Symptoms in Children Receiving Treatment for Cancer—Part II: Pain, Sadness, and Symptom Clusters

Abstract

Children and adolescents receiving treatment for cancer experience multiple symptoms as a consequence of their disease and its treatment that interfere with the child’s quality of life. Understanding of symptom assessment in children with cancer is foundational to the work of the Children’s Oncology Group Nursing Discipline, whose research aims are to address knowledge gaps including understanding illness-related distress. This article is the second of a two-part summary of current evidence addressing the assessment of symptoms frequently reported by children and adolescents receiving treatment for cancer. Studies reporting assessment of pain, sadness, and symptom clusters published between January 2008 and May 2018 were included. Forty-three publications addressed pain. Pain was highly prevalent and distressing, varied in its trajectory across a cycle of chemotherapy and across multiple cycles of treatment, and correlated with biomarkers associated with the pain response. Consequences of pain were poorer functional status and emotional health. Twenty publications addressed sadness. Sadness was the most prevalent psychosocial symptom. Its prevalence decreased over the course of treatment and over a cycle of chemotherapy. Persistent sadness was of greater severity and distress. Eight publications addressed symptom clusters. These studies identified both groups of co-occurring symptoms and groups of patients with common symptom profiles. This two-article series provides evidence for the distressing nature of symptoms among children receiving cancer treatment. Efforts to support clinicians in routine symptom assessment are needed. Additional research directed at alleviating symptoms and building resilience among the child experiencing symptoms is needed.

Electronic Symptom Assessment in Children and Adolescents With Advanced Cancer Undergoing Hematopoietic Stem Cell Transplantation

“…Feeling sad was the most prevalent psychological symptom for children undergoing HSCT and those of the non-HSCT cohort. This finding is consistent with a systematic review by Linder and Hooke (2019) who found that 15% to 61% of children undergoing cancer treatment experienced sadness. Children with relapsed or progressive disease may be at risk for persistent sadness given the data suggesting that sadness can present during initial treatment for cancer.…”

Clinical validity of the PROMIS pediatric sleep short forms in children receiving treatment for cancer

“…In response to recent calls for the systematic study of sleep 10 and symptom burden 20,21 in pediatric cancer, the current study assessed the reliability and clinical validity of the PROMIS pediatric sleep scales…”

Pain at home during childhood cancer treatment: Severity, prevalence, analgesic use, and interference with daily life

“…Previous studies have also revealed the negative impact of pain on quality of life, distress, burden of physical and psychological symptoms, affect, and sleep. 7,27,[31][32][33][34] It is therefore imperative to closely monitor pain in these children in the home setting. We believe that the use of ecological momentary assessments (ie, real-time pain assessment in the subject's natural environment 57 ) over a prolonged period of time is the most reliable source to collect data on pain in the home setting.…”

“…In some cases, undertreatment of pain during childhood cancer treatment can cause sensitization to pain stimuli, causing pain to persist postcancer treatment 26 . Pain has been reported as very stressful by children with cancer, 30 and it interferes with their quality of life 31 . Furthermore, it has been associated with high levels of patient distress, 27,32 greater burden from physical and psychological symptoms, 33 negative affect, 34 and sleeping problems 7,33 .…”

“…26 Pain has been reported as very stressful by children with cancer, 30 and it interferes with their quality of life. 31 Furthermore, it has been associated with high levels of patient distress, 27,32 greater burden from physical and psychological symptoms, 33 negative affect, 34 and sleeping problems. 7,33 In childhood cancer survivors, it has been associated with greater emotional distress and suicidal ideation.…”