News|Articles|February 20, 2026
Integrating ePROs with Palliative Care Improves QOL in Pediatric Cancer
Author(s)Paige Britt
Fact checked by: Sabrina Serani
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Key Takeaways
- Electronic PRO collection produced meaningful benefit when it triggered rapid, tailored palliative actions rather than functioning as passive symptom surveillance.
- PedsQL gains favored the intervention overall (Δ 3.45; P=.023) and for physical HRQOL (Δ 4.61; P=.032), with concordant child- and parent-reported improvements.
Electronic symptom reports plus pediatric palliative care improve physical quality of life in advanced childhood cancer when follow-up is consistent.
The PediQUEST Response study demonstrated that integrating electronic patient-reported outcome (PRO) systems with specialized pediatric palliative care (SPPC) can significantly improve the health-related quality of life (HRQOL) for children with advanced cancer. Conducted across 5 US tertiary-level pediatric cancer centers, the study emphasized that electronic monitoring is most effective when it triggers immediate, personalized clinical action rather than serving as a passive monitoring tool.1,2
While the primary findings showed statistically significant improvements—particularly in physical HRQOL—the magnitude of improvement across the entire study population did not consistently exceed the "minimally clinically important difference" (MCID). However, sensitivity analyses and site-specific data suggest that the intervention's efficacy is heavily dependent on implementation consistency. At clinical sites with the highest adherence to the palliative care protocol, the benefits were markedly more pronounced and exceeded clinical significance thresholds.
Key Findings and Outcomes
The study measured outcomes using the Pediatric Quality of Life Inventory (PedsQL-4.0), where higher scores indicate better HRQOL. The primary outcome was the difference between the 16-week average and baseline scores.
The intervention group showed greater improvements in HRQOL compared with the control group. The PQ Response group showed a mean difference of 3.45 points (P =.023) over the control group. Significant improvements were noted in the physical subscale, with a mean difference of 4.61 points (P =.032). Children in the intervention group reported improvements similar to those reported by their parents.
The MCID for this study was set at 4.5. In the primary intention-to-treat analysis, the overall improvements (3.45) fell just short of this threshold. However, sensitivity analyses indicated that physical HRQOL scores and several child-reported symptom scores did exceed the MCID.
The study did not observe significant improvements in PedsQL-psychosocial scores or overall symptom scores in the primary analysis. Researchers attribute this to several factors: heterogeneity of cancer types among participants, and variable implementation of the palliative protocol across different clinical sites.
Overview of the PediQUEST Response Study
The study addressed the urgent clinical challenge of reducing suffering in children with advanced cancer. While specialized palliative care is a standard of care for adults, its application in pediatrics remains inconsistent.
The PediQUEST Response intervention sought to bridge this gap by combining systematic electronic feedback from patients and parents with a responsive, specialized palliative care team that could act on reported symptoms such as pain, nausea, and fatigue.
The trial was a multicenter, open-label study conducted between April 2018 and December 2021.
A total of 154 patients were enrolled in the study, with 74 patients in the intervention group and 80 in the usual care group. Children aged 2 years and older with advanced cancer were eligible for the study. The mean age of patients was 11 years old. The majority of the patients were White (78%).
Patients in the control group received "usual care," which included routine oncology visits and treatment. Both parents and children (aged 5+) completed weekly electronic surveys for monitoring purposes.
In addition to standard care and weekly surveys, the intervention group received:
- SPPC consultations.
- Routine electronic feedback provided to clinicians and families.
- Personalized pharmacological and non-pharmacological recommendations based on reported symptoms.
- Additional palliative support check-ins.
Conclusion
The PediQUEST Response trial suggests that specialized pediatric palliative care, when driven by electronic PROs, offers a viable pathway to improving the quality of life for children with advanced cancer. While the trial faced challenges regarding consistency across clinical sites, the positive results at high-adherence locations provide a blueprint for future integrated care models. No adverse events were reported, supporting the safety of this integrated approach.
“Our results show that integrating early palliative care is promising, but requires consistent delivery to be effective,” said senior author Joanne Wolfe, MD, MPH, physician-in-chief at Mass General Brigham for Children, in a news release from Mass General Brigham.2 “Study sites with better adherence to the palliative care protocol saw more clinically meaningful benefits, showing that implementation matters.”
REFERENCES
1.Dussel V, Orellana L, Requena M, et al. Integrating electronic patient-reported outcomes and palliative care in pediatric advanced cancer: the PediQUEST Response multisite randomized controlled trial. J Clin Oncol. Published February 4, 2026. Accessed February 17, 2026. doi: 10.1200/JCO-25-01036.
2.Personalized palliative care shows signs of improving quality of life for children with advanced cancer. News release. Mass General Brigham. Published February 4, 2026. Accessed February 17, 2026. https://tinyurl.com/3mtpebnb
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