Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Cancer. 2021 May 15;127(10):1679-1689. doi: 10.1002/cncr.33303. Epub 2020 Dec 28.
Although survivors of childhood cancer are at risk of chronic pain, the impact of pain on daily functioning is not well understood.
A total of 2836 survivors (mean age, 32.2 years [SD, 8.5 years]; mean time since diagnosis, 23.7 years [SD, 8.2 years]) and 343 noncancer community controls (mean age, 35.5 years [SD, 10.2 years]) underwent comprehensive medical, neurocognitive, and physical performance assessments, and completed measures of pain, health-related quality of life (HRQOL), and social functioning. Multinomial logistic regression models, using odds ratios and 95% confidence intervals (95% CIs), examined associations between diagnosis, treatment exposures, chronic health conditions, and pain. Relative risks (RRs) between pain and neurocognition, physical performance, social functioning, and HRQOL were examined using modified Poisson regression.
Approximately 18% of survivors (95% CI, 16.1%-18.9%) versus 8% of controls (95% CI, 5.0%-10.9%) reported moderate to very severe pain with moderate to extreme daily interference (P < .001). Severe and life-threatening chronic health conditions were associated with an increased likelihood of pain with interference (odds ratio, 2.03; 95% CI, 1.62-2.54). Pain with daily interference was found to be associated with an increased risk of impaired neurocognition (attention: RR, 1.88 [95% CI, 1.46-2.41]; and memory: RR, 1.65 [95% CI, 1.25-2.17]), physical functioning (aerobic capacity: RR, 2.29 [95% CI, 1.84-2.84]; and mobility: RR, 1.71 [95% CI, 1.42-2.06]), social functioning (inability to hold a job and/or attend school: RR, 4.46 [95% CI, 3.45-5.76]; and assistance with routine and/or personal care needs: RR, 5.64 [95% CI, 3.92-8.10]), and HRQOL (physical: RR, 6.34 [95% CI, 5.04-7.98]; and emotional: RR, 2.83 [95% CI, 2.28-3.50]).
Survivors of childhood cancer are at risk of pain and associated functional impairments. Survivors should be screened routinely for pain and interventions targeting pain interference are needed.
尽管儿童癌症幸存者存在慢性疼痛风险，但疼痛对日常功能的影响尚不清楚。
共有 2836 名幸存者（平均年龄 32.2 岁[标准差 8.5 岁]；平均诊断后时间 23.7 岁[标准差 8.2 岁]）和 343 名非癌症社区对照者（平均年龄 35.5 岁[标准差 10.2 岁]）接受了全面的医学、神经认知和身体表现评估，并完成了疼痛、健康相关生活质量（HRQOL）和社会功能的测量。使用比值比和 95%置信区间（95%CI）的多分类逻辑回归模型，考察了诊断、治疗暴露、慢性健康状况与疼痛之间的关系。使用修正泊松回归检验了疼痛与神经认知、身体表现、社会功能和 HRQOL 之间的相对风险（RR）。
约 18%的幸存者（95%CI，16.1%-18.9%）报告有中度至重度疼痛，伴有中度至重度日常干扰，而对照组为 8%（95%CI，5.0%-10.9%）（P<.001）。严重和危及生命的慢性健康状况与疼痛伴干扰的可能性增加有关（比值比，2.03；95%CI，1.62-2.54）。发现疼痛伴有日常干扰与神经认知受损的风险增加有关（注意力：RR，1.88[95%CI，1.46-2.41]；记忆力：RR，1.65[95%CI，1.25-2.17]）、身体功能（有氧运动能力：RR，2.29[95%CI，1.84-2.84]；和移动能力：RR，1.71[95%CI，1.42-2.06]）、社会功能（无法工作和/或上学：RR，4.46[95%CI，3.45-5.76]；和需要日常和/或个人护理帮助：RR，5.64[95%CI，3.92-8.10]）和 HRQOL（身体：RR，6.34[95%CI，5.04-7.98]；和情绪：RR，2.83[95%CI，2.28-3.50]）。
儿童癌症幸存者存在疼痛和相关功能障碍的风险。应定期对幸存者进行疼痛筛查，并需要针对疼痛干扰的干预措施。
