Randomized Controlled Trial

. 2025 Jul;14(14):e71053.

doi: 10.1002/cam4.71053.

Factors Associated With Self-Report Symptom Screening Adherence in Pediatric Cancer Patients

L Lee Dupuis^{1

2}, Emily Vettese¹, Catherine Aftandilian³, Vibhuti Agarwal⁴, Christina Baggott³, Scott M Bradfield⁵, Nicole Crellin-Parsons¹, David R Freyer⁶, Kara M Kelly⁷, Allison A King^{8

9}, Wade Kyono¹⁰, Ramamoorthy Nagasubramanian⁴, Etan Orgel⁶, Michael E Roth¹¹, Farha Sherani¹², Lolie Yu¹³, Allison C Grimes¹⁴, Melissa P Beauchemin¹⁵, Lisa M Klesges⁸, George A Tomlinson¹⁶, Lillian Sung^{1

17}

Affiliations

¹ Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada.
² Department of Pharmacy, The Hospital for Sick Children and Leslie dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
³ Division of Pediatric Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University, Palo Alto, California, USA.
⁴ Nemours Children's Hospital, Orlando, Florida, USA.
⁵ Nemours Children's Health, Jacksonville, Florida, USA.
⁶ Cancer and Blood Disease Institute, Children's Hospital los Angeles, Los Angeles, California, USA.
⁷ Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
⁸ Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
⁹ Washington University School of Medicine, St. Louis, Missouri, USA.
¹⁰ Kapi'olani Medical Center for Women & Children, Honolulu, Hawaii, USA.
¹¹ Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹² Driscoll Children's Hospital, Cancer and Blood Disorders Center and Texas A&M University, Corpus Christi, Texas, USA.
¹³ Louisiana State University Health Sciences Center/Children's Hospital, New Orleans, Louisiana, USA.
¹⁴ Pediatric Hematology Oncology, University of Texas Health Science Center at san Antonio, San Antonio, Texas, USA.
¹⁵ Columbia University School of Nursing/Herbert Irving Cancer Center, New York, New York, USA.
¹⁶ Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.
¹⁷ Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada.

PMID: 40686265
PMCID: PMC12277931
DOI: 10.1002/cam4.71053

Randomized Controlled Trial

Factors Associated With Self-Report Symptom Screening Adherence in Pediatric Cancer Patients

L Lee Dupuis et al. Cancer Med. 2025 Jul.

. 2025 Jul;14(14):e71053.

doi: 10.1002/cam4.71053.

Authors

Affiliations

¹ Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada.
² Department of Pharmacy, The Hospital for Sick Children and Leslie dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
³ Division of Pediatric Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University, Palo Alto, California, USA.
⁴ Nemours Children's Hospital, Orlando, Florida, USA.
⁵ Nemours Children's Health, Jacksonville, Florida, USA.
⁶ Cancer and Blood Disease Institute, Children's Hospital los Angeles, Los Angeles, California, USA.
⁷ Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
⁸ Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
⁹ Washington University School of Medicine, St. Louis, Missouri, USA.
¹⁰ Kapi'olani Medical Center for Women & Children, Honolulu, Hawaii, USA.
¹¹ Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹² Driscoll Children's Hospital, Cancer and Blood Disorders Center and Texas A&M University, Corpus Christi, Texas, USA.
¹³ Louisiana State University Health Sciences Center/Children's Hospital, New Orleans, Louisiana, USA.
¹⁴ Pediatric Hematology Oncology, University of Texas Health Science Center at san Antonio, San Antonio, Texas, USA.
¹⁵ Columbia University School of Nursing/Herbert Irving Cancer Center, New York, New York, USA.
¹⁶ Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.
¹⁷ Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada.

PMID: 40686265
PMCID: PMC12277931
DOI: 10.1002/cam4.71053

Abstract

Introduction: Objective was to describe the association between baseline characteristics and the number of Symptom Screening in Pediatrics Tool (SSPedi) assessments completed over an 8-week period.

Methods: This was a sub-analysis of a cluster randomized controlled trial among 10 sites that were randomized to the intervention group. Participants were English- or Spanish-speaking pediatric patients 8-18 years of age newly diagnosed with cancer. Participants were prompted to complete SSPedi three times weekly for 8 weeks. The outcome was the number of SSPedi assessments completed during the 8-week period. Factors associated with the number of assessments were determined using mixed effects Poisson regression.

Results: At the 10 intervention sites, 216 patients were included in the analysis. Among these participants, 129 (59.7%) were male, 112 (51.9%) were white, and 83 (38.4%) were Hispanic. The number of SSPedi assessments was significantly higher for participants 11-14 years (rate ratio (RR) 1.13, 95% confidence interval (CI) 1.02-1.25) and 15-18 years (RR 1.15, 95% CI 1.04-1.27) compared to 8-10 years. Participants completed more SSPedi assessments if they were Asian compared to white (RR 1.27, 95% CI 1.10-1.46), non-Hispanic compared to Hispanic (RR 1.15, 95% CI 1.04-1.28) and from families with a household income ≥$60,000 (RR 1.12, 95% CI 1.03-1.21). Participants completed fewer SSPedi assessments if they had solid tumors compared to leukemia (RR 0.91, 95% CI 0.84-0.99).

Conclusion: Adherence to three-times weekly SSPedi varied by age, race, ethnicity, cancer diagnosis, and family income. This information may facilitate interventions to support routine symptom screening in clinical practice.

Trial registration: NCT04614662.

Keywords: adherence; oncology; pediatric; symptom screening.

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Conflict of interest statement

The following authors declare conflicts of interest: E.O. consults with Jazz Pharmaceuticals.

Figures

**FIGURE 1**
Bar graph showing number of SSPedi assessments completed. SSPedi, Symptom Screening in Pediatrics Tool.

**FIGURE 2**
Number of SSPedi assessments completed by site compared to the average. SSPedi, Symptom Screening in Pediatrics Tool.

**FIGURE 3**
Relationship between number of SSPedi assessments and Baseline Total SSPedi Score. SSPedi, Symptom Screening in Pediatrics Tool.

See this image and copyright information in PMC

References

1. Johnston D. L., Hyslop S., Tomlinson D., et al., “Describing Symptoms Using the Symptom Screening in Pediatrics Tool in Hospitalized Children With Cancer and Hematopoietic Stem Cell Transplant Recipients,” Cancer Medicine 7, no. 5 (2018): 1750–1755, 10.1002/cam4.1433. - DOI - PMC - PubMed
1. Hyslop S., Davis H., Duong N., et al., “Symptom Documentation and Intervention Provision for Symptom Control in Children Receiving Cancer Treatments,” European Journal of Cancer 109 (2019): 120–128, 10.1016/j.ejca.2019.01.002. - DOI - PubMed
1. Dupuis L. L., Cook S., Robinson P. D., Tomlinson D., Vettese E., and Sung L., “Optimizing Symptom Control in Children and Adolescents With Cancer,” Pediatric Research 86, no. 5 (2019): 573–578, 10.1038/s41390-019-0516-3. - DOI - PubMed
1. Tomlinson D., Chakkalackal L., Calligan M., et al., “Symptom Documentation and Intervention in Paediatric Cancer Care‐Association With Severity: Observational Study,” BMJ Supportive & Palliative Care 13, no. e3 (2024): e1265–e1271, 10.1136/spcare-2022-003874. - DOI - PubMed
1. Dupuis L. L., Vettese E., Grimes A., et al., “Symptom Screening Linked to Care Pathways for Pediatric Patients With Cancer: A Cluster Randomized Trial,” (2024) In Press. - PMC - PubMed

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Factors Associated With Self-Report Symptom Screening Adherence in Pediatric Cancer Patients

Affiliations

Factors Associated With Self-Report Symptom Screening Adherence in Pediatric Cancer Patients

Authors

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Abstract

Conflict of interest statement

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References

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