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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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Semerci R, Savaş EH, Kudubeş AA. Utilizing Digital Tools for Self-Report Symptom Assessment and Management in Pediatric Oncology: A Systematic Review. J Pain Symptom Manage 2024:S0885-3924(24)00857-1. [PMID: 39059752 DOI: 10.1016/j.jpainsymman.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
CONTEXT The evaluation of digital tools for measuring self-reported symptoms in children and adolescents undergoing cancer treatment is a critical area of research with significant implications for clinical practice and patient outcomes. OBJECTIVE This study aims to identify, evaluate, and summarize evidence on digital tools that enable self-reported symptom assessment and management for pediatric oncology patients. METHODS Seven academic databases, including PubMed, Cochrane Library, Scopus, Web of Science, CINAHL, and Medline (OVID), were searched systematically from inception until February 28, 2024. Inclusion criteria were the following: (a) study subjects were pediatric oncology patients and young adults, (b) using digital tools, (c) self-report symptom assessment and management, (d) employed either qualitative or quantitative study design, (e) written in English (f) published in peer-reviewed journals. This is a systematic review, and its protocol was registered in PROSPERO (ID: CRD42024528285). The study was conducted following the PRISMA statement. RESULTS Twenty-seven studies were included in this systematic review. All included studies were conducted to develop digital tools for assessing and managing the symptoms. Eight of these studies focused only on the pain; three were only for nausea and vomiting, one for nausea, and the other 15 for all symptoms. The studies' quality ranged from low to high, with overall scores ranging between 4 and 24 out of 28. CONCLUSION It shows that studies have generally focused on developing digital tools to address pain, nausea, vomiting, and other symptoms commonly experienced by pediatric oncology patients. While the quality of the included studies ranged from low to high, the overall findings show promise for the effectiveness and usability of these digital tools for symptom assessment and management in pediatric oncology care.
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Affiliation(s)
- Remziye Semerci
- School of Nursing (R.S., E.H.S.), Koç University, İstanbul, Turkey.
| | | | - Aslı Akdeniz Kudubeş
- Faculty of Health Sciences (A.A.K.), Department of Child Health and Diseases Nursing, Bilecik Şeyh Edabali University, Bilecik, Turkey
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Tomlinson D, Tardif-Theriault C, Schechter T, Dupuis LL, Sung L. Randomized trial of dyadic-report vs proxy-report and self-report symptom assessment for pediatric patients receiving cancer treatments. J Natl Cancer Inst 2024; 116:588-595. [PMID: 38048622 DOI: 10.1093/jnci/djad251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND We validated different approaches to symptom assessment for pediatric cancer patients based on the Symptom Screening in Pediatrics Tool (SSPedi) for self-report (SSPedi and mini-SSPedi), proxy-report (proxy-SSPedi), and structured dyadic-report (co-SSPedi). The objective was to compare co-SSPedi scores vs proxy-report (proxy-SSPedi) and self-report (SSPedi or mini-SSPedi) scores for pediatric patients receiving cancer treatments. METHODS This was a single-center, randomized crossover study enrolling English-speaking dyads of pediatric patients with cancer or hematopoietic cell transplant recipients 4-18 years old and their guardians. Dyads were randomized to first complete the dyadic-report (co-SSPedi) or self-report (patients: SSPedi or mini-SSPedi) and proxy-report (guardians: proxy-SSPedi). Dyads then crossed over to the alternate approach. Primary analysis compared total SSPedi scores between randomized groups. RESULTS We enrolled 420 dyads that were randomized to co-SSPedi first (n = 213) or proxy-SSPedi and self-report SSPedi first (n = 207). Mean total SSPedi scores (± standard deviation) were co-SSPedi (9.6 ± 7.1), proxy-SSPedi (9.7 ± 7.5; P = .950 for comparison vs co-SSPedi), and self-report SSPedi (9.7 ± 8.2; P = .981 for comparison vs co-SSPedi). Co-SSPedi scores were significantly different from proxy-SSPedi for feeling disappointed or sad, feeling cranky or angry, feeling tired, mouth sores, and changes in taste. Co-SSPedi scores were significantly different from self-report SSPedi scores for problems with thinking or remembering things, feeling tired, mouth sores, tingly or numb hands or feet, and diarrhea. CONCLUSIONS Total co-SSPedi scores were not significantly different compared with proxy-report or self-report scores, although there were differences in specific symptom scores. If different reporter types are used during clinical implementation, specifying reporter type will be important. The study was registered at clinicaltrials.gov (NCT #05012917). Symptoms are common and frequently severely bothersome in pediatric patients with cancer and hematopoietic cell transplant (HCT) recipients (1). To measure the extent of bothersome symptoms, the Symptom Screening in Pediatrics Tool (SSPedi) suite of symptom assessment tools was developed for pediatric patients receiving cancer treatments and currently consists of multiple validated instruments. SSPedi was developed for self-report by patients 8-18 years of age (2,3). Mini-SSPedi was developed for self-report by patients 4 to 7 years of age (4). Proxy-SSPedi was developed for proxy-report by guardians of pediatric patients 2-18 years of age (5). These 3 instruments can be categorized as either self-report (SSPedi or mini-SSPedi) or proxy-report (proxy-SSPedi).
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Affiliation(s)
- Deborah Tomlinson
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cassandra Tardif-Theriault
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pharmacy, The Hospital for Sick Children, and Leslie Dan Faculty of Pharmacy, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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Tomlinson D, Dupuis LL, Dix D, Crellin-Parsons N, Cook S, Kulkarni K, Schechter T, Tomlinson GA, Sung L. Validation of co-Symptom Screening in Pediatrics Tool: a novel dyadic approach to symptom screening in pediatric patients receiving cancer treatment. J Natl Cancer Inst 2024; 116:160-166. [PMID: 37672037 DOI: 10.1093/jnci/djad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Co-Symptom Screening in Pediatrics Tool (co-SSPedi) is a dyadic (child-guardian) approach to symptom assessment. Objectives were to evaluate the reliability and validity of co-SSPedi for pediatric patients receiving cancer treatments. METHODS This multicenter study included dyads of patients aged 4-18 years of age with cancer or undergoing hematopoietic cell transplant and their guardians. Two groups were enrolled. The more symptomatic group included those receiving active treatment for cancer or undergoing hematopoietic cell transplant where patients were in hospital or clinic for 4 consecutive days. The less symptomatic group included those receiving maintenance therapy for acute lymphoblastic leukemia or who had completed cancer treatments. At baseline, all dyads completed co-SSPedi, and guardians completed measures of mucositis, nausea, pain, quality of life, and overall symptoms. In the more symptomatic group, dyads completed co-SSPedi and a global symptom change scale on day 4. RESULTS There were 501 dyads included: 301 in the more symptomatic group and 200 in the less symptomatic group. Median time to complete co-SSPedi was less than 3 minutes in both groups. Test-retest reliability intraclass correlation coefficient was 0.85 (95% confidence interval [CI] = 0.77 to 0.90). For internal consistency, total co-SSPedi Cronbach alpha was 0.81 (95% CI = 0.78 to 0.83). For known groups validation, mean difference in total co-SSPedi scores between the more symptomatic and less symptomatic groups was 7.8 (95% CI = 6.7 to 8.8; P < .0001). For convergent validation and responsiveness, all hypothesized relationships were demonstrated. CONCLUSIONS Co-SSPedi is a novel approach to dyadic symptom assessment that is reliable, valid, and responsive in pediatric patients aged 4-18 years.
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Affiliation(s)
- Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Nicole Crellin-Parsons
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Sadie Cook
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Ketan Kulkarni
- Division of Hematology-Oncology, IWK Health Centre, Halifax, NS, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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Tomlinson D, Chakkalackal L, Calligan M, Tardif-Theriault C, Kuczynski S, Schechter T, Vettese E, Tomlinson GA, Dupuis LL, Sung L. Symptom documentation and intervention in paediatric cancer care-association with severity: observational study. BMJ Support Palliat Care 2024; 13:e1265-e1271. [PMID: 36854613 DOI: 10.1136/spcare-2022-003874] [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: 09/15/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES Primary objectives were to determine the relationship between prevalence of symptom documentation and intervention provision, and increasing severity of bothersome symptoms, as identified by guardians using guardian-reported Symptom Screening in Pediatrics Tool (proxy-SSPedi), which is validated and measures the extent of bothersome symptoms in paediatric patients with cancer. METHODS We included guardians of children 2-7 years of age receiving cancer treatments and seen in hospital daily for 4 consecutive days. Guardians reported proxy-SSPedi at study enrolment and 3 days later. Chart review was performed between the day prior and the day following proxy-SSPedi completion. Symptom documentation and intervention provision were determined by two independent abstractors. RESULTS We enrolled 190 guardians who provided 371 proxy-SSPedi assessments in 190 children. The most common severely bothersome symptoms were 'feeling tired', 'feeling more or less hungry than they usually do' and 'feeling cranky or angry'. Among those with increasing severity of bother, documentation was significantly more common for 12 symptoms while intervention was significantly more common for 7 symptoms. Intervention was not significantly more common with increasing severity of bother due to 'feeling tired', 'feeling more or less hungry than they usually do' and 'feeling cranky or angry'. CONCLUSIONS Symptom documentation was generally more common in patients with severely bothersome symptoms. Intervention was not more common among those with increasing severity of bother due to fatigue, changes in hunger or anger, which were the most common severely bothersome symptoms. Future efforts should focus on facilitating intervention provision to patients with bothersome symptoms.
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Affiliation(s)
- Deborah Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren Chakkalackal
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maryann Calligan
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer, Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Tal Schechter
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emily Vettese
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Schechter T, Tardif-Theriault C, Culos-Reed N, Lewis V, Orsey A, Diorio C, Tomlinson GA, Sung L. Yoga versus iPad active control for fatigue in paediatric cancer therapy: a randomised controlled trial. BMJ Support Palliat Care 2023:spcare-2023-004609. [PMID: 38160047 DOI: 10.1136/spcare-2023-004609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The primary objective was to determine if individualised yoga for hospitalised children receiving intensive chemotherapy was associated with less fatigue using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS) compared with iPad control. METHODS This was a multicentre randomised controlled trial of individualised yoga in paediatric patients aged 8-18 years who were inpatients receiving intensive chemotherapy for leukaemia, lymphoma or haematopoietic cell transplantation. Participants were randomised to yoga or iPad groups; allocated programme was delivered individually by trained yoga instructors 5 days/week for 21 days. The primary outcome was day 21 guardian-reported general fatigue using the PedsQL MFS. Secondary outcomes included day 21 PedsQL sleep/rest and cognitive fatigue, Fatigue Scale and PedsQL Acute Cancer Module, and systemic opioid administration. RESULTS The study was closed early for poor accrual when 125/210 planned participants had been enrolled and randomised to yoga (n=62) or iPad (n=63). Guardian-reported PedsQL MFS general fatigue scores on day 21 were not significantly different between groups (adjusted difference 7.2, 95% CI -2.6 to 16.9) in favour of yoga. However, day 21 cognitive fatigue (adjusted difference 9.0, 95% CI 0.9 to 17.1), cognitive problems (adjusted difference 11.2, 95% CI 3.5 to 19.0) and communication (adjusted difference 10.6, 95% CI 0.8 to 20.4) were significantly better in the yoga compared with the iPad group. There were no significant differences in the other secondary outcomes including PedsQL sleep/rest fatigue (adjusted difference 4.9, 95% CI -3.5 to 13.3). CONCLUSIONS The effect of individualised yoga on general fatigue is uncertain in paediatric patients receiving intensive chemotherapy. However, yoga significantly improved cognitive fatigue and cognitive problems. TRIAL REGISTRATION NUMBER NCT02134782.
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Affiliation(s)
- Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Victor Lewis
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrea Orsey
- Hematology Oncology, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Caroline Diorio
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Loves R, Green G, Joseph-Frederick Z, Palmert S, Plenert E, Schechter T, Tomlinson D, Vettese E, Zahra S, Zupanec S, Dupuis LL, Sung L. Describing taste changes and their potential impacts on paediatric patients receiving cancer treatments. BMJ Support Palliat Care 2023; 13:e382-e388. [PMID: 34049968 DOI: 10.1136/bmjspcare-2021-002951] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/12/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Taste changes are common among paediatric patients receiving cancer treatments although specific descriptions and associations are uncertain. Primary objective was to describe the number of paediatric patients receiving cancer therapies who experienced taste changes, its impact on food intake and enjoyment of eating, and coping strategies. METHODS This was a cross-sectional study that included English-speaking paediatric patients aged 4-18 years with a diagnosis of cancer or haematopoietic stem cell transplantation recipients receiving active treatment. Using a structured interview, we asked participants about their experience with taste changes, impacts and coping strategies. The respondent was the paediatric patient. RESULTS We enrolled 108 patients; median age was 11 years (IQR 8-15). The taste changes reported yesterday or today were food tasting bland (34%), bad (31%), different (27%), bitter (25%), extreme (19%), metallic (15%) or sour (12%). Taste changes were associated with decreased food intake (31%) and decreased enjoyment in eating (25%) yesterday or today. The most common coping strategies were eating food they liked (42%), eating strong-tasting food (39%), drinking liquids (35%), brushing teeth (31%) and sucking on candy (25%). Factors significantly associated with food tasting bad were as follows: older age (p=0.003), shorter time since cancer diagnosis (p=0.027), nausea and vomiting (p=0.008) and mucositis (p=0.009). CONCLUSIONS Among paediatric patients receiving cancer treatments, taste changes were common and were associated with decreased food intake and enjoyment in eating. Common coping strategies were described. Reducing nausea, vomiting and mucositis may improve taste changes.
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Affiliation(s)
- Robyn Loves
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Gloria Green
- Division of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zakia Joseph-Frederick
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Sasha Palmert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Erin Plenert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Serena Zahra
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Sue Zupanec
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Department of Pharmacy, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Mehrdadi I, Dhaliwal N, Chakkalackal L, Green G, Schechter T, Zupanec S, Dupuis LL, Sung L. Taste changes in paediatric oncology: longitudinal evaluation. BMJ Support Palliat Care 2023:spcare-2023-004409. [PMID: 37973201 DOI: 10.1136/spcare-2023-004409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Changes in taste is a common symptom in paediatric patients receiving cancer therapies. The primary objective was to describe the prevalence of taste changes longitudinally over a 6-month time frame among paediatric patients with newly diagnosed cancer. Secondary objective was to identify factors associated with taste changes over time. METHODS In this longitudinal, single centre study, we included paediatric patients newly diagnosed with cancer within the previous 8 weeks who were 4-18 years of age. Interviews were conducted once monthly for 6 months. We asked participants about their experience with taste changes, whether potential interventions were successful and whether taste changes influenced eating. Risk factors were evaluated using generalised linear mixed-effects models. RESULTS Overall, 60 participants were included. At baseline, 23 (38.3%) participants reported experiencing changes in taste, with the proportion significantly declining over time to 13 (21.7%) at 6 months. The most common specific taste changes were food tasting different, bad or bland. The most common helpful strategies were eating liked foods only, brushing teeth or using mouthwash, drinking more liquids and eating food with strong flavour. Taste change was commonly associated with eating less than usual and reduced enjoyment in eating. Nausea, dry mouth and recent vincristine were independent risk factors for taste changes. CONCLUSIONS Changes in taste were common within 8 weeks of cancer diagnosis and declined significantly over time. Nausea, dry mouth and recent vincristine were independent risk factors. Future studies should develop and evaluate interventions for managing taste changes in paediatric patients with cancer.
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Affiliation(s)
- Ida Mehrdadi
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Neeraj Dhaliwal
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Lauren Chakkalackal
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Gloria Green
- Division of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sue Zupanec
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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9
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Ehrhardt MJ, Krull KR, Bhakta N, Liu Q, Yasui Y, Robison LL, Hudson MM. Improving quality and quantity of life for childhood cancer survivors globally in the twenty-first century. Nat Rev Clin Oncol 2023; 20:678-696. [PMID: 37488230 DOI: 10.1038/s41571-023-00802-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
The contributions of cooperative groups to performing large-cohort clinical trials and long-term survivorship studies have facilitated advances in treatment, supportive care and, ultimately, survival for patients with paediatric cancers. As a result, the number of childhood cancer survivors in the USA alone is expected to reach almost 580,000 by 2040. Despite these substantial improvements, childhood cancer survivors continue to have an elevated burden of chronic disease and an excess risk of early death compared with the general population and therefore constitute a large, medically vulnerable population for which delivery of high-quality, personalized care is much needed. Data from large survivorship cohorts have enabled the identification of compelling associations between paediatric cancers, cancer therapy and long-term health conditions. Effectively translating these findings into clinical care that improves the quality and quantity of life for survivors remains an important focus of ongoing research. Continued development of well-designed clinical studies incorporating dissemination and implementation strategies with input from patient advocates and other key stakeholders is crucial to overcoming these gaps. This Review highlights the global progress made and future efforts that will be needed to further increase the quality and quantity of life-years gained for childhood cancer survivors.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Global Paediatric Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Qi Liu
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Patel P, Robinson PD, van der Torre P, Tomlinson D, Seelisch J, Oberoi S, Morgan JE, Hinds PS, Götte M, Gibson F, Duong N, Davis H, Culos-Reed SN, Cataudella D, Miranda V, Dupuis LL, Sung L. Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update. EClinicalMedicine 2023; 63:102147. [PMID: 37609066 PMCID: PMC10440444 DOI: 10.1016/j.eclinm.2023.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
Objective was to update a clinical practice guideline (CPG) for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients. We reconvened a multi-disciplinary and multi-national panel. While the previous 2018 CPG evaluated adult and pediatric randomized controlled trials (RCTs) to manage fatigue, this 2023 update revised previous recommendations based only on pediatric RCTs. Twenty RCTs were included in the updated systematic review. Physical activity significantly reduced fatigue (standardized mean difference -0.44, 95% confidence interval -0.64 to -0.24; n = 8 RCTs). Using the 2018 recommendations as a basis, the panel continued to make strong recommendations to use physical activity, and to offer relaxation, mindfulness or both, to manage fatigue in pediatric patients. Cognitive or cognitive behavioral therapies may be offered. Pharmacological approaches should not be routinely used. The panel made a new good practice statement to routinely assess for fatigue, ideally using a validated scale.
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Affiliation(s)
- Priya Patel
- Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
| | - Paula D. Robinson
- Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada
| | - Patrick van der Torre
- Sport and Exercise Center, Princess Máxima Center for Pediatric Oncology, Utrecht 3584CS, the Netherlands
| | - Deborah Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
| | - Jennifer Seelisch
- Division of Hematology/Oncology, Children’s Hospital London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, Max Rady College of Medicine, CancerCare Manitoba, University of Manitoba, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada
| | - Jessica E. Morgan
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
- Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds LS1 3EX, UK
| | - Pamela S. Hinds
- Department of Nursing Science, Professional Practice, and Quality, Children's National Health System, Washington, DC, USA
- Department of Pediatrics, George Washington University, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Miriam Götte
- University Hospital Essen, West German Cancer Center, Hufelandstraße 55, Essen 45147, Germany
| | - Faith Gibson
- Centre for Outcomes and Experiences Research in Children's Health, Illness, and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- School of Health Sciences, University of Surrey, 388 Stag Hill, Guildford GU2 7XH, UK
| | | | | | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - Danielle Cataudella
- Department of Pediatric Psychology, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Vanessa Miranda
- Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
| | - L. Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
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11
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Reeve BB, Greenzang KA, Sung L. Patient-Reported Outcomes in Pediatric Patients With Cancer. Am Soc Clin Oncol Educ Book 2023; 43:e390272. [PMID: 37172266 PMCID: PMC11299117 DOI: 10.1200/edbk_390272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Patient-reported outcomes (PROs) are reported directly by the patients about their own health. The objective of this article was to provide an overview of PROs in pediatric cancer, to describe how PROs can be incorporated into pediatric cancer clinical trials, and to discuss how PROs can guide symptom management treatment choices in pediatric oncology. Pediatric patient self-report provides a distinct voice in describing their experience compared with family caregiver or clinician report. Thus, every effort should be made to allow children to self-report symptoms, functioning, and other quality-of-life impacts and to use that data to inform treatment decision making. In addition to its incorporation into routine clinical care, it is also important to incorporate PROs into clinical trials to understand the patient experience of treatment toxicities and their impact on quality of life. Key considerations include clearly articulated PRO aims, selection of outcomes, choice of PRO measures, and frequency of PRO assessments. Once PROs are integrated into routine clinical care, it will be important to enable evidence-based symptom management. Strategies should be based on clinical practice guidelines (CPGs). Development and adaptation of care pathways on the basis of CPGs is one approach to standardize evidence-based symptom management at individual institutions. PROs are important to pediatric patients with cancer and their families. Self-report should be emphasized wherever possible. Approaches to enable PRO reporting into routine clinical care and enable preventative and therapeutic actions for symptom management are important. These efforts will optimize quality of life for pediatric patients with cancer.
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Affiliation(s)
- Bryce B. Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Katie A. Greenzang
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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12
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Vettese E, Sherani F, King AA, Yu L, Aftandilian C, Baggott C, Agarwal V, Nagasubramanian R, Kelly KM, Freyer DR, Orgel E, Bradfield SM, Kyono W, Roth M, Klesges LM, Beauchemin M, Grimes A, Tomlinson G, Dupuis LL, Sung L. Symptom management care pathway adaptation process and specific adaptation decisions. BMC Cancer 2023; 23:350. [PMID: 37069510 PMCID: PMC10108500 DOI: 10.1186/s12885-023-10835-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/11/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND There is substantial heterogeneity in symptom management provided to pediatric patients with cancer. The primary objective was to describe the adaptation process and specific adaptation decisions related to symptom management care pathways based on clinical practice guidelines. The secondary objective evaluated if institutional factors were associated with adaptation decisions. METHODS Fourteen previously developed symptom management care pathway templates were reviewed by an institutional adaptation team composed of two clinicians at each of 10 institutions. They worked through each statement for all care pathway templates sequentially. The institutional adaptation team made the decision to adopt, adapt or reject each statement, resulting in institution-specific symptom management care pathway drafts. Institutional adaption teams distributed the 14 care pathway drafts to their respective teams; their feedback led to care pathway modifications. RESULTS Initial care pathway adaptation decision making was completed over a median of 4.2 (interquartile range 2.0-5.3) weeks per institution. Across all institutions and among 1350 statements, 551 (40.8%) were adopted, 657 (48.7%) were adapted, 86 (6.4%) were rejected and 56 (4.1%) were no longer applicable because of a previous decision. Most commonly, the reason for rejection was not agreeing with the statement (70/86, 81.4%). Institutional-level factors were not significantly associated with statement rejection. CONCLUSIONS Acceptability of the 14 care pathways was evident by most statements being adopted or adapted. The adaptation process was accomplished over a relatively short timeframe. Future work should focus on evaluation of care pathway compliance and determination of the impact of care pathway-consistent care on patient outcomes. TRIAL REGISTRATION clinicaltrials.gov, NCT04614662. Registered 04/11/2020, https://clinicaltrials.gov/ct2/show/NCT04614662?term=NCT04614662&draw=2&rank=1 .
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Affiliation(s)
- Emily Vettese
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Farha Sherani
- Driscoll Children's Hospital, Cancer and Blood Disorders Center, 3533 S. Alameda Street, Corpus Christi, TX, 78411, US
- Texas A&M University, College Station, TX, US
| | - Allison A King
- Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO, 63110, US
| | - Lolie Yu
- Louisiana State University Health Sciences Center/Children's Hospital, 200 Henry Clay Avenue, New Orleans, LA, 70118, USA
| | | | | | - Vibhuti Agarwal
- Nemours Children's Hospital of The Nemours Foundation, 6535 Nemours Parkway, Orlando, FL, 32827, US
| | | | - Kara M Kelly
- Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 665 Elm St., Buffalo, NY, 14203, US
| | - David R Freyer
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, US
| | - Etan Orgel
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, US
| | - Scott M Bradfield
- Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32207, US
| | - Wade Kyono
- Kapi'olani Medical Center for Women & Children, 1319 Punahou Street, Honolulu, Hawai'i, 96826, US
| | - Michael Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, US
| | - Lisa M Klesges
- Division of Public Health Sciences, Washington University School of Medicine, 600 So Taylor Ave, St. Louis, MO, 63110, US
| | - Melissa Beauchemin
- Columbia University School of Nursing/Herbert Irving Cancer Center, 560 West 168th Street, New York, NY, 10032, USA
| | - Allison Grimes
- Pediatric Hematology Oncology, University of Texas Health, The Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, US
| | - George Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, M5S 3M2, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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13
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Calligan M, Chakkalackal L, Dadzie G, Tardif-Theriault C, Cook S, Vettese E, Soman D, Kuczynski S, Schechter T, Dupuis LL, Sung L. Feasibility of three times weekly symptom screening in pediatric cancer patients. BMC Cancer 2023; 23:4. [PMID: 36597030 PMCID: PMC9809057 DOI: 10.1186/s12885-022-10400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 12/05/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Primary objective was to determine the feasibility of three times weekly symptom reporting by pediatric cancer patients for eight weeks. METHODS We included English-speaking patients 8-18 years of age with cancer. Patients were sent reminders by text or email to complete Symptom Screening in Pediatrics Tool (SSPedi) three times weekly for eight weeks. When patients reported at least one severely bothersome symptom, the symptom report was emailed to the primary healthcare team. Patient-reported outcomes were obtained at baseline, week 4 ± 1 and week 8 ± 1. Symptom documentation, intervention provision for symptoms and unplanned healthcare encounters were determined by chart review at weeks 4 and 8. The primary endpoint was feasibility, defined as at least 75% patients achieving adherence with at least 60% of SSPedi evaluations. We planned to enroll successive cohorts until this threshold was met. RESULTS Two cohorts consisting of 30 patients (cohort 1 (n = 20) and cohort 2 (n = 10)) were required to meet the feasibility threshold. In cohort 1, 11/20 (55%) met the SSPedi completion threshold. Interventions applied after cohort 1 included engaging parents to facilitate pediatric patient self-report, offering mechanisms to remember username and password and highlighting potential benefits of symptom feedback to clinicians. In cohort 2, 9/10 (90%) met the SSPedi completion threshold and thus feasibility was met. Patient-reported outcomes and chart review outcomes were obtained for all participants in cohort 2. CONCLUSIONS Three times weekly symptom reporting by pediatric patients with cancer for eight weeks was feasible. Mechanisms to enhance three times weekly symptom reporting were identified and implemented. Future studies of longitudinal symptom screening can now be planned.
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Affiliation(s)
- Maryann Calligan
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Lauren Chakkalackal
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Grace Dadzie
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Cassandra Tardif-Theriault
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Sadie Cook
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Emily Vettese
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada
| | - Dilip Soman
- grid.17063.330000 0001 2157 2938Rotman School of Management, University of Toronto, 105 St. George Street, Toronto, ON M5S 3E6 Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, ON M2K 1S9 Canada
| | - Tal Schechter
- grid.42327.300000 0004 0473 9646Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - L. Lee Dupuis
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacy, The Hospital for Sick Children, and Leslie Dan Faculty of Pharmacy, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Lillian Sung
- grid.42327.300000 0004 0473 9646Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4 Canada ,grid.42327.300000 0004 0473 9646Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
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14
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Bradford N, Slater P, Fielden P, Condon P, Skrabal Ross X, Douglas M, Radford C, Carter A, Walker R, Badat A, Edwards R, Spencer B, Herbert A. Care at Your Fingertips: Codesign, Development, and Evaluation of the Oncology Hub App for Remote Symptom Management in Pediatric Oncology. JCO Clin Cancer Inform 2023; 7:e2200134. [PMID: 36706346 DOI: 10.1200/cci.22.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To codesign, develop, and evaluate a smartphone app that includes patient-reported measures of symptoms and real-time advice in children's cancer. METHODS The Oncology Hub is a comprehensive approach to symptom management that includes a suite of codesigned tools and resources including clinical algorithms to determine the level of concern, symptom management advice, and resources for families of children with cancer. The evaluation involved Think Aloud interviews with parent and adolescent patients to complete tasks in the app as well as a User Experience questionnaire (score range, 0-120) and qualitative feedback. The accuracy of algorithms was determined by repeated testing of inputs and outputs over 4 weeks. RESULTS Design and wireframes were iteratively refined through consultation with parents and adolescents confirming the final design. Beta testing evaluation was then completed by 25 participants including two adolescents. Across all participants, 84% of tasks were easy to navigate, and the Oncology Hub demonstrated high usability, usefulness, and acceptability with participants' scores ranging between 90 and 120 (mean = 112.2, standard deviation = 9.43). Qualitative feedback was positive. Testing of algorithms identified inconsistencies in understanding between clinical research and coding teams; refinements were made until the expected response notifications were returned with 100% accuracy. CONCLUSION Technology offers new ways to think about how clinicians and families communicate and share information to harness the best of community and hospital services. Understanding how information is exchanged using health apps, and how this affects clinical workflow is critical to successful implementation, and optimizing symptom assessment and management in children with cancer.
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Affiliation(s)
- Natalie Bradford
- Queensland University of Technology, Brisbane, Australia.,Children's Health Queensland, South Brisbane, Australia
| | | | | | - Paula Condon
- Children's Health Queensland, South Brisbane, Australia
| | | | | | | | - Amanda Carter
- Children's Health Queensland, South Brisbane, Australia
| | - Rick Walker
- Children's Health Queensland, South Brisbane, Australia
| | - Ashraf Badat
- Children's Health Queensland, South Brisbane, Australia
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15
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Merrow M, King N. Optimizing antiemetic therapy for children undergoing chemotherapy. J Pediatr Nurs 2022; 66:136-142. [PMID: 35759994 DOI: 10.1016/j.pedn.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/30/2022] [Accepted: 06/11/2022] [Indexed: 11/25/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of most chemotherapy agents. Suboptimal management of CINV impacts quality of life, nutrition, gastrointestinal (GI) integrity, and adherence to chemotherapy treatment plans. This article reviews the principles of CINV management, planning and implementation of antiemetic regimens, and pharmacology of the antiemetics currently available in the United States appropriate for pediatric use. With the advent of more targeted therapies, increased use of immunotherapy, and the effects of radiotherapy to the brain, spine, and abdomen, treatment of CINV now has a broader application than just for chemotherapeutics alone.
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Affiliation(s)
- Mya Merrow
- Department of Pharmacy, Children's Hospital Colorado, 13123 East 16(th) Avenue, Aurora, CO 80045, United States of America.
| | - Nancy King
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, 13123 East 16(th) Avenue, Aurora, CO 80045, United States of America
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16
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Tomlinson D, Dupuis LL, Johnston DL, Kuczynski S, Patel S, Schechter T, Vettese E, Mairs M, Tomlinson GA, Sung L. Reliability and validity of proxy-SSPedi and mini-SSPedi in pediatric patients 2-7 years receiving cancer treatments. BMC Cancer 2022; 22:730. [PMID: 35787263 PMCID: PMC9254487 DOI: 10.1186/s12885-022-09814-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Symptom Screening in Pediatrics Tool (SSPedi) was developed for symptom screening by children 8-18 years. Objectives were to evaluate the reliability and validity of proxy-SSPedi and self-report mini-SSPedi for younger children. Methods This multi-center study enrolled guardians of children 2-7 years receiving cancer treatments (proxy-SSPedi) and their children 4-7 years (mini-SSPedi). The two populations were: (1) More symptomatic group where children were receiving active cancer treatment and were in hospital or clinic for four consecutive days; and (2) Less symptomatic group where children were receiving maintenance therapy for acute lymphoblastic leukemia or had completed cancer therapy. Proxy-SSPedi or mini-SSPedi were completed with measures of mucositis, nausea, pain, quality of life and overall symptoms. Respondents in the more symptomatic group repeated proxy-SSPedi/mini-SSPedi and a global symptom change scale 3 days later. Results There were 402 guardians and 326 children included in the analysis. Test re-test reliability of proxy-SSPedi showed intraclass correlation coefficient (ICC) 0.83 (95% confidence interval (CI) 0.72-0.90). Mean difference in proxy-SSPedi between more and less symptomatic groups was 9.7 (95% CI 8.3-11.1). Proxy-SSPedi was responsive to change and hypothesized relationships between measures were observed. With a priori threshold ≥0.6, inter-rater ICC among all dyads and those 6-7 years were 0.54 (95% CI 0.45-0.62) and 0.62 (95% CI 0.50-0.71) respectively. Among participating children, other hypothesized reliability and validity thresholds were generally met. Conclusions Proxy-SSPedi is reliable, valid and responsive in children 2-7 years old receiving cancer treatments. Mini-SSPedi can be used for children 6-7 years of age. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09814-8.
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Affiliation(s)
- Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.,Department of Pharmacy, The Hospital for Sick Children555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, M5S 3M2, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Serina Patel
- Division of Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Mark Mairs
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada. .,Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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17
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Alelayan H, Huang H, Yang Y, Chen Y, Liao X. Psychometric validation of the simplified Chinese version of the therapy-related symptom checklist in children with cancer. J Pediatr Nurs 2022; 64:e32-e39. [PMID: 35101353 DOI: 10.1016/j.pedn.2022.01.008] [Citation(s) in RCA: 2] [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: 08/17/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To validate a simplified Chinese version of the therapy-related symptom checklist for children (TRSC-C) in children with cancer. METHODS Reliability was assessed by internal consistency and test-retest coefficients. Dimensionality and construct validity were clarified using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Pearson's correlation coefficient was calculated between the TRSC-C and the PedsQL 3.0 cancer model (PedsQL 3.0) and the Lansky Play Performance Scale (LPPS) to test concurrent validity. A Student's t-test was used to compare the scores of the simplified Chinese version of the TRSC-C subscales by gender, age groups, and functional status to test sensitivity of the TRSC-C. RESULTS A sample of 170 children with cancer was recruited (11.27 ± 2.31 years). Cronbach's alpha (0.89) and interclass correlation coefficient (0.98) were acceptable. Seven factors with eigenvalues >1 explained 56.86% of the total variances. CFA demonstrated an acceptable model (CFI = 0.93, RMSE = 0.04). Concurrent validity was supported by moderate to high correlations between the TRSC-C and both the PedsQL 3.0 (r = -0.71) and LPPS (r = -0.43). The TRSC-C scores significantly differed by age groups and functional status (effect size 0.40-0.93), indicating adequate sensitivity. CONCLUSION The simplified Chinese version of the TRSC-C demonstrated acceptable reliability, validity, and sensitivity to support its use in clinical practice and future studies.
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Affiliation(s)
- Hasan Alelayan
- Southern Medical University, Nanfang Hospital, Nursing Department of Zengcheng Branch, China; Southern Medical University, School of Nursing, China
| | - Haiying Huang
- Guangzhou Women and Children's Medical Center, Nursing Department, China
| | - Yiling Yang
- Southern Medical University, School of Nursing, China
| | - Yingying Chen
- Southern Medical University, Nanfang Hospital, Pediatric Department, China
| | - Xiaoyan Liao
- Southern Medical University, Nanfang Hospital, Nursing Department of Zengcheng Branch, China.
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18
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Garani-Papadatos T, Natsiavas P, Meyerheim M, Hoffmann S, Karamanidou C, Payne SA. Ethical Principles in Digital Palliative Care for Children: The MyPal Project and Experiences Made in Designing a Trustworthy Approach. Front Digit Health 2022; 4:730430. [PMID: 35373180 PMCID: PMC8971573 DOI: 10.3389/fdgth.2022.730430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
This paper explores the ethical dimension of the opportunity to offer improved electronic patient-reported outcome (ePRO) systems addressing personal needs of pediatric cancer patients, their parents and caregivers, with regard to technological advance of digital health. This opportunity has been explored in the MyPal research project, which aims to assess a patient-centered service for palliative care relying on the adaptation and extension of digital health tools and concepts available from previous projects. Development and implementation of ePROs need to take place in a safe, secure and responsible manner, preventing any possible harm and safeguarding the integrity of humans. To that end, although the final results will be published at the end of the project, this paper aims to increase awareness of the ethical ramifications we had to address in the design and testing of new technologies and to show the essentiality of protection and promotion of privacy, safety and ethical standards. We have thus reached a final design complying with the following principles: (a) respect for the autonomy of participants, especially children, (b) data protection and transparency, (c) fairness and non-discrimination, (d) individual wellbeing of participants in relation to their physical and psychological health status and e) accessibility and acceptability of digital health technologies for better user-engagement. These principles are adapted from the Ethics Guidelines for a trustworthy Artificial Intelligence (AI) which provide the framework for similar interventions to be lawful, complying with all applicable laws and regulations, ethical, ensuring compliance to ethical principles and values and robust, both from a technical and social perspective.
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Affiliation(s)
- Tina Garani-Papadatos
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | | | - Marcel Meyerheim
- Faculty of Medicine, Clinic of Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University, Homburg, Germany
| | - Stefan Hoffmann
- Serious Games Solutions, a Division of Promotion Software GmbH, Tuebingen, Germany
| | | | - Sheila A Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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Jibb LA, Ameringer S, Macpherson CF, Sivaratnam S. The Symptom Experience in Pediatric Cancer: Current Conceptualizations and Future Directions. Curr Oncol Rep 2022; 24:443-450. [PMID: 35150393 DOI: 10.1007/s11912-022-01222-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW We aimed to review the recent research on the childhood cancer symptom experience pertaining to socioeconomic factors, biology and genetics, growth and development, family psychosocial dynamics, and social and treating environments to begin to formulate recommendations for a personalized approach to symptom management. RECENT FINDINGS Cancer symptoms are common and distressing in children and negatively impact child and family quality of life. Many interacting factors influence children's cancer symptoms experiences, including the assessment and management of such symptoms. This paper highlights several gaps in the research related to the cancer symptom experience including routine symptom assessment, the impact of socioeconomic, biological, and genetic factors on symptoms, and the establishment of effective symptom management partnerships with families. Based on our findings, we provide recommendations related to that research which is ready to be implemented into clinical practice and areas for needed future efforts.
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Affiliation(s)
- Lindsay A Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, M5T 1P8, Toronto, Canada. .,Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.
| | | | | | - Surabhi Sivaratnam
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada.,Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, L8S 4K1, Canada
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20
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Raybin JL, Harnke B, Hendricks-Ferguson V. Does Creative Arts Therapy Improve Distressing Symptoms in Children with Cancer? A Synthesis of Extant Literature. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:60-71. [PMID: 35722867 DOI: 10.1177/27527530211059432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction: Children with cancer experience symptom distress which has been correlated with decreased quality of life (QOL). Creative arts therapy (CAT) encompasses the therapeutic use of creative arts which may improve QOL among children with cancer by affecting symptoms. Therefore, the research question was asked: Does CAT affect symptoms of pain, nausea, fatigue, anxiety, and mood in children with cancer? Methods: Based on the study question, a comprehensive literature search of PubMed, CINAHL, PsycINFO, and Embase was completed. Inclusion criteria limited articles to specific symptom outcomes in two-group intervention studies in the English language. Selected articles were confirmed for inclusion by the study team, followed by group discussion to develop matrices with levels of evidence based on the Grading of Recommendations Assessment, Development, and Evaluation (Grade) guidelines. Results: Initial searches revealed 1,391 articles, screened to 44 for systematic review. Based on the inclusion criteria, 11 articles remained. Four studies had evidence levels graded as low, three were low to moderate, and four were moderate. Outcomes of mood and anxiety were measured in five studies, pain in four, fatigue in two, and nausea in one study. Discussion: Psychological outcomes were measured more commonly than physical outcomes. Evidence reached a moderate grade in four studies. Summary: Through this synthesis of intervention studies with CAT in children with cancer, improvement in distressing symptoms has potential, but the state of the science for symptom management with CAT could be strengthened for nurses to promote CAT to improve QOL among children with cancer.
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Affiliation(s)
- Jennifer L Raybin
- Children's Hospital Colorado, School of Medicine University of Colorado, Aurora, Colorado, United States
| | - Ben Harnke
- Children's Hospital Colorado, School of Medicine University of Colorado, Aurora, Colorado, United States
| | - Verna Hendricks-Ferguson
- Trudy Busch Valentine School of Nursing at Saint Louis University, St. Louis, Missouri, United States
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21
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Chan AYL, Ge M, Harrop E, Johnson M, Oulton K, Skene SS, Wong ICK, Jamieson L, Howard RF, Liossi C. Pain assessment tools in paediatric palliative care: A systematic review of psychometric properties and recommendations for clinical practice. Palliat Med 2022; 36:30-43. [PMID: 34965753 PMCID: PMC8796159 DOI: 10.1177/02692163211049309] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Assessing pain in infants, children and young people with life-limiting conditions remains a challenge due to diverse patient conditions, types of pain and often a reduced ability or inability of patients to communicate verbally. AIM To systematically identify pain assessment tools that are currently used in paediatric palliative care and examine their psychometric properties and feasibility and make recommendations for clinical practice. DESIGN A systematic literature review and evaluation of psychometric properties of pain assessment tools of original peer-reviewed research published from inception of data sources to April 2021. DATA SOURCES PsycINFO via ProQuest, Web of Science Core, Medline via Ovid, EMBASE, BIOSIS and CINAHL were searched from inception to April 2021. Hand searches of reference lists of included studies and relevant reviews were performed. RESULTS From 1168 articles identified, 201 papers were selected for full-text assessment. Thirty-four articles met the eligibility criteria and we examined the psychometric properties of 22 pain assessment tools. Overall, the Faces Pain Scale-Revised (FPS-R) had high cross-cultural validity, construct validity (hypothesis testing) and responsiveness; while the Faces, Legs, Activity, Cry and Consolability (FLACC) scale and Paediatric Pain Profile (PPP) had high internal consistency, criterion validity, reliability and responsiveness. The number of studies per psychometric property of each pain assessment tool was limited and the methodological quality of included studies was low. CONCLUSION Balancing aspects of feasibility and psychometric properties, the FPS-R is recommended for self-assessment, and the FLACC scale/FLACC Revised and PPP are the recommended observational tools in their respective age groups.
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Affiliation(s)
- Adrienne YL Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - Mengqin Ge
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Emily Harrop
- Helen & Douglas House, Oxford, UK
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Margaret Johnson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kate Oulton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon S Skene
- Surrey Clinical Trials Unit, University of Surrey, Surrey, UK
| | - Ian CK Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong
- Research Department of Pratice & Policy, University College London School of Pharmacy, London, UK
- Centre for Medicines Optimisation Research and Education, University College London School of Pharmacy and University College London Hospital, London, UK
| | - Liz Jamieson
- Research Department of Pratice & Policy, University College London School of Pharmacy, London, UK
- Centre for Medicines Optimisation Research and Education, University College London School of Pharmacy and University College London Hospital, London, UK
| | - Richard F Howard
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christina Liossi
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- School of Psychology, University of Southampton, Southampton, UK
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22
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Hoffmann S, Schraut R, Kröll T, Scholz W, Belova T, Erhardt J, Gollmer D, Mauck C, Zacharioudakis G, Meyerheim M, Bonotis P, Kakalou C, Chatzimina M, Karamanidou C, Sander A, Didi J, Graf N, Natsiavas P. AquaScouts: ePROs Implemented as a Serious Game for Children With Cancer to Support Palliative Care. Front Digit Health 2021; 3:730948. [PMID: 34957461 PMCID: PMC8692290 DOI: 10.3389/fdgth.2021.730948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
MyPal is a European initiative focusing on the use of the electronic patient reported outcome (ePRO) measures to enhance patient engagement in palliative cancer care via digital self-reporting palliative care for patients with cancer. As a part of its approach, MyPal also focuses on pediatric patients, implementing a specific digital health platform including a serious game to facilitate the reporting of the symptoms and overall status regarding their quality of life (QoL). To this end, the reduction of psychological burden related to frequent reporting, a.k.a. as “reporting fatigue” has been identified as a priority. In this study, we present the MyPal-CHILD platform, emphasizing on the serious game named AquaScouts and its key design decisions, while also emphasizing on the respective challenges. More specifically, we provide insights on the participatory design approach applied during the design of the platform and the high-level goals defined based on end-user input. In addition, the validation process applied before the use of the platform under real-world conditions is also presented. Finally, we discuss a number of challenges and the prospects of deploying eHealth interventions to support palliative care.
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Affiliation(s)
- Stefan Hoffmann
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Robert Schraut
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Thomas Kröll
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Wiebke Scholz
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Tatiana Belova
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Johann Erhardt
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Daniel Gollmer
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Christian Mauck
- Serious Games Solutions, Promotion Software GmbH, Tübingen, Germany
| | - Giorgos Zacharioudakis
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - Marcel Meyerheim
- Clinic for Pediatric Hematology-Oncology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Panos Bonotis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Christine Kakalou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Maria Chatzimina
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Annette Sander
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Jana Didi
- Centre for Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Norbert Graf
- Clinic for Pediatric Hematology-Oncology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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23
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Dupuis LL, Grimes A, Vettese E, Klesges LM, Sung L. Barriers to symptom management care pathway implementation in pediatric Cancer. BMC Health Serv Res 2021; 21:1068. [PMID: 34627259 PMCID: PMC8500815 DOI: 10.1186/s12913-021-07047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Objectives were to describe barriers to pediatric cancer symptom management care pathway implementation and the impact of the COVID-19 pandemic on clinical research evaluating their implementation. METHODS We included 25 pediatric oncology hospitals in the United States that supported a grant submission to perform a cluster randomized trial in which the intervention encompassed care pathways for symptom management. A survey was distributed to site principal investigators prior to randomization to measure contextual elements related to care pathway implementation. Questions included the inner setting measures of the Consolidated Framework for Implementation Research (CFIR), study-specific potential barriers and the impact of the COVID-19 pandemic on clinical research. The Wilcoxon rank sum test was used to compare characteristics of institutions that agreed that their department supported the implementation of symptom management care pathways vs. institutions that did not agree. RESULTS Of the 25 sites, one withdrew because of resource constraints and one did not respond, leaving 23 institutions. Among the seven CFIR constructs, the least supported was implementation climate; 57% agreed there was support, 39% agreed there was recognition and 39% agreed there was prioritization for symptom management care pathway implementation at their institution. Most common barriers were lack of person-time to create care pathways and champion their use (35%), lack of interest from physicians (30%) and lack of information technology resources (26%). Most sites reported no negative impact of the COVID-19 pandemic across research activities. Sites with fewer pediatric cancer patients were more likely to agree that staff are supported to implement symptom management care pathways (P = 0.003). CONCLUSIONS The most commonly reported barriers to implementation were lack of support, recognition and prioritization. The COVID-19 pandemic may not be a major barrier to clinical research activities in pediatric oncology.
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Affiliation(s)
- L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.,Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, M5S 3M2, Canada
| | - Allison Grimes
- Pediatric Hematology Oncology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Lisa M Klesges
- Division of Public Health Sciences, Washington University School of Medicine, 4444 Forest Park Blvd, St. Louis, MO, 63108, USA
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada. .,Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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24
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Bradford N, Condon P, Pitt E, Tyack Z, Alexander K. Optimising symptom management in children with cancer using a novel mobile phone application: protocol for a controlled hybrid effectiveness implementation trial (RESPONSE). BMC Health Serv Res 2021; 21:942. [PMID: 34503489 PMCID: PMC8427146 DOI: 10.1186/s12913-021-06943-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/26/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intense and aggressive treatment regimens for most children's cancer have achieved vast improvements in survival but are also responsible for both a high number and burden of symptoms. The use of Patient Reported Outcome Measures (PROMs) demonstrates a range of benefits for improved symptom management in adults with cancer. There are, however, multiple barriers to integrating PROMs into routine care in children and adolescents with cancer. This study aims to evaluate: (1) the effectiveness of electronic PROMs to generate stratified alerts, symptom management recommendations and graphical summaries (the RESPONSE system) to improve health outcomes and (2) the implementation of the RESPONSE system by assessing feasibility, acceptability, satisfaction, and sustainability. METHODS A pragmatic hybrid II effectiveness-implementation controlled trial, using mixed methods, will be undertaken, advancing both knowledge of the effectiveness of the intervention and implementation factors. One-hundred and sixty children with cancer receiving active treatment will be recruited 1:1 to a non-randomised study involving two groups with an equal number of participants in each group. The intervention group (n = 80) will be prospectively recruited to receive the RESPONSE system intervention over eight weeks, versus the historical matched control group (n = 80) who will complete the ePROMs without access to the RESPONSE system. The primary outcome of the effectiveness trial is change between groups in total symptom burden. Secondary outcomes include child health-related quality-of-life and implementation outcomes. Trial data will be analysed using linear mixed-effects models. Formative implementation evaluation is informed by CFIR and ERIC frameworks and implementation outcomes will be mapped to the RE-AIM framework and include interviews, field notes, as well as administrative data to evaluate feasibility, acceptability, satisfaction and sustainability. TRIAL REGISTRATION NUMBER ACTRN12621001084875 . Retrospectively Registered 16 August 2021.
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Affiliation(s)
- Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia.
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 62 Graham St, South Brisbane, QLD, 4101, Brisbane, Australia.
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia.
| | - Paula Condon
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 62 Graham St, South Brisbane, QLD, 4101, Brisbane, Australia
| | - Erin Pitt
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
| | - Zephanie Tyack
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
| | - Kimberly Alexander
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Brisbane, Australia
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25
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Payne SA, Moore DC, Stamatopoulos K. MyPal: Designing and Evaluating Digital Patient-Reported Outcome Systems for Cancer Palliative Care in Europe. J Palliat Med 2021; 24:962-964. [PMID: 34128712 DOI: 10.1089/jpm.2021.0120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Sheila A Payne
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Danni Collingridge Moore
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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26
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Identifying clinical practice guidelines for symptom control in pediatric oncology. Support Care Cancer 2021; 29:7049-7055. [PMID: 34041614 DOI: 10.1007/s00520-021-06303-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Children with cancer commonly experience distressing symptoms such as pain, fatigue and nausea. Improvements in patient outcomes have been associated with implementation of clinical practice guideline-consistent care across several domains. The objective of this study was to develop a process to identify symptom management clinical practice guidelines (CPGs) applicable to children and adolescents receiving cancer treatments. METHODS We focused on identifying CPGs to manage 15 symptoms. The process defined three Tiers of CPGs based upon applicability to pediatric cancer patients and ease of identification: Tier 1: endorsed by the Children's Oncology Group; Tier 2: housed in the Emergency Care Research Institute repository, or developed by the American Society of Clinical Oncology or National Institute for Health and Care Excellence; and Tier 3: identified by systematic review. We first searched for CPGs published 2015-2020 and identified Tiers 1 or 2 CPGs. If unavailable or scope was too narrow, we proceeded to Tier 3. If CPGs were not identified, we repeated these steps for CPGs published 2010-2014. RESULTS There were six Tier 1 and 13 Tier 2 CPGs published 2015-2020 across the 15 symptoms. Four symptoms required progression to Tier 3 because CPGs were absent (anger) or because scope was too narrow (pain, anorexia/excessive hunger and diarrhea). The systematic review identified three CPGs for pain and none for the other three symptoms. In total, CPGs were identified for 14 of 15 symptoms. None were identified for anger. CONCLUSION We created a process to identify supportive care CPGs for pediatric cancer symptom management and were able to identify CPGs that addressed 14 of 15 symptoms. Future work should focus on evaluating implementation techniques for these CPGs and determining the impact of these CPGs on provider and patient outcomes.
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27
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Garcia Frausto E, Sivananthan A, Golden C, Szuminski M, Prado LNP, Lopez MP, Diaz V, Nieto D, Plenert E, Langevin AM, Dupuis LL. Translation of the Pediatric Nausea Assessment Tool (PeNAT) Into Spanish and Evaluating Understandability Among Spanish-Speaking Hispanic American Children and Adolescents Receiving Chemotherapy. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:33-39. [PMID: 33853416 PMCID: PMC8804537 DOI: 10.1177/15404153211003341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction: We aimed to create a Spanish-language version of the Pediatric Nausea
Assessment Tool (PeNAT) and examine its understandability among
Spanish-speaking, Hispanic American children. Methods: Translation: Forward and backward translations of the PeNAT
documents were performed and verified by a bilingual panel. Four
monolingual, Spanish-speaking dyads (child/parent) and four bilingual dyads
piloted the Spanish-language PeNAT documents. Four additional bilingual
dyads read both versions and completed the PeNAT using their preferred
version. These were reviewed for errors due to misunderstanding. Understandability: Children aged 4–18 years about to receive chemotherapy who spoke Spanish at
home and were without impairments precluding PeNAT use were eligible.
Participants used the Spanish-language PeNAT during a chemotherapy block.
Parents gave feedback on the PeNAT documents. Recruitment continued until 10
consecutive participants offered no substantive suggestions for
revision. Results: Translation: All child/parent dyads completed the PeNAT
without errors attributable to misunderstanding. The Spanish-language PeNAT
was preferred by three of four bilingual dyads.
Understandability: Ten cancer patients (mean age: 10.6
years) used the Spanish-language PeNAT. All parents felt their child
understood the PeNAT; none felt the documents were hard or very hard to
use. Conclusion: The Spanish-language PeNAT was understood by Spanish-speaking Hispanic
American children. Further psychometric testing is warranted.
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Affiliation(s)
- Erica Garcia Frausto
- Blood and Marrow Stem Cell Transplant, Texas Transplant Institute, Methodist Physicians Practices, San Antonio, TX, USA.,Texas Pediatric Minority Underserved NCORP, San Antonio, TX, USA
| | | | - Carla Golden
- Children's Hospital and Research Center at Oakland, CA, USA.,Bay Area Tumor Institute NCORP, Oakland, CA, USA
| | - Molly Szuminski
- Department of Pediatric Oncology, UCSF Benioff Children's Hospital Oakland, CA, USA
| | | | | | - Virginia Diaz
- Texas Pediatric Minority Underserved NCORP, San Antonio, TX, USA.,UT Health San Antonio, TX, USA
| | - Dominica Nieto
- Texas Pediatric Minority Underserved NCORP, San Antonio, TX, USA.,UT Health San Antonio, TX, USA
| | - Erin Plenert
- Research Institute, SickKids, Toronto, Ontario, Canada
| | - Anne-Marie Langevin
- Texas Pediatric Minority Underserved NCORP, San Antonio, TX, USA.,UT Health San Antonio, TX, USA
| | - L Lee Dupuis
- Research Institute, SickKids, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
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28
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Meyerheim M, Karamanidou C, Payne S, Garani-Papadatos T, Sander A, Downing J, Stamatopoulos K, Ling J, Payne C, Scarfò L, Lokaj P, Maramis C, Graf N. MyPal-Child study protocol: an observational prospective clinical feasibility study of the MyPal ePRO-based early palliative care digital system in paediatric oncology patients. BMJ Open 2021; 11:e045226. [PMID: 33849855 PMCID: PMC8051393 DOI: 10.1136/bmjopen-2020-045226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Electronic patient-reported outcomes (ePROs) have tremendous potential to optimise palliative and supportive care for children with cancer, their families and healthcare providers. Particularly, these children and their families are subjected to multiple strains caused by the disease and its treatment. The MyPal digital health platform is designed to address these complex demands by offering pursuant ePRO-based functionalities via two mobile applications, one developed for children and the other for their parents. METHODS AND ANALYSIS In this observational prospective feasibility study, 100 paediatric oncology patients aged between 6 and 17 years and at least one of their parents/legal guardians will be recruited at three clinical sites in two European countries (Germany and Czech Republic). They will use the mobile applications which are part of the novel digital health platform. During a 6-month study period, participants will complete various ePROs via the applications addressing quality of life, satisfaction with care and impact of the disease on the family at monthly intervals. Additionally, priority-based symptom reporting is integrated into a serious game for children. Outcomes that will be assessed concern the feasibility and the evaluation of the newly designed digital health platform to contribute to the evidence base of clinical ePRO use in paediatric oncology and palliative care process. ETHICS AND DISSEMINATION The MyPal-Child study obtained ethical approval from the Ethics Committee responsible for the University of Saarland, that is, the Ärztekammer des Saarlandes, the Ethics Committee of the Medical School Hannover and the Ethics Committee of the University of Brno. Study results will be disseminated through scientific publications, presentations at international conferences, congresses and a final report to the European Commission. General publicly accessible information can be found on the project website (www.mypal-project.eu) and social media. TRIAL REGISTRATION NUMBERS U1111-1251-0043, DRKS00021458, NCT04381221.
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Affiliation(s)
- Marcel Meyerheim
- Clinic of Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Central Macedonia, Greece
| | - Sheila Payne
- International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster, Lancashire, UK
| | - Tina Garani-Papadatos
- Department of Public Health Policy, University of West Attica, Athens, Attica, Greece
| | - Annette Sander
- Clinic for Paediatric Oncology and Haematology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Julia Downing
- International Children's Palliative Care Network, Bristol, Avon, UK
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Central Macedonia, Greece
| | - J Ling
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Cathy Payne
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Lydia Scarfò
- Department of Onco-Haematology, Division of Experimental Oncology, Università Vita Salute San Raffaele, Milano, Italy
| | - Petr Lokaj
- Department of Pediatric Oncology, University Hospital Brno, Brno, Jihomoravský, Czech Republic
| | - Christos Maramis
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Central Macedonia, Greece
| | - Norbert Graf
- Clinic of Pediatric Oncology and Hematology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
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Husain A, Cohen E, Dubrowski R, Jamieson T, Kurahashi AM, Lokuge B, Rapoport A, Saunders S, Stasiulis E, Stinson J, Subramaniam S, Wegier P, Barwick M. A Clinical Communication Tool (Loop) for Team-Based Care in Pediatric and Adult Care Settings: Hybrid Mixed Methods Implementation Study. J Med Internet Res 2021; 23:e25505. [PMID: 33656445 PMCID: PMC8294640 DOI: 10.2196/25505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/24/2020] [Accepted: 01/22/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops. The patient, their caregiver, or both are part of the Patient Loop. The communication is threaded, it can be filtered and sorted in multiple ways, it is securely stored, and can be exported for upload to a medical record. OBJECTIVE The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. METHODS The study was a hybrid type II mixed methods design to simultaneously evaluate Loop's clinical and implementation effectiveness, and implementation barriers and facilitators in 6 health care sites. Data included monthly user check-in interviews and bimonthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework for Implementation Research (CFIR), and Loop usage extracted directly from the Loop system. RESULTS We recruited 25 initiating health care providers across 6 sites who then identified patients or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 (range 0-28). The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital electronic medical records and patient portals were barriers to its adoption. While participants acknowledged Loop's potential value for engaging the patient and caregiver, and for improving communication within the patient's circle of care, Loop's relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. CONCLUSIONS Fundamental structural and implementation challenges persist toward realizing Loop's potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for health care provider compensation for asynchronous communication.
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Affiliation(s)
- Amna Husain
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Pediatric Medicine and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Raluca Dubrowski
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Trevor Jamieson
- Department of Medicine, Unity Health Toronto, Toronto, ON, Canada
| | | | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada
| | - Adam Rapoport
- Pediatric Advanced Care Team, The Hospital for Sick Children, Toronto, ON, Canada.,Emily's House Children's Hospice, Toronto, ON, Canada
| | - Stephanie Saunders
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Elaine Stasiulis
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Melanie Barwick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Brown AL, Sok P, Taylor O, Woodhouse JP, Bernhardt MB, Raghubar KP, Kahalley LS, Lupo PJ, Hockenberry MJ, Scheurer ME. Cerebrospinal Fluid Metabolomic Profiles Associated With Fatigue During Treatment for Pediatric Acute Lymphoblastic Leukemia. J Pain Symptom Manage 2021; 61:464-473. [PMID: 32889041 PMCID: PMC7914130 DOI: 10.1016/j.jpainsymman.2020.08.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/22/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022]
Abstract
CONTEXT Cancer-related fatigue (CRF) is one of the most distressing and persistent symptoms reported during pediatric acute lymphoblastic leukemia (ALL) therapy; however, information on the pathways underlying CRF severity is limited. OBJECTIVES We conducted global metabolomics profiling of cerebrospinal fluid (CSF) samples to provide insight into the underlying mechanisms of CRF. METHODS Fatigue in pediatric ALL patients (2012-2017) was assessed during postinduction therapy approximately six months after diagnosis. Postinduction CSF was collected from 171 participants, comprising discovery (n = 86) and replication (n = 85) cohorts. We also conducted secondary validation using diagnostic CSF from 48 replication cohort participants. CSF metabolomic profiling was performed using gas chromatography-mass spectrometry (MS) and liquid chromatography-MS/MS. Kendall's rank correlation was used to evaluate associations between metabolite abundance and CRF. False discovery rate was used to account for multiple comparisons. RESULTS Participants were 56% males and 59% Hispanic with a mean age at diagnosis of 8.5 years. A total of 274 CSF-derived metabolites were common to the discovery and replication cohorts. Eight metabolites were significantly associated with fatigue in the discovery cohort (P < 0.05), of which three were significant in the replication cohort, including false discovery rate-corrected associations with gamma-glutamylglutamine (Pcombined = 6.2E-6) and asparagine (Pcombined = 3.5E-4). Notably, the abundance of gamma-glutamylglutamine in diagnostic CSF samples was also significantly associated with fatigue (P = 0.0062). CONCLUSION The metabolites identified in our assessment have been implicated in neurotransmitter transportation and glutathione recycling, suggesting that glutamatergic pathways or oxidative stress may contribute to ALL-associated CRF. This information could inform targeted therapies for reducing CRF in at-risk individuals.
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Affiliation(s)
- Austin L Brown
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
| | - Pagna Sok
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Olga Taylor
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - John P Woodhouse
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - M Brooke Bernhardt
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Lisa S Kahalley
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Michael E Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Adaptation and evaluation of a child-friendly patient reported outcome measure for use in Australia. Collegian 2021. [DOI: 10.1016/j.colegn.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Dupuis LL, Grimes A, Vettese E, Klesges LM, Sung L. Readiness to Implement Symptom Management Care Pathways in Pediatric Cancer. RESEARCH SQUARE 2020. [PMID: 33398260 PMCID: PMC7781319 DOI: 10.21203/rs.3.rs-136225/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: To describe barriers to pediatric cancer symptom management care pathway implementation and the impact of the COVID-19 pandemic on clinical research evaluating their implementation. Methods: We included 25 pediatric oncology hospitals in the United States that supported a grant submission to perform a cluster randomized trial in which the intervention encompassed care pathways for symptom management. A survey was distributed to site principal investigators to measure contextual elements related to care pathway implementation. Questions included the inner setting measures of the Consolidated Framework for Implementation Research (CFIR), study-specific potential barriers and the impact of the COVID-19 pandemic on clinical research. The Wilcoxon rank sum test was used to compare characteristics of institutions that agreed that their department supported the implementation of symptom management care pathways vs. institutions that did not agree. Results: Of the 25 sites, one withdrew because of resource constraints and one did not respond, leaving 23 institutions. Among the seven CFIR constructs, the least supported was implementation climate; 57% agreed there was support, 39% agreed there was recognition and 39% agreed there was prioritization for symptom management care pathway implementation at their institution. Most common barriers were lack of person-time to create care pathways and champion their use (35%), lack of interest from physicians (30%) and lack of information technology resources (26%). Most sites reported no negative impact of the COVID-19 pandemic across research activities. Sites with fewer pediatric cancer patients were more likely to agree that staff are supported to implement symptom management care pathways (P=0.003). Conclusions: The most commonly reported barriers to implementation were lack of support, recognition and prioritization. The COVID-19 pandemic was not a major barrier to clinical research activities in pediatric oncology. Clinical Trial Registration: NCT04614662.
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Sung L, Miller TP, Phillips R. Improving symptom control and reducing toxicities for pediatric patients with hematological malignancies. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:280-286. [PMID: 33275755 PMCID: PMC7727514 DOI: 10.1182/hematology.2020000114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The continuing improvement in pediatric cancer survival over time is largely attributable to the availability of intensive therapies. Increasing attention has been focused on addressing the physical and psychosocial impacts of cancer and cancer treatments. Evidence from adult oncology suggests that routine symptom screening and feedback to health care providers can improve patient-clinician communication, reduce distress, and improve quality of life and may even increase survival. Many questions remain regarding implementation of routine symptom screening in pediatric cancer care, including the best symptom assessment instrument and the reporter type and feasibility of integration with electronic health records (EHRs). Nonsymptom adverse events are also important, for both routine clinical care and adverse event reporting for patients enrolled in clinical trials. However, traditional mechanisms for reporting adverse events lead to substantial inaccuracies and are labor intensive. An automated approach for abstraction from EHRs is a potential mechanism for improving accuracy and reducing workload. Finally, identification of symptom and nonsymptom toxicities must be paired with prophylactic and therapeutic strategies. These strategies should be based on clinical practice guidelines that synthesize evidence and use multiprofessional, multidisciplinary expertise to place this evidence in clinical context and create recommendations. How best to implement clinical practice guidelines remains a challenge, but EHR order sets and alerts may be useful. In summary, although survival is excellent for pediatric patients receiving cancer therapies, more focus is needed on identification of symptoms and nonsymptom toxicities and their management. The EHR may be useful for promoting better supportive care through these mechanisms.
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Affiliation(s)
| | - Tamara P. Miller
- Children’s Healthcare of Atlanta, Emory University, Atlanta, GA; and
| | - Robert Phillips
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
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Plenert E, Grimes A, Sugalski A, Langevin AM, Nieto D, Salaverria C, Gomez S, Gonzalez G, D'Angelo G, Dupuis L, Sung L. Translating the Symptom Screening in Paediatrics Tool (SSPedi) into North American Spanish and Among Spanish-speaking children receiving cancer treatments: evaluating understandability and cultural relevance in a multiple-phase descriptive study. BMJ Open 2020; 10:e037406. [PMID: 33184077 PMCID: PMC7662419 DOI: 10.1136/bmjopen-2020-037406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Symptom screening is important to achieving symptom control. Symptom Screening in Paediatrics Tool (SSPedi) is validated for English-speaking children. Objectives were to translate SSPedi into Spanish, and to evaluate the understandability and cultural relevance of the translated version among Spanish-speaking children with cancer and paediatric haematopoietic stem cell transplant recipients. METHODS We conducted a multiphase, descriptive study to translate SSPedi into Spanish. The first step was to determine whether one Spanish version would be appropriate for both North America and Argentina. Once this decision was made, forward and backward translations were performed. The translated version was evaluated by Spanish-speaking children 8-18 years of age receiving cancer treatments. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was child self-reported difficulty with understanding of the entire instrument and each symptom using a 5-point Likert scale. Secondary outcomes were incorrect understanding of SSPedi items identified by cognitive interviews with the children using a 4-point Likert scale and cultural relevance, which was assessed qualitatively. RESULTS This report focuses on North American Spanish as a separate version will be required for Argentinian Spanish SSPedi based on different common vocabulary and grammatical structure. There were 20 children from Toronto and San Antonio included in cognitive interviews. The most common types of Spanish spoken were Mexican (13, 65%), Central American (2, 10%) and South American (2, 10%). No child reported that it was hard or very hard to complete Spanish SSPedi. Changes to the instrument itself were not required based on understanding or cultural relevance. CONCLUSIONS We translated and finalised Spanish SSPedi appropriate for use in North America. Future research will translate and evaluate SSPedi for use in Argentina and other Spanish-speaking countries.
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Affiliation(s)
- Erin Plenert
- CHES, Hospital for Sick Children SickKids Learning Institute, Toronto, Ontario, Canada
| | - Allison Grimes
- Division of Hematology-Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Aaron Sugalski
- Division of Hematology-Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Anne-Marie Langevin
- Division of Hematology-Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Dominica Nieto
- Division of Hematology-Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Carmen Salaverria
- Department of Oncology, Hospital Nacional De Ninos Benjamin Bloom, San Salvador, El Salvador
| | - Sergio Gomez
- Stem Cell Transplantation Unit, Hospital de Niños Sor María Ludovica, La Plata, Argentina
| | - Gisela Gonzalez
- Stem Cell Transplantation Unit, Hospital de Niños Sor María Ludovica, La Plata, Argentina
| | - Gisela D'Angelo
- Stem Cell Transplantation Unit, Hospital de Niños Sor María Ludovica, La Plata, Argentina
| | - Lee Dupuis
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Lillian Sung
- CHES, Hospital for Sick Children SickKids Learning Institute, Toronto, Ontario, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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Hyslop S, Tomlinson D, Baggott C, Dix D, Gibson P, Johnston DL, Orsey AD, Portwine C, Price V, Vanan M, Kuczynski S, Spiegler B, Tomlinson GA, Dupuis LL, Sung L. Feeling scared or worried self-report in children receiving cancer treatments using the Symptom Screening in Pediatrics Tool (SSPedi). Support Care Cancer 2020; 29:3137-3144. [PMID: 33067767 DOI: 10.1007/s00520-020-05818-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The objectives of this study were to describe reports of bother for feeling scared or worried among children with cancer and pediatric hematopoietic stem cell transplant (HSCT) recipients, and to identify factors associated with it. METHODS We included children receiving cancer treatments who were 8-18 years of age. Three patient types were enrolled: inpatients receiving active cancer treatment, outpatients receiving maintenance acute lymphoblastic leukemia chemotherapy, and outpatients in survivorship. Amount of bother due to feeling scared or worried yesterday or today was self-reported using the Symptom Screening in Pediatrics Tool (SSPedi) on a 0-4 scale. Risk factors were evaluated using logistic regression. RESULTS Among the 502 children included, 225 (45.0%) reported any degree of bother (score ≥ 1) and 29 (5.8%) reported severe bother (score ≥ 3) for feeling scared or worried. In multiple regression evaluating any bother, boys were less likely to be bothered (odds ratio (OR) 0.60, 95% confidence interval (CI) 0.41-0.87) and inpatients receiving active cancer treatment were more likely to be bothered compared to outpatients in survivorship (OR 3.58, 95% CI 2.00-6.52). The only factor associated with being severely bothered by feeling scared or worried was clinic visit or admission due to fever (OR 4.57, 95% CI 1.24-13.60). DISCUSSION We found 45% of children receiving cancer treatments reported being bothered by feeling scared or worried. Girls and inpatients receiving active treatment experienced more bother of any degree, while visiting the hospital due to fever was associated with being severely bothered. Future work should identify interventions to prevent or alleviate this symptom.
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Affiliation(s)
- Shannon Hyslop
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Christina Baggott
- Pediatric Hematology/Oncology, Stanford University Cancer Clinical Trials Office, 800 Welch Road, Palo Alto, CA, 94304, USA
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, BC Children's Hospital, 4480 Oak Street Room B315, Vancouver, V6H 3V4, Canada
| | - Paul Gibson
- Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Andrea D Orsey
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Carol Portwine
- Division of Haematology/Oncology, McMaster Children's Hospital, Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Magimairajan Vanan
- Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Research Institute in Oncology and Hematology, Departments of Pediatrics & Child Health and Biochemistry & Medical Genetics, University of Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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Watling CZ, McCarthy C, Theodorakidis A, Cook S, Vettese E, Schechter T, Abubeker H, Dupuis LL, Sung L. Development of the SPARK family member web pages to improve symptom management for pediatric patients receiving cancer treatments. BMC Cancer 2020; 20:923. [PMID: 32977751 PMCID: PMC7519510 DOI: 10.1186/s12885-020-07433-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/17/2020] [Indexed: 01/13/2023] Open
Abstract
Background Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK) is a web-based application that facilitates symptom screening and access to supportive care clinical practice guidelines (CPGs) for children and adolescents receiving cancer treatments. Objective was to develop SPARK family member web pages for pediatric patient family members accessing: (1) proxy symptom screening and symptom reports, and (2) care recommendations for symptom management based on CPGs. Methods SPARK family member web pages were developed and included access to symptom screening and care recommendations sections. Care recommendations for fatigue and mucositis were created. These were iteratively refined based upon cognitive interviews with English-speaking family members ≥16 years of age until less than two participants incorrectly understood sections as adjudicated by two independent raters. Results A total of 100 family members were enrolled who evaluated the SPARK family member web pages (n = 40), fatigue care recommendation (n = 30) and mucositis prevention care recommendation (n = 30). Among the last 10 participants, none said that the SPARK family member web pages were hard or very hard to use, one incorrectly understood one web page, none said either care recommendation was hard to understand and none were incorrect in their understanding of the care recommendations. Conclusions We successfully developed SPARK web pages for use by family members of pediatric patients receiving cancer treatments. We also developed a process for translating CPG recommendations designed for healthcare professionals to lay language. The utility of SPARK family member web pages after clinical implementation could be a focus for future research.
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Affiliation(s)
- Cody Z Watling
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario, Canada
| | - Clodagh McCarthy
- Canadian Cancer Society, 55 St Clair St W., Toronto, Ontario, Canada
| | - Alexandra Theodorakidis
- AboutKidsHealth, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada
| | - Sadie Cook
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario, Canada
| | - Tal Schechter
- Department of Pediatrics, Division of Haematology/Oncology, The Hospital of Sick Children and Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada
| | - Hanan Abubeker
- Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Research Institute and Department of Pharmacy, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada
| | - Lillian Sung
- Department of Pediatrics, Division of Haematology/Oncology, The Hospital of Sick Children and Faculty of Medicine, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada. .,Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
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Tomlinson D, Plenert E, Dadzie G, Loves R, Cook S, Schechter T, Furtado J, Dupuis LL, Sung L. Discordance between pediatric self-report and parent proxy-report symptom scores and creation of a dyad symptom screening tool (co-SSPedi). Cancer Med 2020; 9:5526-5534. [PMID: 32567173 PMCID: PMC7402841 DOI: 10.1002/cam4.3235] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 11/07/2022] Open
Abstract
Symptom Screening in Pediatrics Tool (SSPedi) (age 8-18 years) and mini-SSPedi (age 4-7 years) can be used to self-report and proxy-report bothersome symptoms in pediatric patients receiving cancer treatments. There are limitations of sole child self-report or proxy-report. An approach in which children and parents complete symptom reports together may be useful. The aim of our study was to describe discordance between child self-report and parent proxy-report symptom scores, and to determine how these scores compare to an approach in which reporting is performed together (co-SSPedi). Children and parents completed SSPedi or mini-SSPedi separately. Discordant symptoms were shared with respondents and discussed. Next, the dyad completed co-SSPedi together and were asked which approach they preferred. Discordance was evaluated for each symptom and was defined as a difference of at least 2 points on an ordinal scale ranging from 0 (not at all bothered) to 4 (extremely bothered). Of the 48 enrolled dyads (children, median age, 10.8 years; 54.2% male), 41 (85.4%) had discordance in at least one symptom. There was no clear pattern in discordance by age group. When a dyad approach was used, more co-SSPedi scores agreed with the original child self-report scores (59 dyads, 56.2%) compared to original parent proxy-report scores (15 dyads, 14.3%) for discordant symptoms. Forty-three (89.6%) dyads preferred to complete SSPedi together. Future work should evaluate the psychometric properties of co-SSPedi.
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Affiliation(s)
- Deborah Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Erin Plenert
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Grace Dadzie
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Loves
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sadie Cook
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tal Schechter
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Furtado
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - L Lee Dupuis
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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[Prevention and treatment of antineoplastic drug-induced nausea and vomiting in pediatric onco-hematology: An update]. Bull Cancer 2020; 107:800-812. [PMID: 32418660 DOI: 10.1016/j.bulcan.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 11/21/2022]
Abstract
Antineoplastic drug induced nausea and vomiting are common adverse events in cancer care of paediatric patients ; therefore, prevention and management of these adverse events is a major concern for healthcare professionals. There are common features between paediatric and adult patients in terms of the emetogenic level depending on antineoplastic agents or about available medicines. However, there are also specificities for paediatric population including individual risk factors of emesis or nausea assessment for example. Knowledge relative to available medicines is also limited in the paediatric population, especially for recent medicines. This review aims to provide a comprehensive overview about antiemetics in paediatric oncology to clinicians and other healthcare professionals involved in paediatric cancer care. First of all, we describe physiopathological paediatric specificity, risk factors and clinical assessment of antineoplastic drug induced nausea and vomiting. Secondly, we focus on available medicines and also address the issue of complementary and alternative medicines.
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Linder LA, Hooke MC. Symptoms in Children Receiving Treatment for Cancer-Part II: Pain, Sadness, and Symptom Clusters. J Pediatr Oncol Nurs 2020; 36:262-279. [PMID: 31307323 PMCID: PMC7197222 DOI: 10.1177/1043454219849578] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Children and adolescents receiving treatment for cancer experience multiple symptoms as a consequence of their disease and its treatment that interfere with the child's quality of life. Understanding of symptom assessment in children with cancer is foundational to the work of the Children's Oncology Group Nursing Discipline, whose research aims are to address knowledge gaps including understanding illness-related distress. This article is the second of a two-part summary of current evidence addressing the assessment of symptoms frequently reported by children and adolescents receiving treatment for cancer. Studies reporting assessment of pain, sadness, and symptom clusters published between January 2008 and May 2018 were included. Forty-three publications addressed pain. Pain was highly prevalent and distressing, varied in its trajectory across a cycle of chemotherapy and across multiple cycles of treatment, and correlated with biomarkers associated with the pain response. Consequences of pain were poorer functional status and emotional health. Twenty publications addressed sadness. Sadness was the most prevalent psychosocial symptom. Its prevalence decreased over the course of treatment and over a cycle of chemotherapy. Persistent sadness was of greater severity and distress. Eight publications addressed symptom clusters. These studies identified both groups of co-occurring symptoms and groups of patients with common symptom profiles. This two-article series provides evidence for the distressing nature of symptoms among children receiving cancer treatment. Efforts to support clinicians in routine symptom assessment are needed. Additional research directed at alleviating symptoms and building resilience among the child experiencing symptoms is needed.
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Affiliation(s)
- Lauri A Linder
- 1 University of Utah College of Nursing, Salt Lake City, UT, USA
- 2 Cancer Transplant Service, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mary C Hooke
- 3 University of Minnesota School of Nursing, Minneapolis, MN, USA
- 4 Children's Minnesota, Minneapolis, MN, USA
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de Andrade Cadamuro S, Onishi Franco J, Paiva CE, Oliveira MAD, Sakamoto Ribeiro Paiva B. Association between multiple symptoms and quality of life of paediatric patients with cancer in Brazil: a cross-sectional study. BMJ Open 2020; 10:e035844. [PMID: 32376756 PMCID: PMC7223154 DOI: 10.1136/bmjopen-2019-035844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify the association of multiple symptoms and clinical characteristics on quality of life (QoL) of paediatric patients with cancer. DESIGN A descriptive, cross-sectional study. SETTING South American Children's Hospital for Cancer Treatment (Barretos, São Paulo, Brazil). PARTICIPANTS A total of 157 participants, 116 paediatric patients, diagnosed with cancer, undergoing chemotherapy treatment, between 7 and 18 years of age and 41 proxies for patients between 2 and 6 years of age. PRIMARY OUTCOME MEASURES The severity and prevalence ofsymptoms were identified through the use of a culturally adapted multi-symptomscreening tool, and the influence these symptoms, in association with clinicalcharacteristics, had on the QOL of Brazilian pediatric cancer patients wasassessed. RESULTS Prevalent symptoms identified by all participants were 'feeling tired' (98, 62.4%), 'feeling more or less hungry (do not feel like eating) than you usually do' (96, 61.1%), 'changes in taste (flavour of the food)' (89, 56.7%), 'throwing up or feeling like you may throw up' (77, 49%) and 'changes in how your body (visually) or face looks' (72, 45.9%). The multivariate analysis for symptom severity as reported by proxies showed that surgery (OR 0.20, 95% CI 0.04 to 0.98, p=0.047) and time of diagnosis (OR 0.14, 95% CI 0.03 to 0.66, p=0.012) were associated with a decreased OR of high severity symptoms.An analysis of the clinical characteristics associated with Pediatric Quality of Life Inventory (PedsQL) demonstrated no significant effect on QoL in any of the domains evaluated. The association between Symptom Screening in Pediatrics Tool and PedsQL in the self-report version demonstrated a significant negative influence of all symptoms on the QoL. CONCLUSIONS The prevalence of symptoms experienced among pediatric patients during treatment was high and significantly influenced all aspects of quality of life,especially in the emotional domain.
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Affiliation(s)
| | | | - Carlos Eduardo Paiva
- Learning and Research Institute, Barretos Cancer Hospital, Barretos, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil
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Loves R, Plenert E, Tomlinson V, Palmert S, Green G, Schechter T, Tomlinson D, Vettese E, Zupanec S, Dupuis LL, Sung L. Changes in hunger among pediatric patients with cancer and hematopoietic stem cell transplantation recipients. Support Care Cancer 2020; 28:5795-5801. [PMID: 32219569 DOI: 10.1007/s00520-020-05425-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/19/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Change in hunger is a common and bothersome symptom among pediatric patients receiving cancer treatments. Objectives were to describe how children and adolescents receiving cancer treatments experience changes in hunger, factors associated with both increases and decreases in hunger, and coping strategies used by these patients. METHODS We enrolled children and adolescents 4-18 years of age with cancer or hematopoietic stem cell transplantation (HSCT) recipients who were actively receiving treatment or who had completed therapy. Using a single, qualitative, semi-structured interview, we asked participants about the experience of increases or decreases in hunger, including characteristics of the change and identified coping strategies. RESULTS There were 50 children enrolled; 25 (50%) were 4-10 years of age and 33 (66%) were boys. Most often, patients associated an increase in hunger with corticosteroid administration, while other treatments, accompanying symptoms, inactivity, and the hospital environment were associated with a decrease in hunger. Many reported that no coping strategies were successful. For those who did report successful strategies to manage an increase in hunger, these included sleep and having food available. Strategies used to manage a decrease in hunger included anti-emetic medications, increased caloric intake, varied food choices, encouragement to eat, scheduling or tracking of meals, and physical activity. CONCLUSIONS Both increases and decreases in hunger were commonly described. Some coping strategies were reported to be successful. Further research should identify and test interventions to manage changes in hunger in pediatric cancer patients.
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Affiliation(s)
- Robyn Loves
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Erin Plenert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Vivian Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Sasha Palmert
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Gloria Green
- Division of Clinical Dietetics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Sue Zupanec
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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Snaman J, McCarthy S, Wiener L, Wolfe J. Pediatric Palliative Care in Oncology. J Clin Oncol 2020; 38:954-962. [PMID: 32023163 DOI: 10.1200/jco.18.02331] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pediatric palliative care aims to alleviate suffering and improve the quality of life of children with serious disease and increase support for their parents and other family members. Integration of palliative care into the routine care of children, adolescents, and young adults with cancer has resulted in improved outcomes in patients and their families. The field of pediatric palliative oncology-encompassing primary palliative care provided by the multidisciplinary oncology team as well as subspecialty palliative care provided by the palliative care team for more complex cases-is unique from palliative care in adults given its focus on care of the child and the larger family. In this review, we focus on advancements in the specific domains within pediatric palliative oncology care including family-centered communication, assessment and management of physical symptoms and distress, psychosocial concerns, and spiritual considerations of the patient, parents, and siblings.
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Affiliation(s)
- Jennifer Snaman
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
| | | | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
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Feasibility of a randomized controlled trial of symptom screening and feedback to healthcare providers compared with standard of care using the SPARK platform. Support Care Cancer 2019; 28:2729-2734. [PMID: 31707500 DOI: 10.1007/s00520-019-05115-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK) is a web-based application that enables symptom screening and access to clinical practice guidelines for symptom management. Objective was to determine the feasibility of a randomized trial of daily symptom screening for 5 days among children receiving cancer treatments. METHODS We included English-speaking pediatric cancer and hematopoietic stem cell transplantation (HSCT) patients who were 8-18 years of age at enrollment and who were expected to be in the hospital or in clinic daily for five consecutive days. We randomized children to either undergo daily symptom screening with symptom reports provided to the healthcare team using the SPARK vs. standard of care. The primary endpoint was feasibility, defined as being able to enroll at least 30 participants within 1 year, and among those randomized to intervention, at least 75% completing symptom screening on at least 60% of on-study days. RESULTS From July 2018 to November 2018, we enrolled and randomized 30 participants. The median age at enrollment was 12.5 (range 8-18) years. Among the intervention group, the median number of days Symptom Screening in Pediatrics Tool (SSPedi) was completed at least once was 5 (range 4 to 5), with one participant missing 1 day of symptom screening. Among all participants, baseline and day 5 SSPedi scores were obtained in 29/30 participants. CONCLUSION A randomized trial of the SPARK with daily symptom screening for 5 days was feasible. It is now appropriate to proceed toward a definitive multi-center trial to test the efficacy of SPARK to improve symptom control.
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Optimizing symptom control in children and adolescents with cancer. Pediatr Res 2019; 86:573-578. [PMID: 31357207 DOI: 10.1038/s41390-019-0516-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 12/25/2022]
Abstract
There is growing recognition of the degree to which symptoms negatively impact on children receiving cancer treatments. A recent study described that almost all inpatient pediatric oncology patients are experiencing at least one bothersome symptom and almost 60% are experiencing at least one severely bothersome symptom. Poor symptom control occurs because of challenges with communication of bothersome symptoms to clinicians, lack of clinical practice guidelines (CPGs) for most of these symptoms, and failure to administer preventative and therapeutic interventions known to be effective for symptom control. This article reviews approaches used to improve symptom control for children receiving cancer treatments. Areas addressed include systematic symptom screening and creation of CPGs for symptom management. Challenges with electronic health integration are also addressed. Several multi-symptom assessment scales have been developed but none have yet been used to directly influence patient management. The number of CPGs applicable to symptom control in pediatric oncology is increasing but remains small. Improving the creation of and adherence to CPGs for symptom management is an important priority. Finally, identifying ways that symptom management systems can be integrated into clinical work flows is essential; these will likely need to focus on electronic health records.
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Hu H, Shear D, Thakkar R, Thompson-Lastad A, Pinderhughes H, Hecht FM, Lown EA. Acupressure and Therapeutic Touch in Childhood Cancer to Promote Subjective and Intersubjective Experiences of Well-being During Curative Treatment. Glob Adv Health Med 2019; 8:2164956119880143. [PMID: 31632842 PMCID: PMC6769200 DOI: 10.1177/2164956119880143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/05/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Acupressure and therapeutic touch may be beneficial for symptom management and increasing general well-being for children undergoing cancer treatment. Acupressure has the benefit of stimulating targeted acupuncture points while providing therapeutic touch. We sought to explore the relationship between acupressure and the experience of well-being among children being treated for cancer who received acupressure. METHODS In the Acupressure for Children in Treatment for a Childhood Cancer trial, hospitalized children received acupressure using specified acupressure points for symptom control as well as points for general well-being. Acupressure was delivered by professionals and by caregivers, following training by the professional. Qualitative data were collected through semistructured interviews with a purposive sample of professional acupressure providers (n = 3) and primary caregivers (n = 13), combined with participant observation during the acupressure intervention. Data were analyzed using grounded theory methods. RESULTS Analysis of provider interview, caregiver interview, and participation observation yielded 3 prominent themes: (1) well-being elicited by acupressure, (2) well-being elicited by touch, and (3) well-being experienced as relational and intersubjective. These themes, taken together, illustrate the intricate ways in which an intervention like acupressure can help alleviate the difficulties of a childhood cancer illness experience by promoting well-being in the child as well as the caregiver. Acupressure brought symptom relief, physical relaxation, and comforting touch to the child, allowing the caregiver to also feel relief and relaxation as caregiver-child experience of well-being are closely intertwined. CONCLUSIONS Data from the 3 sources provided distinct and overlapping insights suggesting the versatile benefits of acupressure in promoting well-being during childhood cancer treatment. Professional acupressure combined with training of caregivers for childhood cancer may be a relational intervention that facilitates the experience of well-being for both the caregiver and the child.
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Affiliation(s)
- Hiroe Hu
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
- College of Osteopathic Medicine, Touro University, Vallejo, California
| | - Deborah Shear
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Radhika Thakkar
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, San Francisco, California
| | - Ariana Thompson-Lastad
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
| | - Howard Pinderhughes
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
| | - E Anne Lown
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
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Lown EA, Banerjee A, Vittinghoff E, Dvorak CC, Hartogensis W, Melton A, Mangurian C, Hu H, Shear D, Adcock R, Morgan M, Golden C, Hecht FM. Acupressure to Reduce Treatment-Related Symptoms for Children With Cancer and Recipients of Hematopoietic Stem Cell Transplant: Protocol for a Randomized Controlled Trial. Glob Adv Health Med 2019; 8:2164956119870444. [PMID: 31453017 PMCID: PMC6696841 DOI: 10.1177/2164956119870444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/02/2019] [Accepted: 07/02/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We describe the study design and protocol of a pragmatic randomized controlled trial (RCT) Acupressure for Children in Treatment for a Childhood Cancer (ACT-CC). OBJECTIVE To describe the feasibility and effectiveness of an acupressure intervention to decrease treatment-related symptoms in children in treatment for cancer or recipients of a chemotherapy-based hematopoietic stem cell transplant (HSCT). DESIGN Two-armed RCTs with enrollment of 5 to 30 study days. SETTING Two pediatric teaching hospitals. PATIENTS Eighty-five children receiving cancer treatment or a chemotherapy-based HSCT each with 1 parent or caregiver. INTERVENTION Patients are randomized 1:1 to receive either usual care plus daily professional acupressure and caregiver delivered acupressure versus usual care alone for symptom management. Participants receive up to 20 professional treatments. MAIN OUTCOME A composite nausea/vomiting measure for the child. SECONDARY OUTCOMES Child's nausea, vomiting, pain, fatigue, depression, anxiety, and positive affect. PARENT OUTCOMES Depression, anxiety, posttraumatic stress symptoms, caregiver self-efficacy, and positive affect. Feasibility of delivering the semistandardized intervention will be described. Linear mixed models will be used to compare outcomes between arms in children and parents, allowing for variability in diagnosis, treatment, and age. DISCUSSION Trial results could help childhood cancer and HSCT treatment centers decide about the regular inclusion of trained acupressure providers to support symptom management.
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Affiliation(s)
- E Anne Lown
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Anu Banerjee
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Wendy Hartogensis
- Osher Center for Integrative Medicine, University of California, San Francisco, California
| | - Alexis Melton
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Christina Mangurian
- Department of Psychiatry, School of Medicine, University of California, San Francisco, California
| | - Hiroe Hu
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Deborah Shear
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Robyn Adcock
- Compass Care/Integrative Pediatric Pain and Palliative Care (IP3), UCSF Benioff Children’s Hospital, San Francisco, California
| | - Michael Morgan
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Carla Golden
- Department of Pediatric Hematology-Oncology, UCSF Benioff Children’s Hospital, Oakland, California
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California, San Francisco, California
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Cadamuro SDA, Franco JO, Paiva CE, de Oliveira CZ, Paiva BSR. Symptom screening in paediatrics tool for screening multiple symptoms in Brazilian patients with cancer: a cross-sectional validation study. BMJ Open 2019; 9:e028149. [PMID: 31377698 PMCID: PMC6687019 DOI: 10.1136/bmjopen-2018-028149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The objective of this study was to translate, culturally adapt and validate the Symptom Screening in Paediatrics Tool (SSPedi) into the Brazilian Portuguese language to be used by paediatric oncology patients in Brazil. DESIGN A descriptive, cross-sectional study that follows an established methodology for translation and cultural adaptation, developed in two phases: phase I, linguistic translation and cultural adaptation of the SSPedi scale and phase II, psychometric properties evaluation. SETTING Children's Hospital for Cancer Treatment in Latin America. PARTICIPANTS Paediatric patients between 7 and 18 years of age and proxies of patients between 2 and 6 years of age, diagnosed with cancer and undergoing chemotherapy treatment. Patients and proxies with significant neuropsychiatric disorders and/or visual impairment that prevented the ability to read were excluded. PRIMARY OUTCOME MEASURES Construct validation of SSPedi using convergent validity and contrasted groups. Reliability was evaluated using Cronbach's alpha test and assessing the retest using the intraclass correlation coefficient (ICC). RESULTS The psychometric properties of the symptom screening tool were evaluated using 157 participants, of which 116 were patients and 41 were proxies. Convergent validity and hypothesised correlations (Spearman's r>0.4) were confirmed for both self- and proxy-reported versions of the assessment tool. No significant differences found between the two contrasting groups. Assessment of SSPedi resulted in an internal consistency of reliability of α=0.77 (95% CI 0.70 to 0.82) for the self and α=0.81 (95% CI 0.71 to 0.88) for the proxy and overall reproducibility ICC values of (95% CI), 0.54 (0.15 to 0.77) and 0.77 (0.64 to 0.86). CONCLUSION SSPedi was found to be culturally and linguistically adaptable and considered valid and reliable for use by paediatric oncology patients in Brazil. The new translated and adapted version was named SSPedi-BR.
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Affiliation(s)
- Sandra de Andrade Cadamuro
- Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Julia Onishi Franco
- Dr. Paulo Prata School of Health Sciences of Barretos and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Carlos Eduardo Paiva
- Department of Clinical Oncology and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Cleyton Zanardo de Oliveira
- Education and Research BP - A, Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, BARRETOS, Brazil
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Changes in taste among pediatric patients with cancer and hematopoietic stem cell transplantation recipients. Qual Life Res 2019; 28:2941-2949. [PMID: 31273626 DOI: 10.1007/s11136-019-02242-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Changes in taste is a common bothersome symptom in children receiving cancer treatments. However, little is known about how pediatric cancer patients experience this symptom. The objective was to describe how children receiving cancer treatments experience taste alterations and the approaches they use to address the issue. METHODS In this qualitative study, we included English-speaking children 4-18 years of age with cancer or hematopoietic stem cell transplantation recipients who were actively receiving cancer treatment or who had completed therapy. Using a semi-structured questionnaire, we asked questions about the experience of altered taste sensation. We asked about its characteristics, impacts and identified coping strategies. RESULTS We included 50 children. Children experienced changes in taste in a heterogeneous fashion although commonly described food as tasting "different", "not right" or "funny". While change in food preferences due to taste alterations was common, specific choices varied. Many found changes started with treatment initiation or mid-way through treatment, and some found that symptoms persisted up to 9 months following treatment completion. Actions taken to address taste changes were sucking on candy, brushing teeth and modifying food choices. CONCLUSIONS The experience of changes in taste was common yet highly variable in its presentation and resultant changes in food preferences. Taste changes did not always resolve soon after treatment completion. Future research should identify ways to manage this symptom in pediatric cancer patients.
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Vettese E, Cook S, Soman D, Kuczynski S, Spiegler B, Davis H, Duong N, Schechter T, Dupuis LL, Sung L. Longitudinal evaluation of Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK), a symptom screening and management application. BMC Cancer 2019; 19:458. [PMID: 31096957 PMCID: PMC6521508 DOI: 10.1186/s12885-019-5662-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/30/2019] [Indexed: 12/15/2022] Open
Abstract
Background Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK) is a web application focused on improving symptom control. It enables pediatric cancer and hematopoietic stem cell transplant (HSCT) patients to self-report and track symptoms, and allows healthcare professionals to access guidelines for symptom management. Objective was to determine the feasibility of longitudinal collection of symptom data. Methods In this longitudinal, single-armed feasibility study, respondents were children 8–18 years of age with cancer or pediatric HSCT recipients. Participants completed symptom reporting daily for 5 days. Cognitive interviews were conducted on day 5. Quantitative evaluation included SPARK ease of use and understandability of SPARK reports. Qualitative feedback on facilitators and barriers to daily symptom screening was solicited. Feasibility was defined as ≥75% of participants completing symptom screening on at least 60% of on-study days during the five-day study. Results Among the 30 children enrolled, the median number of days SSPedi was completed at least once was 5 (range 3 to 5). Overall, 28/29 (96.6%) thought completing symptom screening using SPARK was easy or very easy. All participants understood SPARK symptom reports. Severe symptoms was the most common barrier to daily reporting while an alarm reminder system was the most commonly identified facilitator. Conclusions Daily completion of symptom screening using SPARK over 5 days was feasible in children aged 8 to 18 years with cancer and pediatric HSCT recipients. SPARK is now appropriate for use in randomized trials to evaluate the effect of symptom screening and symptom feedback.
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Affiliation(s)
- Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Sadie Cook
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Dilip Soman
- Rotman School of Management, University of Toronto, 105 St. George Street, Toronto, ON, M5S 3E6, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, ON, M2K 1S9, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Hailey Davis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Nathan Duong
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - L Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Dupuis LL, Tamura RN, Kelly KM, Krischer JP, Langevin AM, Chen L, Kolb EA, Ullrich NJ, Sahler OJZ, Hendershot E, Stratton A, Sung L, McLean TW. Risk factors for chemotherapy-induced nausea in pediatric patients receiving highly emetogenic chemotherapy. Pediatr Blood Cancer 2019; 66:e27584. [PMID: 30561134 DOI: 10.1002/pbc.27584] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/12/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Little is known regarding risk factors for chemotherapy-induced nausea (CIN) in pediatric patients. PROCEDURE A secondary analysis was conducted of a previously published multicenter, prospective, randomized, single-blind, sham-controlled trial assessing the efficacy of acupressure in preventing CIN in pediatric patients receiving highly emetogenic chemotherapy. The primary outcome was nausea severity, self-reported using the Pediatric Nausea Assessment Tool. The relationships between acute and delayed nausea severity and patient- (sex, race, age, and cancer diagnosis) and treatment-related (chemotherapy, antiemetic prophylaxis, CIN, and vomiting control) factors were analyzed by a proportional odds generalized estimating equation approach. The acute phase started with administration of the first and continued for 24 hours after the last chemotherapy dose. The delayed phase started at the end of the acute phase and continued until the next chemotherapy block (maximum seven days). RESULTS In the acute and delayed phases, 165 and 144 patients provided data for analysis, respectively. Nonwhite race was significantly associated with higher acute phase nausea severity (OR, 1.7; 95% CI, 1.1-2.6). Poor CIN control in the acute phase (OR, 16; 95% CI, 4.0-64.6), diagnosis of a cancer other than a central nervous system (CNS) tumor (OR, 2.5; 95% CI, 1.2-5.3), and cisplatin administration (OR, 3.7; 95% CI, 2.1-6.0) were significantly associated with higher delayed phase nausea severity. CONCLUSION Acute phase CIN was associated with nonwhite race. Delayed phase CIN was associated with poor acute phase CIN control, diagnosis of non-CNS cancer, and receipt of cisplatin. These findings will inform future antiemetic trial design.
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Affiliation(s)
- L Lee Dupuis
- Department of Pharmacy and Research Institute, The Hospital of Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Roy N Tamura
- Health Informatics Institute, University of South Florida, Tampa, Florida
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Cancer Institute and Division of Pediatric Hematology/Oncology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Jeffrey P Krischer
- Health Informatics Institute and College of Medicine, University of South Florida, Tampa, Florida
| | - Anne-Marie Langevin
- Division of Pediatric Hematology/Oncology, University of Texas Health Science Centre at San Antonio, San Antonio, Texas
| | - Lu Chen
- Department of Information Sciences, City of Hope, Duarte, California
| | - E Anders Kolb
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Nicole J Ullrich
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - Olle Jane Z Sahler
- Pediatric Hematology/Oncology, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York
| | - Eleanor Hendershot
- Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Ann Stratton
- Department of Cancer and Blood Disorders, Akron Children's Hospital, Akron, Ohio
| | - Lillian Sung
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital of Sick Children and Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Thomas W McLean
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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