title: Current variations in childhood cancer supportive care in the Netherlands.
abstract: BACKGROUND
  Current treatment strategies in pediatric oncology are intensive and lead to high survival rates but also to treatment-related complications. Therefore, supportive care plays an increasingly important role. This study was designed to evaluate variations in supportive care practice in children with cancer in the Netherlands and adherence to selected existing international guidelines through an in-depth review of local guidelines and protocols at all 6 Dutch pediatric cancer centers.
  
  
  METHODS
  Based on shared expert opinion, a questionnaire regarding current supportive care practice was compiled. For each center, the required information was extracted from local supportive care guidelines, and the list was sent to a pediatric oncologist of that center to verify its correspondence with local daily practice. Subsequently, it was determined whether clinical practice was concordant (same in ≥ 5 of 6 centers), partly concordant (highly overlapping in ≥ 5 of 6 centers), or discordant (same in < 5 of 6 centers). Local practices were compared with strong recommendations from high-quality, evidence-based guidelines.
  
  
  RESULTS
  The questionnaire comprised 67 questions regarding supportive care practice. Concordance was observed for 11 of 67 practice items (16%), partial concordance was observed for 6 of 67 practice items (9%), and discordance was observed for 50 of 67 practice items (75%). Adherence to strong recommendations of 4 high-quality, evidence-based guidelines varied but was generally low.
  
  
  CONCLUSIONS
  Large variations exist in pediatric oncology supportive care practice, and this could negatively influence care. Adherence to existing evidence-based guidelines and the development and implementation of new clinical practice guidelines have the potential of standardizing supportive care practice and thereby improving outcomes for children with cancer.
authors.affiliation: Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Erik A H
authors.initials: EA
authors.lastname: Loeffen
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Renée L
authors.initials: RL
authors.lastname: Mulder
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marianne D
authors.initials: MD
authors.lastname: van de Wetering
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Font-Gonzalez
authors.affiliation: Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Floor C H
authors.initials: FC
authors.lastname: Abbink
authors.affiliation: Department of Pediatrics, Stem Cell Transplantation Unit, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Ball
authors.affiliation: Department of Pediatric Oncology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
authors.forename: Jan L C M
authors.initials: JL
authors.lastname: Loeffen
authors.affiliation: Department of Pediatric Oncology/Hematology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Erna M C
authors.initials: EM
authors.lastname: Michiels
authors.affiliation: Department of Hematology and Oncology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Heidi
authors.initials: H
authors.lastname: Segers
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Leontien C M
authors.initials: LC
authors.lastname: Kremer
authors.affiliation: Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Wim J E
authors.initials: WJ
authors.lastname: Tissing
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D019317:Evidence-Based Medicine; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000628:therapy*; D009426:Netherlands; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011832:Radiation Injuries / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects*; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents
keywords: childhood cancer; clinical practice guidelines; evidence-based medicine; practice variations; supportive care