ImportancePediatric patients with cancer commonly experience severely bothersome symptoms. The effectiveness of routine symptom screening with symptom feedback and symptom management care pathways is unknown.ObjectiveTo determine whether thrice-weekly symptom screening with symptom feedback and management care pathways, compared with usual care, improves overall self-reported symptom scores measured by the Symptom Screening in Pediatrics Tool (SSPedi) in pediatric patients with cancer.Design, Setting, and ParticipantsThis cluster randomized trial enrolled participants between July 2021 and August 2023 from 20 pediatric cancer centers in the US. Patients newly diagnosed with cancer aged 8 to 18 years receiving any cancer treatment were included. Twenty sites were randomized to provide symptom screening (n = 10) vs usual care (n = 10); 221 participants were enrolled at intervention sites and 224 participants at control sites. The date of final follow-up was October 18, 2023.InterventionSymptom screening included providing thrice-weekly symptom screening prompts to participants, email alerts to the health care team, and locally adapted symptom management care pathway implementation.Main Outcomes and MeasuresThe primary outcome was self-reported total SSPedi score at week 8 (range, 0-60; higher scores indicate more bothersome). Secondary outcomes were Patient-Reported Outcomes Measurement Information System Fatigue score (mean [SD] score, 50 [10]; higher scores indicate more fatigue), Pediatric Quality of Life 3.0 Acute Cancer Module scores (range, 0-100; higher scores indicate better health), symptom documentation and interventions at week 8, and unplanned health care encounters.ResultsA total of 445 participants (median [range] age, 14.8 [8.1-18.9] years; 58.9% males) were enrolled. The mean (SD) 8-week SSPedi score was 7.9 (7.2) in the symptom screening group vs 11.4 (8.7) in the usual care group. Symptom screening was associated with significantly better 8-week total SSPedi scores (adjusted mean difference, −3.8 [95% CI, −6.4 to −1.2]) and less bothersome individual symptoms, with 12 of 15 symptoms being statistically significantly reduced. There was no difference in fatigue or quality of life. The mean (SD) number of emergency department visits was 0.77 (1.12) in the symptom screening group and 0.45 (0.81) in the usual care group. There were significantly more emergency department visits in the symptom screening group (rate ratio, 1.72 [95% CI, 1.03-2.87]).ConclusionsSymptom screening with symptom feedback and symptom management care pathways was associated with improved symptom scores and increased symptom-specific interventions. Future work should integrate symptom screening into routine clinical care.Trial RegistrationClinicalTrials.gov Identifier: NCT04614662

中文翻译：

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与儿科癌症患者护理路径相关的症状筛查


重要性患有癌症的儿科患者通常会出现严重令人烦恼的症状。使用症状反馈和症状管理护理途径进行常规症状筛查的有效性尚不清楚。目的确定与常规护理相比，每周三次的症状筛查、症状反馈和管理护理途径是否能改善儿科癌症患者症状筛查工具 （SSPedi） 测量的总体自我报告症状评分。设计、设置和参与者该整群随机试验于 2021 年 7 月至 2023 年 8 月期间招募了来自美国 20 个儿科癌症中心的参与者。包括新诊断为癌症的 8 至 18 岁接受任何癌症治疗的患者。20 个地点被随机分配提供症状筛查 （n = 10） 与常规护理 （n = 10）;干预地点招募了 221 名参与者，对照地点招募了 224 名参与者。干预症状筛查包括向参与者提供每周三次的症状筛查提示、向医疗保健团队发送电子邮件警报以及实施因地适应的症状管理护理路径。主要结局和措施主要结局是第 8 周时自我报告的 SSPedi 总分 （范围，0-60;分数越高表示越麻烦）。次要结局是患者报告结局测量信息系统疲劳评分 （平均 [SD] 评分，50 [10];分数越高表示越疲劳）、儿科生活质量 3.0 急性癌症模块评分 （范围，0-100;分数越高表示健康状况越好）、第 8 周的症状记录和干预措施，以及计划外的医疗保健就诊。结果共有 445 名参与者 （中位 [范围] 年龄，14.8 [8.1-18.9] 岁;58.9% 为男性）。症状筛查组的平均 （SD） 8 周 SSPedi 评分为 7.9 （7.2），而常规护理组为 11.4 （8.7）。症状筛查与显着更好的 8 周 SSPedi 总分 （调整后的平均差，-3.8 [95% CI，-6.4 至 -1.2]）和较少令人烦恼的个体症状相关，15 种症状中有 12 种在统计学上显着减轻。疲劳或生活质量没有差异。症状筛查组急诊科就诊的平均 （SD） 次数为 0.77 （1.12），常规护理组为 0.45 （0.81）。症状筛查组的急诊就诊次数显著增加 （比率比，1.72 [95% CI，1.03-2.87]）。结论使用症状反馈和症状管理护理途径进行症状筛查与症状评分改善和症状特异性干预增加相关。未来的工作应将症状筛查纳入常规临床护理。试验注册临床试验。gov 标识符： NCT04614662