Pain in long-term survivors of childhood cancer: A systematic review of the current state of knowledge and a call to action from the Children’s Oncology Group

Schulte FSM, Patton M, Alberts NM, Kunin-Batson A, Olson-Bullis BA, Forbes C, Russell KB, Neville A, Heathcote LC, Karlson CW, Racine NM, Charnock C, Hocking MC, Banerjee P, Tutelman PR, Noel M, Krull KR. Pain in long-term survivors of childhood cancer: A systematic review of the current state of knowledge and a call to action from the Children’s Oncology Group. Cancer. 2021 Jan 1;127(1):35-44. doi: 10.1002/cncr.33289. Epub 2020 Oct 28. PubMed PMID: 33112416; PubMed Central PMCID: PMC7875461.

Survivors of childhood cancer may be at risk of experiencing pain; a systematic review would advance our understanding of pain in this population. To describe: (i) the prevalence of pain in survivors of childhood cancer; (ii) methods of pain measurement; (iii) associations between pain and biopsychosocial factors; iv) recommendations for future research. Articles published from January 1990 to August 2019 identified in PubMed, PsycINFO, EMBASE, and Web of Science. Eligible studies included: 1) original research; 2) quantitative assessments of pain; 3) published in English; 4) a diagnosis of cancer between 0–21 years; 5) survivors at 5 years from diagnosis and/or 2 years from therapy completion; 6) sample size >20. Seventy-three articles were included in the final review. Risk of bias was considered using the Cochrane Risk of Bias Tool. Quality of evidence was evaluated according to the Grading of Recommendations Assessment Development and Evaluation criteria. Common measures of pain were items created by the authors for the purpose of the study (45.2%) or health-related quality of life/ health status questionnaires (42.5%). Pain was present in 4.3–75% of survivors across studies. Three studies investigated chronic pain according the definition by the International Classification of Diseases. Survivors of childhood cancer are at higher risk of experiencing pain compared to controls. Fatigue was consistently associated with pain. Females report more pain than males. Other factors related to pain require stronger evidence. Theoretically grounded, multidimensional measurements of pain are absent from the literature.