By Lynda Williams, medwireNews Reporter
medwireNews: Research shows that young people with a recent diagnosis of cancer benefit from completing an online symptom screening survey three times a week to help direct care.
As reported in JAMA, Symptom Screening in Pediatrics Tool (SSPedi) scores at 8 weeks were significantly lower for children who used the Supportive Care Prioritization, Assessment and Recommendations for Kids (SPARKS) web application to inform their healthcare providers about their symptoms than for those who received usual care.
The cluster randomised trial included patients aged 8 to 18 years who were beginning chemotherapy, radiotherapy or surgery within 28 days of a new diagnosis of cancer or initiation of treatment. They were treated at one of 20 paediatric centres in the USA between July 2021 and August 2023.
The participants were aged a median 14.8 years, 58.9% were boys and the most common diagnosis was leukaemia, while the most common treatment modality was chemotherapy, say Lillian Sung (The Hospital for Sick Children, Toronto, Ontario, Canada) and co-authors.
In all, 221 patients were randomly assigned to receive reminders to complete SPARKS three times a week via a smartphone, tablet or computer. Reports of one or more “severely bothersome” symptoms, defined as 3 or 4 points on a scale of 0 to 4 points, were forwarded to the local health team who were able to access locally adapted symptom management care pathways put in place before the trial.
Compared with 224 patients assigned to receive usual care, participants completing SPARKS had a significantly lower SSPedi score after 8 weeks, at a median of 7.9 versus 11.4 points, with an adjusted mean difference of –3.8 points when considering baseline scores.
Use of SPARKS was also associated with fewer bothersome symptoms, including a significant decrease in 12 of the 15 individual symptoms, such as “feeling cranky or angry”, “feeling tired”, gastrointestinal symptoms such as diarrhoea, and headache. But there were no significant differences between the treatment arms with regard to Patient-Reported Outcomes Measurement Information System fatigue scores.
The researchers also studied the relationship between symptoms and interventions. Receipt of symptom-specific interventions was more common in the SPARKS group than controls for pain (18.2 vs 4.0%), peripheral neuropathy (3.6 vs 0.0%), changes in hunger (4.5 vs 0.0%) and constipation (6.8 vs 2.2%).
The findings were similar for patients in the SPARKS and control groups who had any symptoms, with symptom-specific treatment more commonly given to the former for pain (34.2 vs 5.3%), peripheral neuropathy (10.5 vs 0%) and changes in hunger (5.4 vs 0.0%).
And among participants with severely bothersome symptoms, symptom-specific interventions were more commonly given to the SPARKS group than the control group for feeling sad (80.0 vs 18.2%) and nausea or vomiting (36.8 vs 7.4%).
Of note, unplanned healthcare encounters were, on average, more frequent in the patients who were screening than controls, with 0.77 versus 0.45 emergency department visits, respectively, and a significant rate ratio of 1.72. There were comparable rates of unplanned clinic visits and hospitalisations.
Sung et al write that they had “hypothesized that symptom screening would reduce unplanned encounters” but note that the “contrasting finding suggests that symptoms that require medical attention are being identified more frequently, likely by parents, with symptom screening.”
The authors continue: “Although this result was unexpected, it does not influence the interpretation of the study outcomes and results”, adding that “[f]uture work should focus on better outpatient supports to reduce emergency department visits.”
News stories are provided by medwireNews, which is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group
JAMA 2024; doi:10.1001/jama.2024.19585