Patel Priya, Robinson Paula D, van der Torre Patrick, Tomlinson Deborah, Seelisch Jennifer, Oberoi Sapna, Morgan Jessica E, Hinds Pamela S, Götte Miriam, Gibson Faith, Duong Nathan, Davis Hailey, Culos-Reed S Nicole, Cataudella Danielle, Miranda Vanessa, Dupuis L Lee, Sung Lillian
Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada.
Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
EClinicalMedicine. 2023 Aug 10;63:102147. doi: 10.1016/j.eclinm.2023.102147. eCollection 2023 Sep.
Objective was to update a clinical practice guideline (CPG) for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients. We reconvened a multi-disciplinary and multi-national panel. While the previous 2018 CPG evaluated adult and pediatric randomized controlled trials (RCTs) to manage fatigue, this 2023 update revised previous recommendations based only on pediatric RCTs. Twenty RCTs were included in the updated systematic review. Physical activity significantly reduced fatigue (standardized mean difference -0.44, 95% confidence interval -0.64 to -0.24; n = 8 RCTs). Using the 2018 recommendations as a basis, the panel continued to make strong recommendations to use physical activity, and to offer relaxation, mindfulness or both, to manage fatigue in pediatric patients. Cognitive or cognitive behavioral therapies may be offered. Pharmacological approaches should not be routinely used. The panel made a new good practice statement to routinely assess for fatigue, ideally using a validated scale.
目的是更新一项针对癌症患儿及青少年或儿科造血干细胞移植受者疲劳管理的临床实践指南（CPG）。我们重新召集了一个多学科、多国别的专家小组。虽然之前2018年的CPG评估了成人和儿科随机对照试验（RCT）来管理疲劳，但此次2023年更新仅基于儿科RCT对先前的建议进行了修订。更新后的系统评价纳入了20项RCT。体育活动显著减轻了疲劳（标准化均数差 -0.44，95%置信区间 -0.64至 -0.24；n = 8项RCT）。以2018年的建议为基础，该专家小组继续强烈建议采用体育活动，并提供放松、正念或两者兼用以管理儿科患者的疲劳。可提供认知或认知行为疗法。不应常规使用药物治疗方法。该专家小组提出了一项新的良好实践声明，即理想情况下使用经过验证的量表对疲劳进行常规评估。
