Electronic Symptom Screening in Kids With Cancer Boosts Quality of Care

Symptom screening improved symptom scores among children with cancer compared with usual care, two randomized trials showed.

Among 445 patients in one trial, the mean 8-week Symptom Screening in Pediatrics Tool (SSPedi) score (range 0-60, with higher scores indicating more bothersome symptoms) was 7.9 in patients who underwent symptom screening three times a week compared with 11.4 in the usual care group, with a significant difference in the adjusted mean score in favor of the intervention group (P=0.007), reported Lillian Sung, MD, PhD, of the Hospital for Sick Children in Toronto, and colleagues.

Symptom screening was associated with less bothersome individual symptoms, with statistically significant reductions in 12 of 15 symptoms; the largest differences were for pain, neuropathy, vomiting, and cognitive function, they wrote in JAMA.

In a second study among 345 children receiving ambulatory or inpatient cancer treatment, the SSPedi score at day 5 was 10.2 for patients who underwent symptom screening compared with 12.7 for the usual care group, with a significant difference in the adjusted mean score in favor of the intervention group (PJAMA Pediatrics.

Symptom screening reduced the odds of higher individual symptom scores, and eight of 15 symptom reductions were statistically significant, they said. Overall, five symptoms (pain, changes in hunger, peripheral neuropathy, constipation, and anger) were documented or treated significantly more often with symptom screening.

“Symptom screening with symptom feedback and symptom management care pathways improved SSPedi scores and increased symptom-specific interventions among pediatric patients with cancer,” wrote Sung and colleagues. “These findings provide strong support for integrating symptom screening and care pathways into routine clinical care.”

In an editorial accompanying the studies, Ethan Basch, MD, MSc, of the University of North Carolina at Chapel Hill, and colleagues noted that “taken together, these 2 trials provide compelling evidence that ePRO [electronic-based patient-reported outcome] symptom monitoring confers benefits on symptom management for children receiving cancer treatment.”

“These trials … are practice changing and provide the first level 1 evidence in children of the benefits of remote symptom monitoring with electronic patient-reported outcomes on clinical outcomes,” they wrote. “Now that this evidence exists, adding to the literature of benefits among adults with cancer, the next steps will be development of implementation guides and widely available software to help practices adopt this approach.”

Of note, both studies found no significant differences in quality of life between groups. Basch and colleagues said this finding is not surprising since “this is a broad outcome that frequently does not change in ePRO trials.”

The first study was a cluster randomized trial that enrolled newly diagnosed participants ages 8 to 18 years who were receiving any cancer treatment for leukemia, solid tumors, lymphoma, and brain tumors from July 2021 to August 2023 across 20 pediatric cancer centers in the U.S.

The researchers included 221 patients who underwent symptom screening and 224 receiving usual care. Median age was 14.8 years, and 59% were boys. Twenty percent of kids in the screening group had metastatic disease compared with 35.7% in the usual care group.

The intervention included symptom screening prompts to participants, email alerts to the healthcare team, and locally adapted symptom management care pathway implementation.

Looking at secondary outcomes, the mean number of emergency department visits was 0.77 in the symptom screening group and 0.45 in the usual care group (rate ratio 1.72, 95% CI 1.03-2.87). There was no difference in fatigue scores between groups.

The second study enrolled participants ages 8 to 18 years from July 2018 to September 2023 from eight Canadian tertiary care centers that treat children with cancer. Participants were expected to be in a hospital or clinic daily for at least 5 consecutive days. Included cancer types were leukemia, solid tumors, lymphoma, and brain tumors.

The researchers included 176 patients who completed the SSPedi once daily for 5 days and 169 patients who received usual care. Median age was 13.8, and 43.5% were girls; 27.3% had metastatic disease in the screening group compared with 31.4% in the usual care group.

The intervention also included printed symptom reports provided daily to the healthcare team, as well as email alerts that were distributed for severely bothersome symptoms.

The authors acknowledged that “more work is required to better understand the clinical relevance of SSPedi score differences.”

Basch and colleagues agreed this represented a “minor concern” regarding the design of the studies.

“It is not known what mean score differences in the SSPedi are clinically meaningful,” the editorialists observed. “Future research could evaluate what SSPedi score thresholds are clinically meaningful using appropriate anchors including patient input.”