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The predictive trifecta? Fatigue, pain, and anxiety severity forecast the suffering profile of children with cancer

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Abstract  

Background

Fatigue, pain, and anxiety, symptoms commonly experienced by children with cancer, may predict pediatric symptom suffering profile membership that is amenable to treatment.

Methods

Three latent profiles (Low, Medium, and High symptom suffering) from 436 pediatric patients undergoing cancer care were assessed for association with three single-item symptoms and socio-demographic variables.

Results

Pediatric-PRO-CTCAE fatigue, pain, and anxiety severity scores at baseline were highly and significantly associated with the Medium and High Suffering profiles comprised of PROMIS pediatric symptom and function measures. The likelihood of membership in the Medium Suffering group was 11.37 times higher for patients who experienced fatigue severity than those with did not, while experience of pain severity increased the likelihood of the child’s membership in the Medium Suffering profile by 2.59 times and anxiety by 3.67 times. The severity of fatigue increased the likelihood of presence in the High Suffering group by 2.99 times while pain severity increased the likelihood of the child’s membership in the High Suffering profile by 6.36 times and anxiety by 16.75 times. Controlling for experience of symptom severity, older patients were more likely to be in the Higher or Medium Suffering profile than in the Low Suffering profile; no other socio-demographic or clinical variables had a significant effect on the latent profile classification.

Conclusion

Clinician knowledge of the strong association between fatigue, pain, and anxiety severity and suffering profiles may help focus supportive care to improve the cancer experience for children most at risk from time of diagnosis through treatment.

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Data availability

Data are available upon request from senior author.

Code availability

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Funding

This study was supported by the National Cancer Institute (R01CA175759) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (U19AR069522).

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Nebraska, Nebraska Medicine, Omaha, NE, 68198-2155, USA

    Meaghann S. Weaver

  2. National Center for Ethics in Healthcare, Washington, DC, USA

    Meaghann S. Weaver

  3. Department of Pediatrics, The George Washington University, Washington, DC, USA

    Jichuan Wang & Pamela S. Hinds

  4. Division of Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC, USA

    Jichuan Wang

  5. Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA

    Katie A. Greenzang

  6. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Molly McFatrich

  7. Department of Nursing Science, Professional Practice and Quality, Children’s National Hospital, Washington, DC, USA

    Pamela S. Hinds

Authors
  1. Meaghann S. Weaver
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  2. Jichuan Wang
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  3. Katie A. Greenzang
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  4. Molly McFatrich
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  5. Pamela S. Hinds
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Contributions

Meaghann Weaver, Jichuan Wang, Molly McFatrich, and Pamela Hinds contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jichuan Wang and Pamela Hinds. The first draft of the manuscript was written by Meaghann Weaver and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Meaghann S. Weaver.

Ethics declarations

Ethics approval

This study was approved by the Institutional Review Board Approval.

Consent to participate

Freely given, informed consent to participate in the study was obtained from participants (or their parent or legal guardian in the case of children under legal age of majority). Assent was additionally obtained from pediatric-age patients.

Consent for publication

Not applicable. Data de-identified.

Conflicts of interest

The authors declare no competing interests.

Role of funding/support

Dr Weaver contributed to this paper in a private capacity. No official support or endorsement by the U.S. Department of Veterans Affairs is intended, nor should be inferred.

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Appendix

Appendix

Table 4 Patient-reported outcome vocabulary and validated tools
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Weaver, M.S., Wang, J., Greenzang, K.A. et al. The predictive trifecta? Fatigue, pain, and anxiety severity forecast the suffering profile of children with cancer. Support Care Cancer 30, 2081–2089 (2022). https://doi.org/10.1007/s00520-021-06622-x

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  • DOI: https://doi.org/10.1007/s00520-021-06622-x

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