ImportancePediatric patients with cancer experience severely bothersome symptoms during treatment. It was hypothesized that symptom screening and provision of symptom reports to the health care team would reduce symptom burden in pediatric patients with cancer.ObjectiveTo determine if daily symptom screening and provision of symptom reports to the health care team was associated with lower total symptom burden as measured by the Symptom Screening in Pediatrics Tool (SSPedi) compared to usual care among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days.Design, Setting, and ParticipantsThis randomized clinical trial enrolled participants from July 2018 to September 2023 from 8 Canadian tertiary care centers that diagnose and treat pediatric patients with cancer. Patients aged 8 to 18 years with cancer expected to be in a hospital or clinic daily for at least 5 consecutive days were eligible for inclusion. Participants were randomized to intervention (n = 176) vs control (n = 169) groups. Data were analyzed from November 2023 to December 2023.InterventionIntervention participants completed the SSPedi once daily for 5 days. Printed symptom reports were provided daily to the health care team, and email alerts were distributed for severely bothersome symptoms. Control participants received usual care.Main Outcomes and MeasuresThe primary outcome was self-reported total SSPedi score on day 5. Secondary outcomes were individual SSPedi symptoms, pain, quality of life, symptom documentation, and intervention provision. The primary analysis compared the day 5 total SSPedi scores between randomized groups using a multiple linear regression model. For the secondary analysis comparing individual SSPedi symptom scores, the odds ratio for the intervention was estimated using a proportional odds model. Pain and quality of life were analyzed using the same approach as the primary outcome. Fisher exact test was used to compare symptom documentation, any intervention, and symptom-specific intervention between groups.ResultsA total of 345 participants were enrolled; median (range) participant age was 13.8 (8.0-18.8) years, and 150 participants (43.5%) were female. Day 5 SSPedi score was significantly better with symptom screening compared to usual care (adjusted mean difference, −2.5; 95% CI, −3.8 to −1.2). Symptom screening reduced the odds of higher individual symptom scores; 8 of 15 symptom reductions were statistically significant. There were no significant differences in pain or quality of life scores between groups. Five symptoms were documented or treated significantly more often with symptom screening than usual care.Conclusions and RelevanceIn this randomized clinical trial, among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days, symptom screening with SSPedi improved total symptom scores compared to usual care.Trial RegistrationClinicalTrials.gov Identifier: NCT03593525

中文翻译：

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癌症住院儿科患者的症状筛查


重要性癌症儿科患者在治疗期间会出现严重令人烦恼的症状。据推测，症状筛查和向医疗保健团队提供症状报告会减轻癌症儿科患者的症状负担。目的确定每日症状筛查和向医疗保健团队提供症状报告是否与儿科症状筛查工具 （SSPedi） 衡量的儿科儿科患者总症状负担降低相关，与住院或每天在诊所就诊至少 5 天的癌症患者相比，每天。设计、设置和参与者这项随机临床试验于 2018 年 7 月至 2023 年 9 月招募了来自 8 个加拿大诊断和治疗儿科癌症患者的三级护理中心的参与者。预计每天至少连续 5 天在医院或诊所就诊的 8 至 18 岁癌症患者符合纳入条件。参与者被随机分配到干预组 （n = 176） 和对照组 （n = 169）。数据分析了 2023 年 11 月至 2023 年 12 月。干预干预参与者每天完成一次 SSPedi，持续 5 天。每天向医疗保健团队提供打印的症状报告，并针对严重令人烦恼的症状发送电子邮件警报。对照组受试者接受了常规护理。主要结局和测量主要结局是第 5 天自我报告的 SSPedi 总分。次要结局是个体 SSPedi 症状、疼痛、生活质量、症状记录和干预提供。主要分析使用多元线性回归模型比较随机组之间第 5 天的 SSPedi 总分。 对于比较个体 SSPedi 症状评分的二次分析，使用比例比值模型估计干预的比值比。使用与主要结局相同的方法分析疼痛和生活质量。采用 Fisher 精确检验比较组间症状记录、任何干预和症状特异性干预。结果共纳入 345 名参与者;参与者的中位（范围）年龄为 13.8 （8.0-18.8） 岁，其中 150 名参与者 （43.5%） 为女性。与常规护理相比，症状筛查组第 5 天的 SSPedi 评分显著更好（调整后的平均差，-2.5;95% CI，-3.8 至 -1.2）。症状筛查降低了个体症状评分较高的几率;15 例症状减轻中有 8 例具有统计学意义。两组之间的疼痛或生活质量评分无显著差异。与常规护理相比，症状筛查记录或治疗 5 种症状的频率显著更高。结论和相关性在这项随机临床试验中，在住院或每天在诊所就诊至少 5 天的癌症儿科患者中，与常规护理相比，使用 SSPedi 进行症状筛查提高了总症状评分。试验注册临床试验。gov 标识符： NCT03593525