Department of Social Work, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.
Support Care Cancer. 2021 May;29(5):2279-2288. doi: 10.1007/s00520-020-05845-8. Epub 2020 Nov 5.
To (1) describe and compare, across all eligible guidelines, recommendations that address any aspect of clinical assessment or management of anxiety and distress experienced by children and adolescents undergoing cancer treatment or hematopoietic stem cell transplantation (HSCT), and (2) assess guideline characteristics that influence identified recommendations.
We searched five databases for relevant guidelines and conducted a grey literature search. Guidelines had to refer to children 0-18 years old who were undergoing cancer treatment or HSCT, describe any aspect of clinical assessment or management of symptoms of anxiety and distress, and be publicly accessible and published in English on or after 2000.
We identified 118 guidelines on pediatric cancer of which 13 mentioned clinical assessment or management of anxiety and distress. Six contained ≥ 1 recommendation addressing assessments of symptoms of which only two recommended specific screening instruments. Ten contained ≥ 1 recommendation addressing interventions for symptoms, of which six described specific interventions such as distraction and medication. Psychologists and nurses were the most common panel members and three guideline panels included a patient advocate. Only two guidelines received overall quality ratings > 80.0%.
We identified no guidelines that were specific to clinical assessment or management of anxiety and distress among children and adolescents undergoing cancer treatment or HSCT, and thus, clinicians lack evidence-informed guidance on how to manage these specific symptoms. Future research should establish high-quality guidelines that offer recommendations specific to clinical assessment and management of anxiety and distress in pediatric oncology and HSCT.
（1）描述和比较所有合格指南中针对接受癌症治疗或造血干细胞移植 (HSCT) 的儿童和青少年焦虑和痛苦的临床评估或管理的任何方面的建议；（2）评估影响已确定建议的指南特征。
我们在五个数据库中搜索了相关指南，并进行了灰色文献搜索。指南必须针对正在接受癌症治疗或 HSCT 的 0-18 岁儿童，描述症状的临床评估或管理的任何方面，并且可以公开获取，并于 2000 年或之后以英文出版。
我们确定了 118 项儿科癌症指南，其中 13 项提到了焦虑和痛苦的临床评估或管理。有 6 项建议包含评估症状，其中只有 2 项建议使用特定的筛查工具。有 10 项建议包含针对症状的干预措施，其中 6 项描述了特定的干预措施，如分散注意力和药物治疗。心理学家和护士是最常见的小组成员，三个指南小组中有一个患者代言人。只有两项指南的整体质量评分>80.0%。
我们没有发现专门针对接受癌症治疗或 HSCT 的儿童和青少年焦虑和痛苦的临床评估或管理的指南，因此，临床医生缺乏关于如何管理这些特定症状的循证指导。未来的研究应制定高质量的指南，为儿科肿瘤学和 HSCT 中的焦虑和痛苦的临床评估和管理提供具体建议。
