More Voices Are Better When It Comes to Symptom and Toxicity Reporting

By Dustin Samples - Last Updated: January 24, 2023

According to a new editorial in Cancer Nursing, multiple, not singular, voices should be the gold standard in pediatric symptom and treatment toxicity reporting.

Prior to a shift toward child/adolescent self-reporting, the gold-standard had been reporting by treating clinicians. With technological advances in the ability to self-report or have caregivers report symptoms and treatment toxicity, studies have demonstrated discrepancies between self/caregiver reports and clinician reports. Because of these discrepancies, there has been a shift towards self-reporting as the gold-standard.

Regardless of from whom the reporting comes, the commonality has been that one voice is more important than others. Whether the clinician or the patient, the trend has largely been that one perspective is more correct.

According to the editorial by lead author Pamela S. Hinds, PhD, Department of Nursing Science, Professional Practice & Quality, Children’s National Hospital, Washington, DC, it is essential that clinicians, caregivers, and patients act as a “triad of voices to accurately and fully grasp and then address the pediatric oncology symptom and toxicity experiences.” This is quite a different take than the traditionally accepted belief that one voice is more accurate than others, whichever that voice may be.

The crux of the authors’ argument is that “listening to the voices from those that know the child (including the child’s voice) is essential, because each contributes complementary clinically relevant information. Only the diagnosed child can disclose to us his/her internal experience of subjective symptoms and toxicities secondary to treatment. Only the family caregiver can describe the functional impact of the diagnosis and/or the most recent treatment on the child or adolescent in diverse settings (eg, home, school), allowing us to see treatments’ impact over time. Only the clinician can compare how this child or adolescent is faring compared with all others enrolled in the same clinical trial and at the same point in treatment.”

This take on the accuracy of reporting as having to do with a complete, multi-faceted perspective may be novel, but its merit seems obvious. The challenge will be figuring out the best ways to incorporate patient/caregiver voices into clinical reporting.

The authors concluded, “We fully expect that we, as clinicians and researchers, will be uncertain initially about how to include the different voices into an actionable treatment plan moving forward. We shall need to develop clinical strategies for discussing the diverse perspectives and what they mean for care of this ill child at this time.”


One voice is good, but more is better: symptom and toxicity reporting in pediatric oncology.