A recent study revealed a variation in how symptomatic toxicity is reported Differences among children receiving cancer treatment in clinical trials. Doctors often underestimate or miss symptoms in children, and caregivers often overestimate symptoms.
Children’s Hospital of Los Angeles was one of nine hospitals participating in the study. David R. Freyer, DO, MS, director of the Survival and Supportive Care Program at the CHLA Cancer and Blood Disease Institute, is the study’s lead author. The study, recently published in the Journal of Clinical Oncology
, highlights the children’s direct self The necessity – reporting during cancer treatment.
Of the 40,000 children treated for cancer each year, more than 60% participate in clinical trials. Adverse event reports completed by physicians are relied on by research teams, regulatory agencies and patients to determine the safety of treatments and impact on quality of life. If reports do not accurately convey side effects, patients may continue to receive cancer treatments that cause excessive symptoms.
Symptom reports collected by the research team from 438 children aged 7 to 18 years, their doctors, and their caregivers. Study participants included children with various cancer types from nine pediatric cancer centers across the country. The study focused on 15 common symptoms during cancer treatment, including fatigue, nausea, vomiting, mouth sores, pain, trouble sleeping, and more.
PhD. Freyer and the research team found significant differences between doctors’ and caregivers’ symptom reports compared with children’s self-reports. The agreement between children and physician reports was poor to fair. Significantly more children reported symptoms than doctors reported for them. About 20-40% of children report symptoms that are more severe than their doctor. On average, children reported twice as many symptoms as doctors.
“These findings are consistent with earlier studies, but the size and design of our study add weight. More than 400 patients with several Patients with different types of cancer were involved, and we assessed 15 symptoms before and after treatment,” said Dr. Freyer.
Although this difference applies to all symptoms, fatigue, depression, anxiety, and insomnia are difficult to observe during the visit Physician reports are especially rare. For example, more than 60% of children who reported no fatigue by doctors actually had fatigue. Commonly missed symptoms include those that indicate a need for changes in clinical management, such as mouth ulcers and vomiting.
Parent or guardian reports tend to overestimate symptoms, including nausea, loss of appetite, pain, fatigue, and anxiety. Concordance between child and caregiver reports was better.
“Our findings suggest that children’s self-reports should complement physician reports of adverse events whenever possible,” Freer Dr. said. “Children are best at recognizing and remembering their symptoms during cancer treatment.”
When children can’t When making self-reports, physicians should consider the opinions of nursing staff. Although the study did not include children under the age of 7, the researchers believe that caregivers’ reports would also be helpful in these cases.
An invited editorial by an oncologist at Seattle Children’s Hospital published alongside the published study Emphasizes the need for change. The review noted that studies have repeatedly pointed to these same differences in symptom reporting. To optimize pediatric cancer outcomes, research and clinical care must directly engage the child’s voice and experience. The editorial believes that Dr. Freyer and his team have provided the necessary scientific evidence and rationale—it is time to transform research and clinical practice.
During each cancer clinical trial, doctors use the National Cancer Institute (NCI) The Common Terminology Criteria for Adverse Events (CTCAE) reports symptoms experienced by patients. CTCAE evaluates any harmful side effects of cancer treatment. NCI recently created a version of the measure that adults with cancer do on their own, capturing the patient’s experience directly. However, cancer trials in children currently do not use similar direct reporting measures. So far, there is no version of CTCAE for children.
As part of their preparation for this study, the research team developed and validated a version of CTCAE for children and Its caregiver is done. The measure captures the physical and mental health symptom side effects of cancer treatment, ranking them in severity on a scale of 0 to 3.
“We hope that future pediatric cancer clinical trials will incorporate direct child reporting using our measure or a similar approach,” Dr. Freyer Say. “More accurate reporting will limit new treatment toxicity and help children and families decide which of two similar treatments is better tolerated.”
PhD. Freyer and the research team gained a better understanding of how children, their doctors and their caregivers perceive the side effects of cancer treatment. The benefits of children’s self-reports may not only inform clinical trial toxicity assessments, but also improve their clinical care.
Studies suggest that toxicity assessment is often improved using direct symptom reports from adult cancer patients. According to the findings, a more complete and accurate understanding of patient symptoms could help clinicians better understand the patient experience and improve care.
For more information: David R. Freyer et al, Children, clinicians, and caregivers in symptomatic Lack of Consistency in Incident Reporting: Implications for Cancer Clinical Trials, Journal of Clinical Oncology (2022 ). DOI: 10.1200/JCO.21.02669
Citation : The way doctors, caregivers and patients report side effects of cancer treatment exist Differences (August 26, 2022) Retrieved September 4, 2022 from https://medicalxpress.com/news/2022-08-differences-doctors-caregivers-patients-side.html
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