Daily Symptom Screening Lowers Burden in Pediatric Cancer Trial

Key Takeaways

• Day 5 total SSPedi score was lower with daily symptom screening than with usual care.
• Scores were lower across all 15 SSPedi symptoms, with 8 statistically significant differences.
• Faces Pain Scale-Revised and PedsQL 3.0 Acute Cancer Module scores were not significantly different, while documentation or treatment increased for 5 symptoms.

Participants were children and adolescents with cancer who were hospitalized or seen in clinic daily for at least 5 consecutive days. Total SSPedi scores were lower at day 5 with screening during the trial’s structured 5-day period at the enrolled centers.

The multicenter, open-label randomized clinical trial was conducted at 8 Canadian tertiary care centers from July 2018 to September 2023. Eligible patients were 8 to 18 years old, had cancer, and were expected to be in hospital or clinic daily for 5 days. Randomization assigned 176 participants to symptom screening and 169 to usual care, and baseline characteristics were generally well balanced. Median age was 13.8 years, 43.5% were female, one participant withdrew, and 3.8% were missing the primary outcome. Enrollment paused during early COVID-19 disruptions, and follow-up focused on a structured 5-day symptom-reporting period.

In the intervention group, participants completed SSPedi once each day for 5 days through the SPARK platform. Printed symptom reports were delivered daily to the bedside nurse and direct clinician, and copies were placed in the medical record. Email alerts were sent on days 1 and 3 to the most responsible physician if any symptom was rated "a lot" or "extremely" bothersome. The comparator was usual care, and the primary endpoint was the self-reported total SSPedi score on day 5.

For the primary outcome, the adjusted day 5 total SSPedi score favored screening by -2.5 points, with a 95% CI of -3.8 to -1.2 and P<.001. Scores were also lower for all 15 individual SSPedi symptoms in the screening group. Eight of those reductions reached statistical significance, spanning both physical and psychosocial items. The overall pattern favored screening across the full instrument, although significance was not uniform for every symptom.

Faces Pain Scale-Revised scores and PedsQL 3.0 Acute Cancer Module domain scores did not differ significantly between groups. Five symptoms were documented or treated significantly more often with screening: pain, changes in hunger, peripheral neuropathy, constipation, and anger. The authors noted that the observed 2.5-point difference was below the 2.7 minimal important difference used for sample size planning. They also cited guideline access rather than adapted care pathways, possible contamination, multiple secondary analyses, and no comparison of specific intervention details. Those caveats keep the findings within the 5-day randomized trial and the participating Canadian pediatric oncology centers.