Factors Associated With Symptom Burden Among Pediatric Patients With Cancer

Adam P. Yan, The Hospital for Sick Children, Toronto, ON, Canada
L. Lee Dupuis, The Hospital for Sick Children, Toronto, ON, Canada
Catherine Aftandilian, Stanford University School of Medicine, Palo Alto, CA
Vibhuti Agarwal, Nemours Children's Hospital, Orlando, FL
Christina Baggott, Stanford University School of Medicine, Palo Alto, CA
Melissa P. Beauchemin, Columbia University, New York, NY
Scott M. Bradfield, Nemours Children's Hospital, Orlando, FL
Daniel Cannone, Children's Hospital of Richmond at VCU, Richmond, VA
Emi H. Caywood, Nemours Children's Hospital, Wilmington, DE
Nicole Crellin-Parsons, The Hospital for Sick Children, Toronto, ON, Canada
Jenna Demedis, Children's Hospital Colorado, Aurora, CO
David Dickens, University of Iowa Stead Family Children's Hospital, Iowa City, IA
Adam J. Esbenshade, Vanderbilt University Medical Center, Nashville, TN
David R. Freyer, University of Southern CA, Los Angeles, CA
Allison C. Grimes, University of Texas Health Science Center at San Antonio, San Antonio, TX
Kara M. Kelly, University at Buffalo, Buffalo, NY
Allison A. King, Washington University School of Medicine in St. Louis
Lisa M. Klesges, Washington University School of Medicine in St. Louis
Wade Kyono, Kapi'olani Medical Center for Women and Children. Honolulu, HI
Ramamoorthy Nagasubramanian, Nemours Children's Hospital, Orlando, FL
Etan Orgel, University of Southern CA, Los Angeles, CA
Andrea D. Orsey, Connecticut Children's Medical Center, Hartford, CT
Michael E. Roth, The University of Texas MD Anderson Cancer Center, Houston, TX
Farha Sherani, Texas A and M University - Corpus Christi, TX
Emily Vettese, The Hospital for Sick Children, Toronto, ON, Canada
Alexandra Walsh, Phoenix Children's Hospital, Phoenix, AZ
Wendy Woods-Swafford, Blank Children's Hospital-UnityPoint Health, Des Moines, IA
Lolie C. Yu, LSU Health Sciences Center - New OrleansFollow
et al

Document Type

Article

Publication Date

8-14-2025

Publication Title

JCO Oncology Practice

Abstract

PURPOSE The objective was to identify factors associated with self-reported symptom burden measured using Symptom Screening in Pediatrics Tool (SSPedi) in pediatric patients with cancer.METHODS This was a secondary analysis of a cluster randomized trial enrolling pediatric patients newly diagnosed with cancer. Twenty sites were randomized to routine symptom screening versus usual care. Intervention included thrice-weekly symptom screening with SSPedi, delivery of severely bothersome scores to health care teams, and implementation of locally adapted symptom management care pathways. Primary outcome was total SSPedi scores, 0 (no bothersome symptoms) to 60 (worst bothersome symptoms), obtained at baseline, week four, and week eight in 430 patients (n = 217 intervention and n = 213 usual care). We created a mixed linear regression model evaluating design (including time point), patient/guardian, and site characteristics for their associations with symptom burden after controlling for treatment assignment.RESULTSSS Pedi scores were significantly lower at weeks 4 and 8 compared with baseline (P < .0001 overall), and at intervention versus control sites (P < .0001). In the full model, males (estimate, -3.3 [95% CI, -4.6 to -2.0]; P < .0001) and sites with higher physician staffing ratios (each physician full-time equivalent per 100 new diagnoses estimate -0.20 [95% CI, -0.5 to 0.0]; P =.024) had significantly lower total SSPedi scores.CONCLUSION Total symptom burden was reduced by time, intervention (symptom screening and care pathways), and greater physician staffing ratio. Females had higher symptom burden. These data may inform programmatic implementation of routine symptom screening in pediatric patients with cancer.

PubMed ID

40811761

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