Chronic pain and posttraumatic stress disorder (PTSD) symptoms have been found to co-occur in adults; however, research has not examined this co-occurrence in adolescence, when pediatric chronic pain often first emerges. The aims of this study were to compare the frequency and intensity of PTSD symptoms and stressful life events in cohorts of youth with (n = 95) and without (n = 100) chronic pain and their parents and to determine the association between PTSD symptoms, health-related quality of life, and pain symptoms within the chronic pain sample. All participants completed questionnaire measures through an online survey. Findings revealed that youth with chronic pain and their parents had significantly higher levels of PTSD symptoms as compared with pain-free peers. More youth with chronic pain (32%) and their parents (20%) reported clinically significant elevations in PTSD symptoms than youth without chronic pain (8%) and their parents (1%). Youth with chronic pain also reported a greater number of stressful life events than those without chronic pain, and this was associated with higher PTSD symptoms. Among the chronic pain cohort, higher levels of PTSD symptoms were predictive of worse health-related quality of life and were associated with higher pain intensity, unpleasantness, and interference. Results suggest that elevated PTSD symptoms are common and linked to reduced functioning among youth with chronic pain. Future research is needed to examine PTSD at the diagnostic level and the underlying mechanisms that may explain why this co-occurrence exists.

Objective Somatic symptoms (e.g., pain, fatigue) are common after childhood cancer and are associated with greater fear of cancer recurrence and poorer health‐related quality of life (HRQoL). Qualitative studies indicate that survivors of childhood cancer (SCCs) worry about somatic symptoms as indicating cancer recurrence, which could in part explain associations between symptoms and poorer psychosocial outcomes. However, the prevalence, characteristics, and impact of symptom worry has not been quantitatively studied. Methods SCCs (N = 111; 52% female; Mage at study = 17.67 years, range = 8–25 years; Mage at diagnosis = 6.70 years) across a variety of diagnoses were recruited from a pediatric cancer center in Canada and completed self‐report measures of symptom worry, symptom frequency, general anxiety, fear of cancer recurrence, and HRQoL. Results A majority (62%) of SCCs worried about at least one symptom as a sign of recurrence. Pain was the most worrisome symptom, but SCCs also reported worrying about symptoms that are rarely associated with cancer recurrence such as hunger, dizziness, and feeling cold. Symptom worry was more strongly associated with fear of cancer recurrence than the mere frequency of those symptoms, and this relationship held while controlling for treatment factors and general anxiety. Symptom worry and frequency each explained unique variance in HRQoL. Conclusions Worry about somatic symptoms as a sign of cancer recurrence is common and may be impactful after childhood cancer. Excessive worry about somatic symptoms could be an important target to reduce fear of recurrence and increase HRQoL in SCCs.

Survivors of childhood cancer may be at risk of experiencing pain, and a systematic review would advance our understanding of pain in this population. The objective of this study was to describe: 1) the prevalence of pain in survivors of childhood cancer, 2) methods of pain measurement, 3) associations between pain and biopsychosocial factors, and 4) recommendations for future research. Data sources for the study were articles published from January 1990 to August 2019 identified in the PubMed, PsycINFO, EMBASE, and Web of Science data bases. Eligible studies included: 1) original research, 2) quantitative assessments of pain, 3) articles published in English, 4) cancers diagnosed between birth and age 21 years, 5) survivors at 5 years from diagnosis and/or at 2 years after therapy completion, and 6) a sample size >20. Seventy-three articles were included in the final review. Risk of bias was considered using the Cochrane risk of bias tool. The quality of evidence was evaluated according to Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. Common measures of pain were items created by the authors for the purpose of the study (45.2%) or health-related quality-oflife/health status questionnaires (42.5%). Pain was present in from 4.3% to 75% of survivors across studies. Three studies investigated chronic pain according the definition in the International Classification of Diseases. The findings indicated that survivors of childhood cancer are at higher risk of experiencing pain compared with controls. Fatigue was consistently associated with pain, females reported more pain than males, and other factors related to pain will require stronger evidence. Theoretically grounded, multidimensional measurements of pain are absent from the literature. Cancer 2021;127:35-44.

ObjectivesFear of cancer recurrence (FCR) has not been widely explored in survivors of childhood cancer. Yet, childhood survivors are at risk of experiencing late effects and may be especially vulnerable. The aims of the current study were to conduct a retrospective chart review to determine the prevalence and persistence of FCR among survivors of childhood cancer and to examine factors that may be related to FCR.MethodsSurvivors of childhood cancer (n = 228, mean attained age = 14.5 years [range = 4.7‐21 years]; mean diagnosis age = 4.4 years [range = 0‐16.5 years]; mean time off treatment = 8.7 years [range = 2.8‐19.3 years]) seen in a Long‐Term Survivor Clinic (LTSC) completed questionnaires at each clinic visit detailing their current health. FCR was measured with a single item. Data from questionnaires from 2011 to 2018 were analyzed retrospectively. Descriptive statistics and a random effects model were used to address study aims.ResultsFCR was reported in 43% (n = 98) of survivors at least once across all clinic visits. Among survivors reporting FCR at least once, 66% were diagnosed with cancer under the age of 5, and 64% were 13 years or older at their most recent follow‐up. Twenty‐one percent of survivors (n = 48/224) reported FCR during at least 50% of their visits. Survivors with a higher number of depressive symptoms were more likely to report FCR (OR = 1.66, P = .03).ConclusionsFCR is prevalent among survivors of childhood cancer and is related to other health concerns. Research is needed to understand who is at risk and how to.

Objective Fear of cancer recurrence (FCR) is a common and distressing psychosocial concern for adult cancer survivors. Data on this construct in child survivors is limited and there are no validated measures for this population. This study aimed to adapt the Fear of Cancer Recurrence Inventory‐Short Form (FCRI‐SF) for survivors of childhood cancer aged 8–18 years (Fear of Cancer Recurrence Inventory—Child version [FCRI‐C]) and their parents (Fear of Cancer Recurrence Inventory—Parent version [FCRI‐P]) to self‐report on their own FCR and to examine the initial psychometric properties. Methods The FCRI‐SF was adapted through expert panel input and cognitive interviews with child survivors <18 years. The factor structure, internal consistency and construct and criterion validity of the FCRI‐C and FCRI‐P were examined in 124 survivors of childhood cancer (43% female; Mage = 14.58 years, SD = 2.90) and 106 parents (90% mothers). Results All FCRI‐SF items were retained for the FCRI‐C with simplified language. The internal consistencies of the FCRI‐C (α = 0.88) and FCRI‐P (α = 0.83) were good. Exploratory factor analyses yielded one‐factor structures for both measures. Higher scores on the FCRI‐C and FCRI‐P were associated with greater intolerance of uncertainty and pain catastrophizing. Higher child FCR was also related to more hypervigilance to bodily symptoms. Parents with higher FCR reported contacting their child's doctors and nurses and scheduling medical appointments for their child more frequently. Children reported significantly lower FCR compared to parents. Conclusions The FCRI‐C and FCRI‐P demonstrated strong reliability and preliminary validity. This study offers preliminary data to support the use of the FCRI‐C and FCRI‐P to measure FCR in survivors of childhood cancer aged 8–18 years and their parents.

Many long-term survivors of childhood cancer (LTSCCs) experience late-and long-term effects from their treatments, including pain. Yet, pain is poorly understood among LTSCCs. The current study aims to 1a) identify rates and patterns of chronic pain 1b) describe multiple dimensions of pain, and 2) test predictors of chronic pain in LTSCCs. Survivors [n=140; 48.6% male, Mage=17.3 years (SD=4.9)] were recruited from across Canada. Participants completed the

Individuals suffering intolerably from a medical condition are legally able to request medical assistance in dying (MAiD) under certain circumstances. MAiD can either entail a physician or nurse practitioner prescribing fatal drugs for the patient to self-administer (physician-assisted suicide) or a physician directly administering lethal drugs (euthanasia). Whereas laws regulating MAiD have been in effect in different areas of the world since 1942, Canada only recently decriminalized MAiD in 2016. Individuals under the age of 18 years are not permitted to receive MAiD in Canada. Because legislation exists in other countries that permit MAiD, the current review aims to (a) review legislation and data pertaining to MAiD in Canada and other countries with particular attention on legislation for minors; (b) address important ethical considerations for extending MAiD services to minors in Canada; and (c) provide recommendations for amendments to current MAiD legislation in Canada based on the findings. Combining data from other countries with ethical implications for offering all options to relieve suffering, it is recommended that Canada extend MAiD legislation to mature minors with the inclusion of psychologists in the assessment of decision-making capacity and informed consent.

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