies between mother's, father's, and children's reports on health-related quality of life (HRQOL) during the first two months of pediatric cancer treatment. METHODS In this cohort study, children and parents completed the generic and cancer-specific Pediatric Quality-of-Life Inventory (PedsQL) questionnaires at initial diagnosis and in the subsequent months. Evaluation of discrepancies included intraclass correlations between mother-child and father-child dyads at different domain levels. RESULTS Thirty-six children with a diagnosis of cancer between May 2020 and November 2021 and their parents were included in this study. At diagnosis, mother-child dyads showed better agreement on more domains of the PedsQL Generic Core Scale than father-child dyads; moderate agreement persisted for both parents at subsequent time points on the physical domain. The disease-specific PedsQL Cancer Module revealed moderate and better agreement for mother-child dyads during active cancer therapy. In particular, agreement of mother-child dyads was pronounced for domains such as worry (0.77 [95% CI 0.52-0.89, P < 0.001]), whereas fathers tended to overestimate the child's symptom burden for most of the remaining domains of the PedsQL Cancer Module. CONCLUSION This cohort study shows that both parent proxy reports can provide valid information on child's HRQOL, but that fathers tend to overestimate, particularly for non-observable domains. Proxy reports derived from mothers more closely agreed with children's HRQOL and might be more weighted, if there is uncertainty between parents.
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Affiliation(s)
- Andreas Meryk
- Department of Pediatrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Benjamin Hetzer
- Department of Pediatrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - David Riedl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
- Ludwig Boltzmann, Institute for Rehabilitation Research, Vienna, Austria
| | - Jens Lehmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandra Haid
- Department of Pediatrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Verena Schneeberger-Carta
- Department of Pediatrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christina Salvador
- Department of Pediatrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Evelyn Rabensteiner
- Department of Pediatrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Maria-Sophie Rothmund
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Pediatrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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