Speaker
Lillian Sung, MD, PhD
Canada Research Chair in Pediatric Oncology Supportive Care
Division of Haematology/Oncology
Chief Clinical Data Scientist
The Hospital for Sick Children
Ontario, Canada
Keywords
Cancer; Pediatrics; Cancer Symptoms; Symptom Control
Key Points
- Symptom control in pediatric cancer patients is very poor; almost all children undergoing treatment for cancer will experience difficult symptoms, including fatigue, changes in hunger, pain, and nausea or vomiting.
- The Multinational Association for Supportive Care in Cancer issued ambitious goals for care of cancer patients in 2030, including routine symptom screening to facilitate timely individualized care and pairing symptom identification with evidence-based treatment.
- With this goal in mind, the research team developed Symptoms Screening and Pediatrics tool, or SSPedi. SSPedi is a validated instrument for measuring self-reported symptoms that is simple, quick, and designed for use in clinical care.
- They integrated SSPedi with care pathways through SPARK (Supportive care Prioritization Assessment and Recommendations for Kids), a web-based application that the team used to enroll patients and remind them to report their symptoms via SSPedi.
- The researchers conducted two randomized controlled trials (RCTs): A cluster RCT in the United States, from July 2021 to August 2023, and an inpatient RCT in Canada, from July 2018 to September 2023. In both cases, they randomized cancer patients, aged 8 to 18, to either symptom screening or usual care. In the U.S. study, they worked with the sites to adapt 14 care pathways.
- Their primary outcome was the patient’s symptom severity, measured by their SSPedi score.
- In both trials, the research team found a reduction in symptom severity for the intervention group. The benefits were more pronounced in the U.S. trial, with statistically significant improvements for 12 out of 15 symptoms (compared to 8 out of 15 in the Canadian trial).
- In the U.S. study, symptom-specific interventions (i.e., treatment was clearly provided to address a given symptom) were most common for hurt or pain; changes in hunger; constipation; peripheral neuropathy; feelings of disappointment or sadness; and nausea and vomiting. The first four symptoms were also identified as being documented or treated more often in the Canadian study, in addition to feelings of crankiness or anger.
- The research team concluded, following both the Canadian and U.S. studies, that symptom screening improves symptom control and that there was strong support for its integration into routine care.
- There were a couple of additional takeaways from the U.S. study: 1) Care pathway use has independent effects on improving symptoms and 2) symptom screening was associated with increased emergency department visits – likely due to identification of symptoms requiring medical attention.
Discussion Themes
Despite launching right before the COVID-19 pandemic and the labor-intensive process of adapting the care pathways for each individual site, the team completed accrual for the U.S.-based-study about a year ahead of schedule. Dr. Sung attributed this to enthusiastic support from the sites around operationalizing supportive care and a study design which allowed patients to be enrolled remotely and report their symptoms remotely.
Pragmatic trials are a team sport. Having a range of expertise and experience can provide a research team with an advantage that makes all the difference. For example, Dr. Sung’s team had a connection to Epic Systems leadership, which facilitated a partnership between the two groups and allowed them to pilot SSPedi in remote care management.