1. PAIN IN HOSPITALIZED PORTUGUESE CHILDREN WITH CANCER
Fernandes, Ananda1; Batalha, Luís1; Campos, Diana1; Perdigão, Ana1; Oliveira, Armando2; Seabra, Sara3; Brito, Manuel3
1 Nursing School of Coimbr, Portugal; 2 Faculty of Psychology , University of Coimbra, Portugal; 3 Pediatric Department, University Hospital of Coimbra, Portugal
It is estimated that every year 17,5 per children below the age of 19 will be diagnosed with cancer. In Europe, in spite of some disparities between countries and regions, the survival rate for all cancers combined in children 0-14 years old is 79,1%. In the central and north region of Portugal there are 165 new cases of cancer in children and the results of the EUROCARE-5 study in children diagnosed between 1999 and 2007 show a survival rate of 78% in our country (1).
Survival, however, is not the only concern as these individuals are at risk of long term consequences and more likely to develop serious diseases in adulthood (2). Post-traumatic stress disorder has been reported in survivors of childhood cancer, related not only to the impact of the diagnosis but also to the exposure to distressing events throughout the course of treatment (3). Among sources of stress, physical effects of treatment, namely pain and sleep disturbances play a significant role (4) and may impair quality of life.
AIM The aim of this study was to characterize the pain experience of Portuguese children treated for cancer during hospitalization, regarding location, intensity and quality, and its relation to sleep and quality of life.
METHODS This was a prospective study. Children aged 8-17 years-old diagnosed with cancer and hospitalized in two Portuguese university hospitals participated between two and four consecutive days. The Adolescent Pediatric Pain Tool-PT was used to assess pain(5). Sleep data were obtained by means of a wrist actigraph. The PedsQL–Cancer Module3.0 was used to assess quality of life (6).
SAMPLE
PAIN CHARACTERISTICS
n = 75 Portuguese children
The majority (72%) completed all four assessments
More than 50% had leukemia
Analgesia was given at least once to 75% of the children
Presence
more than ½ reported pain at least once (66,7%)
22,7% reported pain during all days of hospitalization
Intensity
mean intensity varied between 1,9 – 2,1 (0-10 scale)
3-6% reported severe pain
Location
38,5% reported head & neck pain
Quality
evaluative & affective descriptors were predominant
(uncomfortable, annoying, awful)
persistent pain was present
(pressure, sore, aching)
SLEEP CHARACTERISTICS
Sleep percentage ,3±16,4% of the recorded time
Sleep efficiency ,3±21,2% (quality of sleep)
QUALITY OF LIFE
Self-report ,0 ±13,3 (0-100)
nausea & worry are reported as the two major problems
Parent-report ,3 ±15,0 (0-100)
procedural anxiety & worry are reported as the two major problems
Sleep characteristics & quality of life were not related to pain intensity
DISCUSSION
Since attention is given to analgesia, intensity may not be the most important feature of pain in cancer children.
The choice of evaluative & affective pain descriptors may be a sign of disruption caused by even mild pain.
CONCLUSION
Pain is still a frequent experience among hospitalized children with cancer, although it is usually of mild intensity. Pain assessment should include pain quality. It is necessary to recognize and address emotional and cognitive dimensions of pain experienced by these children. Pain management must move beyond analgesics to adding integrative approaches.
BIBLIOGRAPHY
1. Gatta G, Botta L, Rossi S, Aareleid T, Bielska-Lasota M, Clavel J, et al. Childhood cancer survival in Europe : Results of EUROCARE-5-a population-based study. Lancet Oncol. 2014;15:35–47.
2. Nathan PC, Greenberg ML, Ness KK, Hudson MM, Mertens AC, Mahoney MC, et al. Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2008;26:4401–9.
3. Kazak AE, Alderfer M, Rourke MT, Simms S, Streisand R, Grossman JR. Posttraumatic Stress Disorder (PTSD) and Posttraumatic Stress Symptoms (PTSS) in families of adolescent childhood cancer survivors. J Pediatr Psychol. 2004;29:211–9.
4. Jacob E, Hesselgrave J, Sambuco G, Hockenberry M. Variations in pain, sleep, and activity during hospitalization in children with cancer. J Pediatr Oncol Nurs. 2007;24(4):208–19.
5. Fernandes A, De Campos C, Batalha L, Perdigão A, Jacob E. Pain assessment using the Adolescent Pediatric Pain Tool: A systematic review. Pain Res Manag Jun 20;
6. Varni JW, Ph D, Burwinkle TM, Katz ER, Meeske K, Dickinson P, et al. The PedsQL TM in Pediatric Cancer Reliability and Validity of the Pediatric Quality of Life Inventory TM Generic Core. 2002;2090–106.
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