Feasibility of Conducting a Palliative Care Randomized Controlled Trial in Children With Advanced Cancer: Assessment of the PediQUEST Study

• Published in: Journal of pain and symptom management Vol. 49; no. 6; pp. 1059 - 1069
• Main Authors: Dussel, Veronica, MD, MPH, Orellana, Liliana, PhD, Soto, Natalie, MD, Chen, Kun, PhD, Ullrich, Christina, MD, MPH, Kang, Tammy I., MD, MSCE, Geyer, Jeffrey R., MD, Feudtner, Chris, MD, PhD, MPH, Wolfe, Joanne, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015
• Subjects: Adolescent; Anesthesia & Perioperative Care; attrition; Child; Child, Preschool; end-of-life care; feasibility; Feasibility Studies; Female; Humans; Longitudinal Studies; Male; Neoplasms - therapy; Pain Medicine; palliative care; Palliative Care - methods; Patient Dropouts; Patient Selection; patient-reported outcomes; pediatric oncology; Pediatrics; Pilot Projects; randomized controlled trial; supportive care; Terminal Care; United States > US; feasibility; Pediatrics; patient-reported outcomes; attrition; pediatric oncology; supportive care; palliative care; end-of-life care; randomized controlled trial
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2014.12.010

Abstract Context Pediatric palliative care randomized controlled trials (PPC-RCTs) are uncommon. Objectives To evaluate the feasibility of conducting a PPC-RCT in pediatric cancer patients. Methods This was a cohort study embedded in the Pediatric Quality of Life and Evaluation of Symptoms Technology Study (NCT01838564). This multicenter PPC-RCT evaluated an electronic patient-reported outcomes system. Children aged two years and older, with advanced cancer, and potentially eligible for the study were included. Outcomes included: pre-inclusion attrition (patients not approached, refusals); post-inclusion attrition (drop-out, elimination, death, and intermittent attrition (IA; missing surveys) over nine months of follow-up); child/teenager self-report rates; and, reasons to enroll/participate. Results Over five years, of the 339 identified patients, 231 were eligible (in 22, we could not verify eligibility); 84 eligible patients were not approached and 43 declined participation. Patients not approached were more likely to die or have brain tumors. We enrolled 104 patients. Average enrollment rate was one patient per site per month; shortening follow-up from nine to three months (with optional re-enrollment) increased recruitment by 20%. A total of 87 patients completed the study (24 died) and 17 dropped out. Median IA was 41% in the first 20 weeks of follow-up and more than 60% in the eight weeks preceding death. Child/teenager self-report was 94%. Helping others, low burden procedures, incentives, and staff attitude were frequent reasons to enroll/participate. Conclusion A PPC-RCT in children with advanced cancer was feasible, post-inclusion retention adequate; many families participated for altruistic reasons. Strategies that may further PPC-RCT feasibility include: increasing target population through large multicenter studies, approaching sicker patients, preventing exclusion of certain patient groups, and improving data collection at end of life.