Paula D Robinson1, Deborah Tomlinson2, Melissa Beauchemin3, Paul Gibson1,4, Allison Grimes5, Grace Dadzie2, Maryam Safi2, Emily Vettese2, L Lee Dupuis2,6, Lillian Sung7,8. 1. Pediatric Oncology Group of Ontario, 1014 - 480 University Avenue, Toronto, ON, M5G 1V2, Canada. 2. Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. 3. Pediatric Oncology, Columbia University/Herbert Irving Cancer Center, 161 Fort Washington Ave, New York, NY, 10032, USA. 4. Division of Haematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. 5. Division of Pediatric Hematology Oncology, University of Texas Health Science Center At San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA. 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. 7. Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. lillian.sung@sickkids.ca. 8. Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. lillian.sung@sickkids.ca.
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.
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.
Authors: Jeremy Grimshaw; Martin Eccles; Ruth Thomas; Graeme MacLennan; Craig Ramsay; Cynthia Fraser; Luke Vale Journal: J Gen Intern Med Date: 2006-02 Impact factor: 5.128