Male Pediatric Patients Have Lower Self-Reported Symptom Burden From Cancer

Pediatric patients self-reported symptom burden using the SSPedi tool, which observed symptom burden from baseline, 4 weeks, and 8 weeks.

The Symptom Screening in Pediatrics (SSPedi) tool determined that symptom burden was reduced by time, intervention, and a greater physician staffing ratio for pediatric patients with cancer, according to a phase 3 study (NCT04614662) published in JCO Oncology Practice.

At week 8, the effect of the intervention was –3.6 compared with –3.4 at week 4 (P <.0001). Other factors that were associated with baseline, week 4, and week 8 SSPedi scores included being male (–3.3; 95% CI, –4.6 to 2.0; P <.001), ethnicity being unknown/prefer not to say (4.6; 95% CI, 1.7-7.6; P = .002), and physician full-time equivalent per 100 new diagnoses (–0.2; 95% CI, –0.5 to 0.0; P = .024).

Additional factors included the additional effect of the intervention group at week 4, which was –1.6 (95% CI, –3.0 to –0.2; P = .023) compared with the week 8 effect of –1.8 (95% CI, –3.2 to –04; P = .011); difference between intervention and control at baseline(–1.8; 95% CI, –3.6 go –0.1; P = .039); annual household income of $60,000 or more (–0.9; 95% CI, –2.5 to 0.6; P = .244); and cancer diagnosis of solid tumor (–1.2; 95% CI, –2.5 to 0.2; P = .095), brain tumor (–1.8; 95% CI, –4.7 to 1.4; P = .238), or metastatic disease (–0.3; 95% CI, –1.7 to 1.2; P = .723).

“In this evaluation of longitudinal self-reported symptom scores among pediatric patients newly diagnosed with cancer, we reiterate that the symptom screening intervention paired with adapted care pathways for symptom management significantly decreased total SSPedi scores,” Adam Yan, MD, MBI, FRCPC, FAAP, a staff oncologist at SickKids and assistant professor in the Faculty of Medicine at the University of Toronto, and coauthors wrote in the article. “In this study, we found that the magnitude of benefit was sustained over the 8-week period, demonstrated by a similar effect between weeks 4 and 8. We also demonstrated that females had higher symptom burden than males, and increasing the physician full-time equivalent [FTE] per 100 new cancer diagnoses was associated with lower symptom burden. Finally, physician FTE per 100 new cancer diagnoses had the largest impact on reducing variability between sites in total SSPedi scores.”

A total of 445 patients were recruited between July 2021 and August 2023 across 20 sites. Patients were aged 8 to 18, were English- or Spanish-speaking, and had a treatment plan. If patients had a recurrence or second malignancy, they were excluded from the study.

The SSPedi scores collected at baseline, 4 weeks, and 8 weeks were the primary end point. The results were collected using SPARK, a web-based application that facilitated access to the SSPedi.

To calculate the SSPedi score, 15 individual item scores were divided by the score range of 0 to 4, and the total score range was 0 (no bothersome symptoms) to 60 (worst bothersome symptoms). The recall period was “yesterday or today”. The secondary end point was the SSPedi self-reported score at week 8.

A total of 217 patients were enrolled in the intervention sites and 213 in the control sites who were eligible for analysis. Completed SSPedi scores at 4 weeks occurred in 94.1% of patients at the intervention site and 92.4% at the control site, and at 8 weeks, it was 89.6% vs 93.3%.

“An important finding of our study was that the impact of the intervention, namely symptom screening and adapted care pathways, persisted at week 8 compared with week 4. In our study, we performed routine symptom screening for 8 weeks to establish a consistent duration of the intervention. However, this finding suggests that the intervention likely should continue beyond 8 weeks, although the ideal duration of symptom screening is unknown and might vary depending on the specific cancer diagnosis, treatment duration or intensity, and patient-specific attributes,” the authors concluded.

Reference

Yan AP, Dupuis LL, Aftandilian C, et al. Factors associated with symptom burden among pediatric patients with cancer. JCO Oncol Pract. 2025. doi:10.1200/OP-25-00244