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Children
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Total Pain Management in Children with Cancer
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Total Pain Management in Children with Cancer

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Hematology & Oncology".

Deadline for manuscript submissions: closed (1 December 2021) | Viewed by 25223

Special Issue Editor

Dr. Karen Moody

E-Mail Website
Guest Editor
Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
Interests: communication; palliative care; cancer pain; pediatrics; integrative medicine; energy balance

Special Issue Information

Dear Colleagues,

The management of total pain remains an ongoing challenge in pediatric oncology. Pain primarily occurs as a direct effect of cancer, or due to procedures and cancer treatments. Pain (acute and chronic) is a common problem both during and after cancer treatment. Total pain management takes into account psychosocial and spiritual factors that can exacerbate the experience of physical pain. Despite the ongoing refinement of cancer treatment algorithms, pain management strategies are not commonly evaluated in prospective randomized clinical trials and therefore management remains quite variable and best practices are largely defined by expert consensus. Furthermore, the ongoing opioid crisis and resulting opioid medication regulation adds another layer of complexity to the management of both cancer and non-cancer pain in this population.

In this Special Issue, we will be emphasizing advances in and optimal strategies for managing total pain in children, adolescents, and young adults with cancer across the spectrum of active treatment, end of life, and survivorship. We welcome articles pertaining to all aspects of this topic, including non-pharmacological interventions, spiritual and psychosocial distress, as well as pharmacologic and interventional pain management. Articles reflecting points of intersection between cancer pain management and the opioid crisis are also welcome, as are reports concerning newly identified effects of drug interactions, the management of side effects, and the use of novel therapeutics. Reviews, original research articles, case studies, and manuscripts that identify significant knowledge gaps are welcome. In addition, papers that describe methodology for novel interventions are also acceptable. Outcomes related to pain, fatigue, function, safety, and quality of life are all of interest.

Dr. Karen Moody
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cancer pain
  • child
  • adolescent/young adult
  • neuropathic pain
  • psychosocial
  • palliative care
  • late effects

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Published Papers (12 papers)

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Editorial

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3 pages, 158 KiB  
Editorial
Interdisciplinary Collaborative Care to Manage Total Pain in Children with Cancer
by Karen M. Moody
Children 2022, 9(4), 562; https://doi.org/10.3390/children9040562 - 14 Apr 2022
Viewed by 1773
Abstract
The pain and suffering of children with cancer became national news in the winter of 2000 with the publication of Wolfe’s landmark paper in the New England Journal of Medicine, “Symptoms and Suffering Children with Cancer” [...] Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)

Research

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14 pages, 240 KiB  
Article
Bereaved Parent Perspectives on End-of-Life Conversations in Pediatric Oncology
by Rhonda Robert, Shehla Razvi, Lisa L. Triche, Eduardo Bruera and Karen M. Moody
Children 2022, 9(2), 274; https://doi.org/10.3390/children9020274 - 17 Feb 2022
Cited by 10 | Viewed by 2870
Abstract
Background: Professional education pertaining to end-of-life care with pediatric oncology patients is limited. Pediatric trainees learn about end-of-life conversations largely from the provider’s perspective. Bereaved parents can inform the education of oncologists and the interdisciplinary team by sharing their perceptions and preferences through [...] Read more.
Background: Professional education pertaining to end-of-life care with pediatric oncology patients is limited. Pediatric trainees learn about end-of-life conversations largely from the provider’s perspective. Bereaved parents can inform the education of oncologists and the interdisciplinary team by sharing their perceptions and preferences through personal narratives. Methods: The aim of this project was to enhance the healthcare teams’ understanding of bereaved parents’ end-of-life care preferences through narratives. Bereaved parents were recruited from our institution’s Pediatric Supportive Care Committee membership. Parents were tasked with identifying elements of care that were of the greatest importance to them, based upon their personal experiences during their child’s end-of-life care. Narratives were analyzed using standard qualitative methods. Results: Parents of five patients participated, including four mothers and three fathers. Ten themes summarizing essential elements of end-of-life care were identified, including early ongoing and stepwise prognostic disclosure, honoring the child’s voice, support of hope and realism, anticipatory guidance on dying, and continued contact with the bereaved. Conclusion: Bereaved parents emphasize the need for providers to have ongoing honest conversations that support realism and hope that can help them to best prepare for their child’s end of life and to remain in contact with them after death. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
12 pages, 1124 KiB  
Article
Pain and Analgesia in Children with Cancer after Hemipelvectomy: A Retrospective Analysis
by Vamshi R. Revuri, Karen Moody, Valerae Lewis, Rodrigo Mejia, Douglas J. Harrison and Ali H. Ahmad
Children 2022, 9(2), 237; https://doi.org/10.3390/children9020237 - 11 Feb 2022
Cited by 5 | Viewed by 3124
Abstract
A paucity of data exists centering on the pain experience of children following hemipelvectomy performed for primary bone and soft tissue sarcomas. In this study, we aimed to describe the incidence, severity, and evolution of perioperative pain and function in pediatric oncology patients [...] Read more.
A paucity of data exists centering on the pain experience of children following hemipelvectomy performed for primary bone and soft tissue sarcomas. In this study, we aimed to describe the incidence, severity, and evolution of perioperative pain and function in pediatric oncology patients undergoing hemipelvectomy, and, additionally, we sought to detail the analgesic regimens used for these patients perioperatively. A retrospective chart review was conducted, studying cancer patients, aged 21 years and under, who underwent hemipelvectomy at MD Anderson Cancer Center (MDACC) from 2018 to 2021. Primary outcomes included the evolution of pain throughout the perioperative course, as well as the route, type, dose, and duration of analgesic regimens. Eight patients were included in the analysis. The mean age at operation was 13 ± 2.93 years. All patients received opioids and acetaminophen. The mean pain scores were highest on post-operative day (POD)0, POD5, and POD 30. The mean opioid use was highest on POD5. A total of 75% of patients were noted to be ambulating after hemipelvectomy. The mean time to ambulation was 5.33 ± 2.94 days. The combination of acetaminophen with opioids, as well as adjunctive regional analgesia, non-steroidal anti-inflammatory drugs, gabapentin, and/or ketamine in select patients, appeared to be an effective analgesic regimen, and functional outcomes were excellent in 75% of patients. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
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16 pages, 571 KiB  
Article
Using the MDASI-Adolescent for Early Symptom Identification and Mitigation of Symptom Impact on Daily Living in Adolescent and Young Adult Stem Cell Transplant Patients
by Irtiza N. Sheikh, Jeffrey Miller, Basirat Shoberu, Clark R. Andersen, Jian Wang, Loretta A. Williams, Kris M. Mahadeo and Rhonda Robert
Children 2022, 9(1), 19; https://doi.org/10.3390/children9010019 - 29 Dec 2021
Cited by 4 | Viewed by 1905
Abstract
Hematopoietic stem cell transplantation (HSCT) requires an intensive pre- and post-procedure course that leads to symptoms including fatigue, nausea/vomiting, and pain, all of which interfere significantly with activities of daily living. These symptoms place a substantial burden on patients during the time period [...] Read more.
Hematopoietic stem cell transplantation (HSCT) requires an intensive pre- and post-procedure course that leads to symptoms including fatigue, nausea/vomiting, and pain, all of which interfere significantly with activities of daily living. These symptoms place a substantial burden on patients during the time period surrounding transplant as well as during long-term recovery. The MD Anderson Symptom Inventory (MDASI) is a symptom-reporting survey that has been successfully used in adult patients with cancer and may have utility in the adolescent and young adult (AYA) population. At the Children’s Cancer Hospital at MD Anderson Cancer Center, we adopted a modified version of the MDASI, the MDASI-adolescent (MDASI-Adol), as a standard of care for clinical practice in assessing the symptom burden of patients in the peri-transplant period. We then conducted a retrospective chart review to describe the clinical utility of implementing this symptom-screening tool in AYA patients admitted to our pediatric stem cell transplant service. Here, we report our findings on the symptom burden experienced by pediatric and AYA patients undergoing stem cell transplantation as reported on the MDASI-Adol. Our study confirmed that the MDASI-Adol was able to identify a high symptom burden related to HSCT in the AYA population and that it can be used to guide symptom-specific interventions prior to transplant and during recovery. Implementing a standard symptom-screening survey proved informative to our clinical practice and could mitigate treatment complications and alleviate symptom burden. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
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7 pages, 206 KiB  
Article
Development of an Enhanced Recovery Program in Pediatric, Adolescent, and Young Adult Surgical Oncology Patients
by Stephanie J. Wells, Mary Austin, Vijaya Gottumukkala, Brittany Kruse, Lauren Mayon, Ravish Kapoor, Valerae Lewis, Donna Kelly, Alexander Penny, Brent Braveman, Eliana Shkedy, Rebekah Crowder, Karen Moody and Maria C. Swartz
Children 2021, 8(12), 1154; https://doi.org/10.3390/children8121154 - 8 Dec 2021
Cited by 12 | Viewed by 3156
Abstract
Enhanced recovery after surgery (ERAS) protocols are standardized perioperative treatment plans aimed at improving recovery time in patients following surgery using a multidisciplinary team approach. These protocols have been shown to optimize pain control, improve mobility, and decrease postoperative ileus and other surgical [...] Read more.
Enhanced recovery after surgery (ERAS) protocols are standardized perioperative treatment plans aimed at improving recovery time in patients following surgery using a multidisciplinary team approach. These protocols have been shown to optimize pain control, improve mobility, and decrease postoperative ileus and other surgical complications, thereby leading to a reduction in length of stay and readmission rates. To date, no ERAS-based protocols have been developed specifically for pediatric patients undergoing oncologic surgery. Our objective is to describe the development of a novel protocol for pediatric, adolescent, and young adult surgical oncology patients. Our protocol includes the following components: preoperative counseling, optimization of nutrition status, minimization of opioids, meticulous titration of fluids, and early mobilization. We describe the planning and implementation challenges and the successes of our protocol. The effectiveness of our program in improving perioperative outcomes in this surgical population could lead to the adaptation of such protocols for similar populations at other centers and would lend support to the use of ERAS in the pediatric population overall. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)

Review

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10 pages, 219 KiB  
Review
Interventional Pain Management for the Pediatric Cancer Patient: A Literature Review
by Christina Le-Short, Kavya Katragadda, Neil Nagda, David Farris and Marianne Halphen Gelter
Children 2022, 9(3), 389; https://doi.org/10.3390/children9030389 - 10 Mar 2022
Cited by 8 | Viewed by 3925
Abstract
This literature review examines the use of interventional treatments for pain management in pediatric cancer patients. While interventional procedures may be effective in cancer pain management, these procedures are infrequently employed in pediatric cohorts. This underutilization of interventional procedures may be supported by [...] Read more.
This literature review examines the use of interventional treatments for pain management in pediatric cancer patients. While interventional procedures may be effective in cancer pain management, these procedures are infrequently employed in pediatric cohorts. This underutilization of interventional procedures may be supported by a deficit in randomized, controlled studies and literature regarding their role in pediatric cancer populations. Particularly because literature on the efficacy of interventional treatments in adult populations may not directly translate to pediatric populations, more research about the role of interventional procedures in managing pediatric cancer pain is necessary for a strengthened understanding of pediatric cancer pain treatment. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
8 pages, 965 KiB  
Review
Psychosocial Distress Due to Interference of Normal Developmental Milestones in AYAs with Cancer
by Nelda Itzep and Michael Roth
Children 2022, 9(3), 309; https://doi.org/10.3390/children9030309 - 24 Feb 2022
Cited by 12 | Viewed by 3358
Abstract
Cancer in the adolescent and young adult phase poses additional challenges to this period of development that is crucial to the transition to independence. This report provides a brief review of normal developmental milestones in this age range while highlighting the disruptive effects [...] Read more.
Cancer in the adolescent and young adult phase poses additional challenges to this period of development that is crucial to the transition to independence. This report provides a brief review of normal developmental milestones in this age range while highlighting the disruptive effects of cancer. We focus on the psychological burden of cancer in patients aged 15–39 years and explore the application of the total pain model to highlight the psychological/emotional, social, and spiritual aspects of non-physical pain. We also briefly review posttraumatic growth and resilience. Lastly, we provide a review of areas for possible development and future research. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
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8 pages, 226 KiB  
Review
Addressing Common Pain Syndromes in Pediatric Stem Cell Transplant: A Review
by Avis Harden, Kimberly Kresta and Nelda Itzep
Children 2022, 9(2), 139; https://doi.org/10.3390/children9020139 - 21 Jan 2022
Cited by 2 | Viewed by 2561
Abstract
Assessment and management of pain for pediatric patients receiving stem cell transplants can be challenging for a health care team. Diagnostic evaluation and interventions vary between institutions and individual provider practices. In this review, we investigate and describe approaches to pain management for [...] Read more.
Assessment and management of pain for pediatric patients receiving stem cell transplants can be challenging for a health care team. Diagnostic evaluation and interventions vary between institutions and individual provider practices. In this review, we investigate and describe approaches to pain management for the most common sources of pain in pediatric patients undergoing stem cell transplants. Mucositis pain, abdominal pain, and hemorrhagic cystitis emerged as the most frequent sources of acute pain in children during conditioning and transplantation periods. Furthermore, psychosocial distress and psychological pain or distress constitute significant components of the total pain experienced by children undergoing stem cell transplantation. We will expand upon appropriate usage and escalation of opioids, as well as complementary interventions and timely initiation of interventions, in order to help control pain in these clinical syndromes. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
11 pages, 242 KiB  
Review
Collaborative Legacy Building to Alleviate Emotional Pain and Suffering in Pediatric Cancer Patients: A Case Review
by Laura Cahalan, Ashley Smith, Melissa Sandoval, Gwendolyn Parks and Zachary Gresham
Children 2022, 9(1), 33; https://doi.org/10.3390/children9010033 - 1 Jan 2022
Cited by 7 | Viewed by 3476
Abstract
Childhood cancer patients experience emotional hardship associated with their life-threatening diagnoses. Interdisciplinary team members working in pediatric cancer care can help alleviate physical pain and psychological suffering of children by facilitating collaborative legacy-building activities with patients and families. The contents of this article [...] Read more.
Childhood cancer patients experience emotional hardship associated with their life-threatening diagnoses. Interdisciplinary team members working in pediatric cancer care can help alleviate physical pain and psychological suffering of children by facilitating collaborative legacy-building activities with patients and families. The contents of this article aim to support legacy building as a medium for emotional healing prior to the end of life. The authors use a case review to contextualize legacy-building projects and provide a comprehensive overview of methods and considerations for these initiatives. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
15 pages, 805 KiB  
Review
Educational Pain Points for Pediatric Brain Tumor Survivors: Review of Risks and Remedies
by Peter L. Stavinoha, Thuy Trinh-Wong, Laura N. Rodriguez, Chawncey M. Stewart and Kris Frost
Children 2021, 8(12), 1125; https://doi.org/10.3390/children8121125 - 3 Dec 2021
Cited by 18 | Viewed by 3321
Abstract
Evolving treatment paradigms have led to increased survival rates for children diagnosed with a brain tumor, and this has increasingly shifted clinical and research focus to morbidity and quality of life among survivors. Among unfavorable outcomes, survivors of pediatric brain tumors are at [...] Read more.
Evolving treatment paradigms have led to increased survival rates for children diagnosed with a brain tumor, and this has increasingly shifted clinical and research focus to morbidity and quality of life among survivors. Among unfavorable outcomes, survivors of pediatric brain tumors are at risk for academic failure and low educational attainment, which may then contribute to lower health related quality of life, lower income and vocational status, and a greater likelihood of dependence on others in adulthood. Several specific risk factors for lower educational performance and attainment have been investigated. These are typically examined in isolation from one another which clouds understanding of the full range and potential interplay of contributors to educational difficulties. This review integrates and summarizes what is known about the direct and indirect barriers to educational success and performance (i.e., educational pain points) to enhance clinician knowledge of factors to consider when working with pediatric brain tumor survivors. Specific barriers to educational success include neurocognitive difficulties, school absences, psychosocial challenges, challenges to knowledge and communication, and physical and sensory difficulties. Finally, we discuss the current state of educational interventions and supports and offer recommendations for future research to improve educational outcomes for pediatric brain tumor survivors. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
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20 pages, 1864 KiB  
Review
Prevalence of Sleep Disturbances in Pediatric Cancer Patients and Their Diagnosis and Management
by Irtiza N. Sheikh, Michael Roth and Peter L. Stavinoha
Children 2021, 8(12), 1100; https://doi.org/10.3390/children8121100 - 29 Nov 2021
Cited by 11 | Viewed by 6600
Abstract
Sleep disturbances represent an understudied yet common source of distress among pediatric cancer patients and survivors, with deleterious effects on quality of life. Sleep issues stem from multiple risk factors, yet individual contributors are difficult to isolate, consequently impeding the identification of targets [...] Read more.
Sleep disturbances represent an understudied yet common source of distress among pediatric cancer patients and survivors, with deleterious effects on quality of life. Sleep issues stem from multiple risk factors, yet individual contributors are difficult to isolate, consequently impeding the identification of targets for intervention. In many pediatric cancer patients, disrupted sleep and its negative impact on quality of life continue into adulthood and may affect various functional domains. This literature review highlights the types and prevalence of sleep disturbances in pediatric cancer patients during active treatment and through survivorship. Potential etiological and risk factors for disturbed sleep are summarized, including the effects of cancer and its treatment, psychosocial and family factors, as well as individual-patient aspects, such as genetics, mood and coping skills. While existing assessment and management strategies are reviewed, the literature is incomplete, and significant gaps emerge in our understanding of sleep disturbances in pediatric cancer patients and survivors. The review concludes with recommendations of areas where further research is needed. The aims of this review include increasing clinicians’ awareness of sleep disturbances as a significant source of poor quality of life in pediatric cancer patients and survivors and directing researchers to gaps in our understanding of sleep disturbances in pediatric cancer patients and survivors. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
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Other

11 pages, 898 KiB  
Project Report
Totally Excited about Moving Mobility and Exercise (TEAM Me): A Successful Multidisciplinary Exercise Quality Improvement Initiative for Pediatric and Young Adult Oncology and Stem Cell Transplant Inpatients
by Angela M. Shaw, Rhonda Robert, Kimberly Kresta, Clark R. Andersen, Betsy Lewis, Brittni Maetzold, Raymund Valderrama, Ian Cion and Priti Tewari
Children 2022, 9(2), 186; https://doi.org/10.3390/children9020186 - 2 Feb 2022
Cited by 4 | Viewed by 2070
Abstract
Background: Pediatric, adolescent and young adult (PAYA) patients are less active than their healthy counterparts, particularly during inpatient stays. Methods: We conducted a quality improvement initiative to increase activity levels in patients admitted to our pediatric oncology and cellular therapy unit using a [...] Read more.
Background: Pediatric, adolescent and young adult (PAYA) patients are less active than their healthy counterparts, particularly during inpatient stays. Methods: We conducted a quality improvement initiative to increase activity levels in patients admitted to our pediatric oncology and cellular therapy unit using a Plan-Do-Study-Act (PDSA) model. An interdisciplinary team was assembled to develop an incentive-based inpatient exercise and activity program titled Totally Excited About Moving Mobility and Exercise (TEAM Me). As part of the program, patients were encouraged by their care team to remain active during their inpatient stay. As an additional incentive, patients earned stickers to display on TEAM Me door boards along with tickets that could be exchanged for prizes. Activity was assessed by documentation of physical therapy participation, tests of physical function, and surveys of staff perceptions of patient activity levels, motivations, and barriers. Results: Compared to baseline, patient refusals to participate in physical therapy decreased significantly (24% vs. 2%) (p < 0.02), and staff perceptions of patient motivation to stay active increased from 40% to 70% in the post implementation period. There were no changes in physical function tests. Conclusions: An incentive-based exercise program for young oncology inpatients greatly improved patient activity levels, participation in physical therapy and influenced professional caregivers’ beliefs. Full article
(This article belongs to the Special Issue Total Pain Management in Children with Cancer)
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