Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
J Adolesc Young Adult Oncol. 2019 Dec;8(6):641-648. doi: 10.1089/jayao.2019.0029. Epub 2019 Jul 19.
Survivors of pediatric brain tumors (PBTs) are at high risk for medical late effects, including pain. Although pain is common at PBT diagnosis and during treatment, less is known about survivors' pain after completing therapy. This study examined the prevalence and correlates of pain in long-term PBT survivors enrolled on Project REACH (Research Evaluating After Cancer Health), a cohort study of locally treated cancer survivors. Participants were 116 PBT survivors (ages 13-32; 51% male; mean 10.6 years from diagnosis) who completed self-report measures of pain and quality of life (QOL). Survivors reporting "moderate pain" ≥2 days/week or "severe pain" ≥1 day/week were classified as pain cases. Correlates of pain were examined using logistic regression. In total 42 participants (36.2%) met pain case criteria with headache and muscular/skeletal pain most common sources of their worst pain (16 and 11 survivors, respectively). In adjusted analysis, pain cases were more likely to be female (odds ratio [OR] = 1.96, = 0.034), and less likely to be in the older age group (18-22 years) than younger (13-17 years) age group (OR = 0.232, = 0.006). No other demographic, disease, or treatment variables were associated with pain case status. Survivors categorized as pain cases reported inferior QOL across all domains of the PedsQL. A subset of PBT survivors experience significant pain that negatively impacts QOL years after completing therapy. Clinics caring for PBT survivors must incorporate appropriate pain assessment and treatment into standard care. Research is needed to better understand both risk factors and effective treatment strategies for pain in this vulnerable population.
儿童脑肿瘤 (PBT) 幸存者面临着较高的医疗晚期效应风险，包括疼痛。尽管在 PBT 诊断和治疗期间疼痛很常见，但对治疗完成后幸存者的疼痛知之甚少。本研究调查了登记在项目 REACH（研究评估癌症后的健康）中的长期 PBT 幸存者的疼痛患病率和相关性，这是一项对局部治疗癌症幸存者的队列研究。参与者为 116 名 PBT 幸存者（年龄 13-32 岁；51%为男性；诊断后平均 10.6 年），他们完成了疼痛和生活质量 (QOL) 的自我报告测量。报告“中度疼痛”≥2 天/周或“重度疼痛”≥1 天/周的幸存者被归类为疼痛病例。使用逻辑回归检查疼痛的相关性。共有 42 名参与者（36.2%）符合疼痛病例标准，头痛和肌肉/骨骼疼痛是他们最严重疼痛的最常见来源（分别有 16 名和 11 名幸存者）。在调整分析中，疼痛病例更可能是女性（优势比 [OR] = 1.96， = 0.034），并且不太可能属于较年轻（13-17 岁）年龄组，而更可能属于较年长（18-22 岁）年龄组（OR = 0.232， = 0.006）。其他人口统计学、疾病或治疗变量与疼痛病例状态无关。被归类为疼痛病例的幸存者在 PedsQL 的所有领域的 QOL 都较差。一部分 PBT 幸存者经历了严重的疼痛，对治疗完成后多年的 QOL 产生负面影响。照顾 PBT 幸存者的诊所必须将适当的疼痛评估和治疗纳入标准护理。需要研究来更好地了解这一弱势群体的疼痛风险因素和有效治疗策略。
