Symptom Assessment and Management Across the Cancer Trajectory

Children undergoing cancer treatment experience substantial symptom burden related to the disease, treatment, and alterations in family life. Not surprisingly, children receiving cancer-directed therapy as well as survivors of childhood cancers have reported poorer psychological, social, and physical health-related quality of life as compared to siblings, same-age peers, and children with other chronic conditions. Too often, symptoms are seen by patients, families, and providers as part of the treatment process leading to a complex interaction of underreporting of symptoms by children and parents and under-recognition of the extent of symptom burden by providers. The obligation to relieve pain and suffering related to disease is inherent in both medical and nursing codes of ethics related to principles of beneficence, patient autonomy, and veracity. It is incumbent on health-care providers to attend to the known symptom burden of children and their family members by engaging in open and honest conversations aimed at establishing the expectation that symptoms will be managed to the best of their ability to maximize quality of life and minimize unnecessary suffering.