Patient-reported outcome measures useful in the clinical treatment of pediatric cancer patients
Electronic self-measurement of symptoms provided early detection of toxic effects and helped anticipate necessary medical interventions for pediatric cancer patients.
According to a study published in JAMA network open.
PROMs have been found to reflect everyday symptoms in pediatric cancer patients and aid in clinical management and intervention for adverse events (AEs). Although PROMs are becoming an essential component of adult oncology care, they have not previously been implemented for pediatric oncology care.
Researchers conducted a single-cohort study to identify pediatric cancer patients who are at risk for serious AEs from treatment and provide individualized supportive care using PROMs.
The researchers conducted the study from May 1, 2020 to November 15, 2021 at the Medical University of Innsbruck in Austria. The cohort included pediatric patients with a diagnosis of cancer or their proxies. PROMs were implemented in the daily clinical routine and patients were followed up to end of treatment or throughout treatment until November 15, 2021.
Participant inclusion criteria included chemotherapy treatment and at least 30 days of active participation in ePROtect, the online approach for daily child self-reporting and parent-based proxy reporting used in the study.
Researchers analyzed the occurrence and severity of complications from cancer treatment, such as nausea, loss of appetite, pain, sleep disturbances and deterioration in physical functioning. They also identified early and appropriate clinical interventions based on the detection of cancer-related symptoms via PROMs.
The cohort included 40 children, including 35 children aged 5-18 years and 5 proxies for children aged 1-4 years (median age, 9.1 [IQR, 6.3-12.2] years; 26 [65.0%] Male). A total of 4410 daily PROMs and 7082 therapy days were analyzed for these children during a median follow-up of 145.5 days. All study participants were white.
The researchers noted that most patients in this study could complete questionnaires almost every day, regardless of age, diagnosis, and treatment; however, patient completion rates differed between modalities.
The overall median completion rate was 60.1% (IQR, 37.9%-81.0%). The completion rate was 57.5% during the stay at home, slightly lower than that of the stay in hospital (65.6%).
Patients were found to complete follow-up for more than 50% of days, even during unplanned hospital stays. The researchers recommend further in-depth analysis of completion rates and are currently preparing for this.
Severe symptoms were reported over 657 days (15.9%), with most symptoms related to physical functioning, followed by pain, trouble sleeping, nausea, and loss of appetite.
A total of 321 AEs and cases of health deterioration were reported. PROMs were completed for 251 (78.2%) of these events. Since most of the days (56.4%) are spent by the patient at home, researchers investigated whether ePROtect reports allow early detection of health deterioration before clinical manifestation.
Mean scores for the domains of pain, nausea, physical activity and sleep disturbance were found to be 15-20 points lower in unplanned hospitalization compared to planned hospitalization 1 day before the admission. The researchers found that self-reported pain was the most useful marker for all AEs, especially when analyzed the day before its onset.
Collectively, these results suggest that electronic self-measurement of symptoms with ePROtect is very welcome for inpatient and outpatient use, according to the authors. They suggest that electronic self-measurement of symptoms can provide early detection of toxic effects and can anticipate admissions or necessary medical interventions.
Electronic symptom measurement also facilitates symptom communication and awareness for healthcare professionals, which can result in more effective patient treatment.
“In the context of increasing demands for patient self-advocacy and self-management, self-reporting of symptoms allows patients to participate more actively in their therapy and can help improve their quality of life,” they wrote. concluded the authors.
The study had some limitations, including the single center design with a small sample size. Additionally, randomization or design of cross-sectional studies with and without access to ePROtect was not currently possible, according to the authors.
However, they state that their results still contribute to the lack of knowledge about the possibility of pediatric self-reporting and its integration into clinical routine, highlighting the high rates of adherence and participation among patients with various cancers observed in this study. cohort.
Meryk A, Kropshofer G, Hetzer B. Use of daily patient-reported outcome measures in pediatric cancer care. JAMA Netw Open. 2022;5(7):e2223701. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794638. Published July 26, 2022. Accessed July 27, 2022.