Rappaport Faculty of Medicine (O.G., S.A., M.B.A., E.B.A.), Technion-Israel Institute of Technology, Haifa, Israel; Division of Pediatric Hematology Oncology and Bone Marrow Transplantation (O.G., S.A., M.B.A.), Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel; Integrative Oncology Program (O.G., E.B.A.), The Oncology Service, Lin, Zebulun, and Carmel Medical Centers, Clalit Health Services, Haifa, Israel.
Division of Pediatric Hematology Oncology and Bone Marrow Transplantation (O.G., S.A., M.B.A.), Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel.
J Pain Symptom Manage. 2024 Dec;68(6):e508-e515. doi: 10.1016/j.jpainsymman.2024.08.035. Epub 2024 Aug 31.
Parents of children with cancer face bio-psycho-social-spiritual concerns which can significantly reduce quality of life (QoL). We examined the impact of an integrative oncology (IO) intervention on QoL-related concerns among parents of children in a pediatric hematology-oncology department.
The study was prospective, controlled, nonrandomized and patient-preferenced. Parents of children recently (≤6 weeks) diagnosed with cancer were assessed using the measure yourself concerns and wellbeing (MYCaW), Edmonton Symptom Assessment Scale (ESAS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Parents in both groups were reassessed after three weeks.
An IO consultation was provided, with training in daily relaxation-breathing and manual treatments, and guidance on herbal medicine.
Of 68 parents consenting to participate, 37 (54%) underwent the intervention with 31 serving as controls. Multivariate analysis found the IO intervention group to contain more Hebrew-speakers (OR=5.96, 95% CI=1.3-27.3, P=0.022); females (OR=5.23, 95% CI=1.1-24.8, P=0.038); and report pain (OR=1.2, 95% CI=1.0-1.4, P=0.045) and impaired appetite on ESAS (OR=1.23, 95% CI=1.01-1.48, P=0.034) when compared to controls. Only the intervention group showed improved baseline-to-3-week scores for physical functioning (P<0.001), cognitive functioning (0=0.018) and fatigue on EORTC (P<0.001); and for ESAS appetite (P<0.001) and anxiety (P=0.02). ESAS sleep increased only in controls (P=0.029).
CONCLUSIONS/LESSONS LEARNED: IO interventions in pediatric hematology-oncology addressing QoL-related concerns among parents are feasible, potentially increasing predominantly physical symptoms and functioning. Further research is needed to confirm these "real-world" clinical outcomes, and the role of IO in "Caring for the Caregiver".
癌症患儿的父母面临着生物心理社会精神方面的担忧，这会显著降低生活质量（QoL）。我们研究了综合肿瘤学（IO）干预对儿科血液肿瘤学部门患儿父母的 QoL 相关问题的影响。
该研究为前瞻性、对照、非随机和患者偏好研究。最近（≤6 周）被诊断为癌症的患儿的父母使用自我评估关切和幸福感量表（MYCaW）、埃德蒙顿症状评估量表（ESAS）和欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-C30）进行评估。两组父母在 3 周后进行了再次评估。
提供了 IO 咨询，包括日常放松呼吸和手动治疗培训，以及草药指导。
在 68 位同意参与的父母中，有 37 位（54%）接受了干预，其中 31 位作为对照组。多变量分析发现 IO 干预组包含更多说希伯来语的人（OR=5.96，95%CI=1.3-27.3，P=0.022）；女性（OR=5.23，95%CI=1.1-24.8，P=0.038）；并且报告在 ESAS 上有疼痛（OR=1.2，95%CI=1.0-1.4，P=0.045）和食欲受损（OR=1.23，95%CI=1.01-1.48，P=0.034）。与对照组相比，只有干预组在基线至 3 周的身体功能（P<0.001）、认知功能（0=0.018）和 EORTC 疲劳（P<0.001）方面以及 ESAS 食欲（P<0.001）和焦虑（P=0.02）方面的评分有所改善。仅在对照组中，ESAS 睡眠增加（P=0.029）。
结论/经验教训：在儿科血液肿瘤学中针对父母的 QoL 相关问题开展的 IO 干预是可行的，可能会主要增加身体症状和功能。需要进一步研究来证实这些“真实世界”的临床结果，以及 IO 在“照顾照顾者”中的作用。
