Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.
Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Res. 2019 Nov;86(5):573-578. doi: 10.1038/s41390-019-0516-3. Epub 2019 Jul 29.
There is growing recognition of the degree to which symptoms negatively impact on children receiving cancer treatments. A recent study described that almost all inpatient pediatric oncology patients are experiencing at least one bothersome symptom and almost 60% are experiencing at least one severely bothersome symptom. Poor symptom control occurs because of challenges with communication of bothersome symptoms to clinicians, lack of clinical practice guidelines (CPGs) for most of these symptoms, and failure to administer preventative and therapeutic interventions known to be effective for symptom control. This article reviews approaches used to improve symptom control for children receiving cancer treatments. Areas addressed include systematic symptom screening and creation of CPGs for symptom management. Challenges with electronic health integration are also addressed. Several multi-symptom assessment scales have been developed but none have yet been used to directly influence patient management. The number of CPGs applicable to symptom control in pediatric oncology is increasing but remains small. Improving the creation of and adherence to CPGs for symptom management is an important priority. Finally, identifying ways that symptom management systems can be integrated into clinical work flows is essential; these will likely need to focus on electronic health records.
人们越来越认识到症状在多大程度上会对接受癌症治疗的儿童产生负面影响。最近的一项研究表明，几乎所有住院接受儿科肿瘤治疗的患者都至少有一种令人不适的症状，近 60%的患者至少有一种严重令人不适的症状。症状控制不佳的原因是与临床医生沟通令人不适的症状存在挑战，缺乏针对这些症状的大多数临床实践指南（CPG），以及未能实施已知对症状控制有效的预防和治疗干预措施。本文综述了改善接受癌症治疗的儿童症状控制的方法。讨论的领域包括系统的症状筛查和制定症状管理的 CPG。还讨论了电子健康集成方面的挑战。已经开发了几种多症状评估量表，但没有一种用于直接影响患者管理。适用于儿科肿瘤学症状控制的 CPG 数量正在增加，但仍然很少。改善症状管理 CPG 的制定和遵守是一个重要的优先事项。最后，确定症状管理系统可以整合到临床工作流程中的方法至关重要；这些可能需要专注于电子健康记录。
