Klages Kimberly L, James Ryan N, Kain Zeev N, Phipps Sean, Alberts Nicole M, Fortier Michelle A
Division of Behavioral Medicine and Clinical Psychology and the Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital Medical Center, Memphis, TN, United States.
Front Psychol. 2025 Apr 29;16:1507560. doi: 10.3389/fpsyg.2025.1507560. eCollection 2025.
Cancer pain remains a significant burden among children with cancer, and many patients experience pain starting around the time of diagnosis and throughout the course of treatment. A biopsychosocial treatment approach has been recommended to improve pain management in this population; however, specific psychosocial factors that contribute to pain in the early phases of pediatric cancer treatment have yet to be identified. The purpose of this study was to explore the biopsychosocial factors associated with pain experiences during the early phases of pediatric cancer treatment, with the goal of identifying children who may be at the highest risk for pain to inform future intervention and prevention efforts.
Data were collected from 203 children with cancer ( = 12.3 years of age, 53.2% male, 41.4% White, 26.6% Latino) and their primary caregiver within the first several weeks of treatment ( = 10 weeks). Children completed self-report questionnaires and caregivers completed self- and parent-proxy questionnaires at baseline. Cancer-related data, including diagnosis and date of diagnosis, were abstracted from the child's electronic medical record. Multiple regression analysis was used to examine associations between biopsychosocial risk factors, pain intensity, and pain interference.
Older age, female gender, and elevated depressive symptoms, fatigue, and child self-reported pain catastrophizing were significantly associated with increased pain intensity. Additionally, lower annual income, decreased physical functioning, and greater fatigue, child pain catastrophizing, and parent stress were significantly associated with increased pain interference.
Findings underscore the importance of utilizing a comprehensive biopsychosocial approach to pain assessment and management in pediatric oncology. This approach highlights the need for targeted interventions that address not only the physical aspects of pain but also the psychological and social contexts of patients, ensuring a more holistic and effective treatment strategy.
癌症疼痛仍是患癌儿童面临的一项重大负担，许多患者在诊断前后及整个治疗过程中都会经历疼痛。推荐采用生物心理社会治疗方法来改善该群体的疼痛管理；然而，导致儿童癌症治疗早期疼痛的具体心理社会因素尚未明确。本研究的目的是探讨儿童癌症治疗早期与疼痛体验相关的生物心理社会因素，以便识别出疼痛风险最高的儿童，为未来的干预和预防工作提供依据。
在治疗的最初几周（平均10周）内，收集了203名患癌儿童（平均年龄12.3岁，53.2%为男性，41.4%为白人，26.6%为拉丁裔）及其主要照顾者的数据。儿童在基线时完成自我报告问卷，照顾者完成自我及家长代理问卷。从儿童的电子病历中提取癌症相关数据，包括诊断和诊断日期。采用多元回归分析来检验生物心理社会风险因素、疼痛强度和疼痛干扰之间的关联。
年龄较大、女性、抑郁症状加重、疲劳以及儿童自我报告的疼痛灾难化与疼痛强度增加显著相关。此外，年收入较低、身体功能下降、疲劳加重、儿童疼痛灾难化以及家长压力与疼痛干扰增加显著相关。
研究结果强调了在儿科肿瘤学中采用全面的生物心理社会方法进行疼痛评估和管理的重要性。这种方法凸显了针对性干预的必要性，这些干预不仅要解决疼痛的身体方面，还要关注患者的心理和社会背景，确保采取更全面、有效的治疗策略。
