Patterns of symptoms and functional impairments in children with cancer

Abstract

Background Children with cancer experience multiple symptoms due to their disease and as a result of treatment. The purpose of this study was to demonstrate the feasibility and potential utility of using latent profile analysis (LPA), a type of cluster analysis, in children with cancer to identify groups of patients who experience similar levels of symptom severity and impairment of physical function. Procedure We analyzed patient-reported symptom and functional data previously collected using the Pediatric Patient Reported Outcomes Measurement Information System (PROMIS). LPA was used to identify and characterize groups of patients who reported similar levels of symptom severity and functional impairment. We then used the multinomial logit model to examine demographic and disease characteristics associated with symptom/ function profile membership. Results The analysis included 200 patients in treatment or in survivorship. We identified four symptom/ function profiles; children currently receiving cancer treatment and those with at least one other medical problem were more likely to be members of the profile with the highest levels of symptom severity and functional impairment. Gender, age, race/ethnicity, and tumor type were not associated with profile membership. Conclusions LPA is a cluster research methodology that provides clinically useful results in pediatric oncology patients. Future studies of children with cancer using LPA could potentially lead to development of clinical scoring systems that predict patients’ risk of developing more severe symptoms and functional impairments, allowing clinicians, patients, and parents to better anticipate and prevent the multiple symptoms that occur during and after treatment for childhood cancer.

Patient-reported outcomes in clinical practice

“…[3][4][5][6][7] Patient symptoms often go undetected during typical clinic interviews, and clinicians may underestimate the impact of symptoms from interview alone. [8][9][10] The impact of cancer and cancer treatment on patient health status can be systematically quantified using PRO measures in children and adults.…”

Patient-Reported Outcomes Measurement Information System in Children with Crohn's Disease

“…This pattern is consistent with our clinical experience, as well as PROMIS pediatric studies in other chronic disease settings where peer relationships are less affected by disease severity than other domains. (14),(30),(7) Although incremental changes in Crohn’s disease activity and health-related QoL are associated with differences in patient-reported anxiety, depression, fatigue, and pain interference, peer relationships tend to remain intact except in those whose Crohn’s disease is very active or QoL very impaired.…”

“…(5, 6) Researchers and clinicians will then be able to use these endpoints to identify previously unrecognized psychological, social, or functional health disorders, reveal correlations between these disorders and underlying chronic disease activity, and prompt appropriate interventions. (7), (8), (9, 10) …”

Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment

“…fatigue) allowing for group comparisons within and between reporters. The pediatric PROMIS measures have been utilized in a variety of pediatric chronic health conditions such as asthma, cancer, chronic kidney disease, obesity, rheumatic disease, sickle cell disease, as well as those with chronic pain [4,9,25]. These measures are calibrated with a norming population of patients in the US with chronic conditions and their families, as well as general populations from schools and primary care clinics [51].…”