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Few guidelines offer recommendations on how to assess and manage anxiety and distress in children with cancer: a content analysis

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Abstract

Purpose

To (1) describe and compare, across all eligible guidelines, recommendations that address any aspect of clinical assessment or management of anxiety and distress experienced by children and adolescents undergoing cancer treatment or hematopoietic stem cell transplantation (HSCT), and (2) assess guideline characteristics that influence identified recommendations.

Methods

We searched five databases for relevant guidelines and conducted a grey literature search. Guidelines had to refer to children 0–18 years old who were undergoing cancer treatment or HSCT, describe any aspect of clinical assessment or management of symptoms of anxiety and distress, and be publicly accessible and published in English on or after 2000.

Results

We identified 118 guidelines on pediatric cancer of which 13 mentioned clinical assessment or management of anxiety and distress. Six contained ≥ 1 recommendation addressing assessments of symptoms of which only two recommended specific screening instruments. Ten contained ≥ 1 recommendation addressing interventions for symptoms, of which six described specific interventions such as distraction and medication. Psychologists and nurses were the most common panel members and three guideline panels included a patient advocate. Only two guidelines received overall quality ratings > 80.0%.

Conclusion

We identified no guidelines that were specific to clinical assessment or management of anxiety and distress among children and adolescents undergoing cancer treatment or HSCT, and thus, clinicians lack evidence-informed guidance on how to manage these specific symptoms. Future research should establish high-quality guidelines that offer recommendations specific to clinical assessment and management of anxiety and distress in pediatric oncology and HSCT.

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Funding

TL is supported by a Doctoral Research Award from the Canadian Institutes of Health Research (FRN#201610GSD-385574-255928).

Author information

Authors and Affiliations

  1. Department of Social Work, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada

    Tanya Lazor

  2. Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada

    Claire De Souza

  3. Department of Psychiatry, University of Toronto, Toronto, Ontario, M5S 1A8, Canada

    Claire De Souza

  4. Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada

    Robin Urquhart

  5. Centre for Addiction and Mental Health, Toronto, Ontario, M5J 2C9, Canada

    Eva Serhal

  6. Toronto General Hospital Research Institute, Toronto, Ontario, M5G 2C4, Canada

    Anna R. Gagliardi

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  1. Tanya Lazor
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  2. Claire De Souza
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  4. Eva Serhal
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  5. Anna R. Gagliardi
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Contributions

TL and ARG contributed to research conception and design, acquisition and analysis of data, and drafting and revising the manuscript. CD and RU contributed to research conception and design, analysis of data, and critical revision of the manuscript. ES contributed to acquisition and analysis of data and critical revision of the manuscript. All authors have approved of the final version for submission for publication and agree to be accountable for all aspects of the work.

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Correspondence to Tanya Lazor.

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Lazor, T., De Souza, C., Urquhart, R. et al. Few guidelines offer recommendations on how to assess and manage anxiety and distress in children with cancer: a content analysis. Support Care Cancer 29, 2279–2288 (2021). https://doi.org/10.1007/s00520-020-05845-8

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  • DOI: https://doi.org/10.1007/s00520-020-05845-8

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