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Identifying clinical practice guidelines for symptom control in pediatric oncology

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Supportive Care in Cancer Aims and scope Submit manuscript

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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Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

Abbreviations

ASCO:

American Society of Clinical Oncology

COG:

Children’s Oncology Group

CPG:

Clinical Practice Guidelines

ECRI:

Emergency Care Research Institute

NICE:

National Institute for Health and Care Excellence

SSPedi:

Symptom Screening in Pediatrics Tool

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Acknowledgements

We would like to thank Elizabeth Uleryk for her assistance in conducting the literature searches and Sandra Cabral for her research assistance. LS is supported by a Canada Research Chair in Pediatric Oncology Supportive Care.

Funding

This study was supported by the Pediatric Oncology Group of Ontario.

Author information

Authors and Affiliations

  1. Pediatric Oncology Group of Ontario, 1014 - 480 University Avenue, Toronto, ON, M5G 1V2, Canada

    Paula D. Robinson & Paul Gibson

  2. Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Deborah Tomlinson, Grace Dadzie, Maryam Safi, Emily Vettese, L. Lee Dupuis & Lillian Sung

  3. Pediatric Oncology, Columbia University/Herbert Irving Cancer Center, 161 Fort Washington Ave, New York, NY, 10032, USA

    Melissa Beauchemin

  4. Division of Haematology/Oncology, McMaster Children’s Hospital, Hamilton Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Paul Gibson

  5. Division of Pediatric Hematology Oncology, University of Texas Health Science Center At San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Allison Grimes

  6. Department of Pharmacy, The Hospital for Sick Children, and Leslie Dan Faculty of Pharmacy, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    L. Lee Dupuis

  7. Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Lillian Sung

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  1. Paula D. Robinson
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Contributions

PDR, DT, LLD and LS conceptualized the study, designed the study and wrote the manuscript; PDR, DT, GD and MS identified and screened articles for inclusion. All authors critically revised the manuscript for important content. All authors approve the final version of the manuscript.

Corresponding author

Correspondence to Lillian Sung.

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The authors declare no competing interests.

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Contributions to the Literature

• While improvements in patient outcomes have been associated with implementation of evidence-based guideline-consistent care across several domains, identification of clinical practice guidelines can be challenging.

• We developed a standardized process to identify clinical practice guidelines for pediatric cancer symptom management and were able to identify clinical practice guidelines that addressed 14 of 15 symptoms.

• This process should facilitate use of clinical practice guidelines for pediatric cancer symptom management thereby improving outcomes by increasing the delivery of evidence-based care. This process is likely generalizable to other populations and settings.

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Robinson, P.D., Tomlinson, D., Beauchemin, M. et al. Identifying clinical practice guidelines for symptom control in pediatric oncology. Support Care Cancer 29, 7049–7055 (2021). https://doi.org/10.1007/s00520-021-06303-9

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