Journal article
Factors Associated With Symptom Burden Among Pediatric Patients With Cancer
JCO oncology practice, Vol.22(6), pp.1087-1095
06/2026
DOI: 10.1200/OP-25-00244
PMCID: PMC12393674
PMID: 40811761
Abstract
The objective was to identify factors associated with self-reported symptom burden measured using Symptom Screening in Pediatrics Tool (SSPedi) in pediatric patients with cancer.
This was a secondary analysis of a cluster randomized trial enrolling pediatric patients newly diagnosed with cancer. Twenty sites were randomized to routine symptom screening versus usual care. Intervention included thrice-weekly symptom screening with SSPedi, delivery of severely bothersome scores to health care teams, and implementation of locally adapted symptom management care pathways. Primary outcome was total SSPedi scores, 0 (no bothersome symptoms) to 60 (worst bothersome symptoms), obtained at baseline, week four, and week eight in 430 patients (n = 217 intervention and n = 213 usual care). We created a mixed linear regression model evaluating design (including time point), patient/guardian, and site characteristics for their associations with symptom burden after controlling for treatment assignment.
SSPedi scores were significantly lower at weeks 4 and 8 compared with baseline (
< .0001 overall), and at intervention versus control sites (
< .0001). In the full model, males (estimate, -3.3 [95% CI, -4.6 to -2.0];
< .0001) and sites with higher physician staffing ratios (each physician full-time equivalent per 100 new diagnoses estimate -0.20 [95% CI, -0.5 to 0.0];
= .024) had significantly lower total SSPedi scores.
Total symptom burden was reduced by time, intervention (symptom screening and care pathways), and greater physician staffing ratio. Females had higher symptom burden. These data may inform programmatic implementation of routine symptom screening in pediatric patients with cancer.
Details
- Title: Subtitle
- Factors Associated With Symptom Burden Among Pediatric Patients With Cancer
- Creators
- Adam P Yan - Institute for Clinical Evaluative SciencesL Lee Dupuis - Institute for Clinical Evaluative SciencesCatherine Aftandilian - Stanford UniversityVibhuti Agarwal - Nemours Children's ClinicChristina Baggott - Stanford UniversityMelissa P Beauchemin - Columbia UniversityScott M Bradfield - Nemours Children's ClinicDaniel Cannone - Children's Hospital of Richmond at VCUEmi H Caywood - Nemours Children's Hospital, Delaware, Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders, Wilmington, DENicole Crellin-Parsons - Institute for Clinical Evaluative SciencesJenna Demedis - University of Colorado DenverDavid Dickens - University of Iowa Stead Family Children’s HospitalAdam J Esbenshade - Vanderbilt University Medical CenterDavid R Freyer - Children's Hospital of Los AngelesAllison C Grimes - The University of Texas at San Antonio Health Science CenterKara M Kelly - Roswell Park Comprehensive Cancer CenterAllison A King - Washington University in St. LouisLisa M Klesges - Washington University in St. LouisWade Kyono - Kapiolani Medical Center for Women and ChildrenRamamoorthy Nagasubramanian - Nemours Children's ClinicEtan Orgel - Children's Hospital of Los AngelesAndrea D Orsey - Center for Cancer and Blood DisordersMichael E Roth - The University of Texas MD Anderson Cancer CenterFarha Sherani - Driscoll Children's HospitalEmily Vettese - Hospital for Sick ChildrenAlexandra Walsh - Center for Cancer and Blood DisordersWendy Woods-Swafford - Blank Children's HospitalLolie C Yu - Louisiana State University Health Sciences Center New OrleansGeorge A Tomlinson - Toronto General HospitalLillian Sung - Hospital for Sick Children
- Resource Type
- Journal article
- Publication Details
- JCO oncology practice, Vol.22(6), pp.1087-1095
- DOI
- 10.1200/OP-25-00244
- PMID
- 40811761
- PMCID
- PMC12393674
- NLM abbreviation
- JCO Oncol Pract
- ISSN
- 2688-1535
- eISSN
- 2688-1535
- Language
- English
- Electronic publication date
- 08/14/2025
- Date published
- 06/2026
- Academic Unit
- Stead Family Department of Pediatrics; Hematology/Oncology
- Record Identifier
- 9984946705002771
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