PDF(Pubmed)
Abstract：
OBJECTIVE: In current clinical practice, recommendations regarding restrictions in daily life for children with cancer are often lacking or not evidence-based. Critically reviewing the evidence and formulating recommendations are therefore of great importance as social restrictions (e.g., swimming, school attendance, sports) can impair the quality of life of these children severely. Therefore, our aim was to develop a clinical practice guideline for clinicians, children, and their parents regarding social restrictions in children with cancer.
METHODS: A comprehensive multidisciplinary panel was assembled, comprising 21 professionals and patient representatives. A systematic literature review was performed, including dual appraisal of all citations. The GRADE methodology was used to extract, summarize, and assess the evidence. Multiple in-person meetings were held to rank outcomes, discuss evidence, complete evidence-to-decision frameworks, and formulate recommendations. Final recommendations were unanimously supported by all panel members.
RESULTS: Six studies, including 758 children, formed the evidence base for the recommendations. Given the scarcity of the available evidence and various designs of studies in children with cancer, additional evidence was extracted from adult oncology guidelines, and shared expert opinions were utilized. In total, 14 recommendations were formulated of which multiple result in changes in current policy and standard of practice in the Netherlands. Topics covered in this guideline are swimming, having pets, visiting the zoo or farm, performing sports or high-velocity events, attending school or kindergarten, and use of public transport. This guideline is not intended to provide recommendations for patients after end of treatment, for palliative care settings, or for children undergoing a stem cell transplantation.
CONCLUSIONS: In this clinical practice guideline, we provide recommendations regarding restrictions in daily life in children with cancer. These include evidence-based recommendations and, in the absence of sufficient evidence, recommendations based on expert evidence. With these recommendations, we provide guidance for clinicians, children, and parents and contribute to improving quality of life for children with cancer.
METHODS: A comprehensive multidisciplinary panel was assembled, comprising 21 professionals and patient representatives. A systematic literature review was performed, including dual appraisal of all citations. The GRADE methodology was used to extract, summarize, and assess the evidence. Multiple in-person meetings were held to rank outcomes, discuss evidence, complete evidence-to-decision frameworks, and formulate recommendations. Final recommendations were unanimously supported by all panel members.
RESULTS: Six studies, including 758 children, formed the evidence base for the recommendations. Given the scarcity of the available evidence and various designs of studies in children with cancer, additional evidence was extracted from adult oncology guidelines, and shared expert opinions were utilized. In total, 14 recommendations were formulated of which multiple result in changes in current policy and standard of practice in the Netherlands. Topics covered in this guideline are swimming, having pets, visiting the zoo or farm, performing sports or high-velocity events, attending school or kindergarten, and use of public transport. This guideline is not intended to provide recommendations for patients after end of treatment, for palliative care settings, or for children undergoing a stem cell transplantation.
CONCLUSIONS: In this clinical practice guideline, we provide recommendations regarding restrictions in daily life in children with cancer. These include evidence-based recommendations and, in the absence of sufficient evidence, recommendations based on expert evidence. With these recommendations, we provide guidance for clinicians, children, and parents and contribute to improving quality of life for children with cancer.
摘要：
目的：在目前的临床实践中，关于癌症患儿日常生活限制的建议往往缺乏或没有循证依据.因此，严格审查证据和制定建议作为社会限制非常重要(例如，游泳,学校出勤率,运动）会严重损害这些孩子的生活质量。因此,我们的目标是为临床医生制定临床实践指南，孩子们,和他们的父母关于癌症儿童的社会限制。
方法：组建了一个综合的多学科小组，由21名专业人士和患者代表组成。进行了系统的文献综述，包括对所有引文的双重评估。等级方法用于提取，总结，并评估证据。举行了多次面对面会议，对结果进行排名，讨论证据,完整的证据决策框架，并提出建议。最后建议得到所有小组成员的一致支持。
结果：六项研究，包括758名儿童,形成了建议的证据基础。鉴于现有证据的缺乏和各种癌症儿童研究的设计，其他证据来自成人肿瘤学指南，并利用了共同的专家意见。总的来说,提出了14项建议，其中多项建议导致荷兰现行政策和实践标准的变化。本指南涵盖的主题是游泳，有宠物,参观动物园或农场，进行运动或高速比赛，上学或上幼儿园，和使用公共交通工具。本指南并不旨在为治疗结束后的患者提供建议。对于姑息治疗设置，或接受干细胞移植的儿童。
结论：在本临床实践指南中，我们提供了有关癌症儿童日常生活限制的建议.这些包括基于证据的建议和,在没有充分证据的情况下,基于专家证据的建议。有了这些建议,我们为临床医生提供指导，孩子们,和父母，并有助于提高癌症儿童的生活质量。
方法：组建了一个综合的多学科小组，由21名专业人士和患者代表组成。进行了系统的文献综述，包括对所有引文的双重评估。等级方法用于提取，总结，并评估证据。举行了多次面对面会议，对结果进行排名，讨论证据,完整的证据决策框架，并提出建议。最后建议得到所有小组成员的一致支持。
结果：六项研究，包括758名儿童,形成了建议的证据基础。鉴于现有证据的缺乏和各种癌症儿童研究的设计，其他证据来自成人肿瘤学指南，并利用了共同的专家意见。总的来说,提出了14项建议，其中多项建议导致荷兰现行政策和实践标准的变化。本指南涵盖的主题是游泳，有宠物,参观动物园或农场，进行运动或高速比赛，上学或上幼儿园，和使用公共交通工具。本指南并不旨在为治疗结束后的患者提供建议。对于姑息治疗设置，或接受干细胞移植的儿童。
结论：在本临床实践指南中，我们提供了有关癌症儿童日常生活限制的建议.这些包括基于证据的建议和,在没有充分证据的情况下,基于专家证据的建议。有了这些建议,我们为临床医生提供指导，孩子们,和父母，并有助于提高癌症儿童的生活质量。
