Managing childhood cancer pain into survivorship: recognition and emerging principles

Abstract

Purpose of review Continual refinement and further stratification of childhood cancer treatment has led to increased survivorship with recognized improvements in many long-term health outcomes. Despite this progress, persisting pain prevalence in childhood cancer survivors is increasing and emerging as a significant long-term health concern. Recent findings Currently, there is no guidance on how to approach and manage persisting pain in survivors of childhood cancer. Summary Clinicians should work with children and young people to optimize the management of pain and other symptoms on treatment. Focusing on an early post treatment screening for pain and other symptoms (including sleep and fatigue), and the role of on-going analgesic use. Follow-up should offer a multidisciplinary approach, aimed at lessening reliance on pharmacological approaches to pain management, addressing psychological concerns and promoting increased physical activity. The onus is on clinicians to mitigate the long-term risk of pharmacological reliance, particularly opioid dependency, in patients leaving their care and heading into adulthood. In this article, we highlight the emerging evidence of persisting pain in survivors of childhood cancer as a significant long-term health outcome and consider some initial principles of management.

Pain, depressive symptoms, and health‐related quality of life among survivors of pediatric hematopoietic stem cell transplant

“…Overall, our data indicate that survivors of pediatric HCT generally experience nonclinical levels of pain intensity, depressive symptoms, and HRQoL post HCT. These results suggest that survivors that are at least 1 year post HCT are doing generally well and better than expected based on previous studies 8,11,36 . However, similar to previous research among survivors of pediatric cancer and youth with chronic pain, 5,17–21,37 survivors of pediatric HCT who reported greater pain intensity endorsed increased depressive symptoms.…”

“…[2][3][4][5] Pain is one of the most prominent and debilitating late effects among youth who have received intensive chemotherapy treatments, 6,7 and approximately 21%-75% of survivors of pediatric HCT struggle with debilitating pain. [8][9][10][11][12][13] This is concerning as persistent pain is linked to a number of long-term adverse health and socioeconomic outcomes, including greater physical and mental health problems, substance misuse or abuse, greater healthcare utilization and costs, lower educational attainment, unemployment, and less financial security in the general population. [14][15][16] Among survivors of pediatric cancer, greater pain intensity is associated with increased depressive symptoms.…”

“…Although survival rates are increasing (currently estimated at 58%–77%), treatment is associated with significant late effects (i.e., therapy‐related sequelae that persist or arise after completion of treatment) that negatively impact the physical and psychosocial functioning of survivors 2–5 . Pain is one of the most prominent and debilitating late effects among youth who have received intensive chemotherapy treatments, 6,7 and approximately 21%–75% of survivors of pediatric HCT struggle with debilitating pain 8–13 . This is concerning as persistent pain is linked to a number of long‐term adverse health and socioeconomic outcomes, including greater physical and mental health problems, substance misuse or abuse, greater healthcare utilization and costs, lower educational attainment, unemployment, and less financial security in the general population 14–16 …”