Less restrictions in daily life: a clinical practice guideline for children with cancer
Support. care cancer; 32 (7), 2024
Publication year: 2024
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.
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. 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. 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 sufcient 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.