The overlooked path to chronic pain in childhood cancer survivors: a thorough look at the literature and recommendations for clinical guidelines

Abstract

Cancer remains as the second most common cause of death among children aged 1 to 14 in the U.S.1 However, advancements in the treatment of childhood cancers have increased significantly over the last 30 years and now the survival rate for children living 5 years or more has grown to be 80%.2 This advancement is largely due to more aggressive protocols which can cause late effects down the line. Importantly, it is too soon for longitudinal studies to reveal the extent of the late effects of these treatments. With this statistic in mind, the focus on survivorship care for childhood cancer survivors must be on preventing the further progression of late effects while managing them appropriately when they arise. Late effects in childhood cancer survivors can be both physical (e.g. heart murmurs) and psychosocial (e.g. suicidal ideation). Children who receive treatments for their cancer are particularly at risk for developing late effects because their bodies are not fully developed at the time that they receive these treatments. One understudied late effect of childhood cancers is pain. Pain is a symptom of both cancer, cancer treatment, and survivorship that is often overlooked due to its ambiguity. Overall, pain is a thoroughly misunderstood and under-treated problem. Childhood cancer survivors are particularly prone to developing pain from their treatment plans whether it be chemotherapy, radiation, surgery, or a combination. Clinical guidelines for the management and prevention of pain in pediatric and adolescent cancer survivors are needed. The aim of this thesis is to present information on the pathways for the development of chronic pain in pediatric cancer survivors, highlight inconsistencies in literature, and present clinical guidelines for preventing and managing chronic pain.