QOL-04. Managing headaches in pediatric neuro-oncology patients, a nationwide survey of providers

Abstract Background Headache is a frequently reported symptom among pediatric patients with brain tumors. Standards of care exist for headache management in this population. It is unknown what pediatric neuro-oncologists’ perspectives are about the perceived prevalence, confidence in management, or barriers to care that exist in this realm. Methods Sub-specialty membership lists were compiled create a population of 256 U.S. pediatric neuro-oncologists. Redcap was utilized to create surveys and capture participant data. A unique identifier was utilized to ensure confidentiality and single participant submission. Survey invitation was sent once with two subsequent reminders separated by one week. Results 29% response rate was obtained (75/256) with equal distribution of years in clinical practice (1-20yrs) and representative sampling from small, medium, and large institutions. Majority estimated headaches as a problem for 1-25% of their patients and not uncommon to incur health care costs and burdens of extra MRIs for headaches alone. Only 13.3% and 9.3% of physicians felt “very comfortable” managing abortive and preventative headache medications, respectively. Almost half (49.4%) were neutral to very uncomfortable managing abortive medications and the vast majority (70.2%) felt neutral to very uncomfortable managing preventative medications. Approximately half (52.7%) endorsed effective headache management, but restrictions related to oncology protocols, drug-drug interactions, or patient comorbidities were not significant perceived barriers (97.3%, 100%, and 77% of participants, respectively). Most physicians (77%) felt comfortable counseling on appropriate headache hygiene, but only half (56.8%) felt they have adequate time to counsel patients. Conclusions Pediatric neuro-oncologists across variable practices collectively indicated headaches affect 1–25% of their patients. Significant discomfort was reported in managing both abortive and preventative headache medications with only half of participants endorsing headaches are effectively managed during oncologic treatment. Time is a limiting factor and there are opportunities for improvement in management.