Self-assessment pain control in end-of-life children with bone tumors: a cohort study

Abstract

BACKGROUND: INCA estimated, for 2020 – 2022, Brazil would have 8,460 new pediatric cancer cases and 5% are bone cancer. Pain is the most prevalent symptom and is present in 75% - 90%. Advanced ill patients have 40% pain undertreated. OBJECTIVE: This study was to evaluate pain in pediatric bone cancer patients and investigate if there was a difference between those who survived and those at end-of-life. PROCEDURE: Patients were registered at INCA Pediatric Department, January 2011 – October 2016, with the diagnosis confirmed of primary bone cancer and under 19 years old. Pain was evaluated and registered at three moments during their treatment: at registration, three months after and the last visit before the end of this study or patients death, using pain scores. RESULTS: 157 patients were bone cancer, 15 (9.6%) had lost the follow up; 142 were analyzed, osteosarcoma 69.7% and Ewing sarcoma 30.3%, metastatic patients 50.7%. At the registration 53.5% had pain, 69.71% were receiving pain treatment and 42.25% had pain medications changed. Comparison of the three study moments was observed a decrease of pain status, with the absence of excruciating pain, and an increased use of opioids. There was no difference (p = 0.68) in pain status between groups of who survived and who died (39.4%). CONCLUSION: Pain management resulted in reduction of pain complaint and reduction in pain intensity, together with increasing opioid use. End-of-life patients did not have more pain than others, but disease progression was associated to more pain.