Care Pathway- and Guideline-Consistent Care in Pediatric Cancer Symptom Management

Authors

Nicole Crellin-Parsons, The Hospital for Sick Children, Toronto, Canada
L Lee Dupuis, The Hospital for Sick Children, Toronto, Canada
Emily Vettese, The Hospital for Sick Children, Toronto, Canada
Catherine Aftandilian, Stanford University, Stanford, CA
Vibhuti Agarwal, Nemours Children's Hospital, Orlando, FL
Christina Baggott, Stanford University, Stanford, CA
Scott M. Bradfield, Nemours Children's Health, Jacksonville, FL
David R. Freyer, Children's Hospital Los Angeles, Los Angeles, CA
Kara M. Kelly, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
Allison A. King, Washington University School of Medicine, St. Louis, MO
Wade Kyono, Kapi'olani Medical Center for Women & Children, Honolulu, HI
Ramamoorthy Nagasubramanian, Nemours Children's Hospital, Orlando, FL
Etan Orgel, Children's Hospital Los Angeles, Los Angeles, CA
Michael E. Roth, The University of Texas MD Anderson Cancer Center, Houston, TX
Farha Sherani, Cancer and Blood Disorders Center and Texas A&M University, Corpus Christi, TX
Lolie Yu, LSU Health Sciences Center - New OrleansFollow
Allison C. Grimes, University of Texas Health Science Center at San Antonio, San Antonio, TX
Melissa P. Beauchemin, Columbia University School of Nursing/Herbert Irving Comprehensive Cancer Center, New York, NY
Lisa M. Klesges, Washington University School of Medicine, St. Louis, MO
George A. Tomlinson, Toronto General Hospital, Toronto, Canada
Lillian Sung, The Hospital for Sick Children, Toronto, Canada

Document Type

Article

Publication Date

4-23-2025

Publication Title

JCO: Oncology Practice

Abstract

PURPOSE: Ten pediatric cancer treatment sites previously implemented site-specific symptom management care pathways for 15 symptoms, which were based upon clinical practice guidelines (CPGs). The primary objective of this analysis was to describe the prevalence of care pathway- and CPG-consistent care for symptom management. The secondary objective was to identify factors associated with care pathway-consistent care. METHODS: Participants were patients age 8-18 years diagnosed with cancer within the previous 4 weeks. We identified any intervention to manage each of 15 symptoms during a 3-day period 8 weeks after enrollment. We determined whether the intervention appeared in that site's care pathway and whether it was recommended in the CPG. We determined whether type of symptom (observable v nonobservable) or patient characteristics were associated with care pathway-consistent care. RESULTS: Two hundred twenty participants were analyzed. The prevalence of care pathway-consistent care for each symptom ranged from 0% (problems thinking, body or face changes, and diarrhea) to 52.3% (throwing up) and was < 27% for 14 of 15 symptoms. Similarly, the prevalence of CPG-consistent care was < 50% across all symptoms. Participants received significantly more care pathway-consistent interventions for observable symptoms compared with nonobservable symptoms (difference 30% [95% CI, 3 to 54]). Factors associated with receipt of at least one care pathway-consistent intervention were age group, race, ethnicity, and cancer type. CONCLUSION: Care pathway- and CPG-consistent care were surprisingly uncommon. Care pathway-consistent interventions were more common for observable than nonobservable symptoms and were associated with patient characteristics. Future work should identify approaches to improve care pathway-consistent care delivery.

PubMed ID

40267372

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