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Childhood cancer AEs may be under-reported by clinicians

By Lynda Williams, medwireNews Reporter

Children undergoing treatment for cancer report significantly more symptomatic adverse events (AEs) than their clinicians but fewer than their caregivers, suggests research comparing assessments for triads of patients, caregivers and clinicians.

“[O]ur findings strongly support inclusion of child self-report whenever possible for the most comprehensive assessment of symptomatic AEs”, recommend David Freyer (Children’s Hospital Los Angeles, California, USA) and co-authors in the Journal of Clinical Oncology.

The team followed up 438 patients aged 7–18 years (mean 13 years) before and after they began treatment for a first malignancy. Over half (54%) were male, White (67%) and had a diagnosis of leukaemia or lymphoma (56%), with 92% of the patients undergoing chemotherapy.

The children’s clinicians were asked to assess 15 core symptomatic AEs using the Common Terminology Criteria for Adverse Events (CTCAE 4.0), and these outcomes were compared directly with the patient-reported outcome forms completed by the children (Ped-PRO-CTCAE) and their caregivers (Ped-PRO-CTCAE [Caregiver]).

At the first assessment, 72 hours before beginning treatment, clinicians gave significantly better average scores for all the assessed AEs than their matched children and this continued to be true after treatment, except for constipation, nausea, anorexia, neuropathy and anxiety, the investigators report.

And 1–4 weeks after beginning treatment, approximately 25–30% of patients gave higher AE grades than their clinicians. Of concern, 64% of children reported fatigue when their clinician reported there was no symptom, as did 43% for abdominal pain, 42% for insomnia, 41% for pain or nausea, 35% for anorexia, 32% for oral mucositis, and over 20% of patients for other symptoms including vomiting, constipation, diarrhoea, headache, neuropathy and depression.

Overall, caregivers had similar AE grade assessments as their children before treatment but caregivers gave significantly more severe AE grades after treatment for nausea, vomiting, anorexia, pain, fatigue, anxiety and depression.

Weighted analysis confirmed that the AE assessments by clinicians and children had poor-to-fair agreement both before and after treatment (k range 0.08–0.34 and 0.11–0.35 respectively), whereas caregivers and children had fair-to-good agreement on AEs at both timepoints (k range 0.34–0.65 and 0.24–0.60, respectively).

Freyer and co-authors found “no consistent patterns across AEs” that predicted concordance of AE grading between children and their clinicians or caregivers among factors such as age, type of cancer, time since diagnosis or caregiver education.

“Routine use of Ped-PRO-CTCAE measures for children treated on cancer clinical trials would result in more accurate and complete assessment of treatment-related toxicity than clinician-based reporting alone”, the investigators believe.

“Such information would enrich treatment comparisons, evaluation of new agents, drug labeling for children, and patient/family education.”

 

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J Clin Oncol; 2022; doi:10.1200.JCO.21.02669

https://pubmed.ncbi.nlm.nih.gov/35294262/