Pediatric Cancer: An App For Pain Management
Pain, a pervasive and troubling symptom in childhood cancer, manifests in a significant portion of patients, affecting between 40% to 78% of those undergoing treatment. This distressing experience can arise either directly from the illness itself or as an adverse effect of the treatments administered.
The evolution of contemporary treatment modalities has facilitated a shift towards home-based care, affording patients greater comfort and flexibility in their surroundings. However, this transition also entails a heightened responsibility for pain management, primarily falling upon the shoulders of caregivers and parents.
Within the realm of home care, parental misconceptions and anxieties regarding pain and its treatment often surface, contributing to the underestimation or neglect of pain management protocols. When pain is inadequately addressed or untreated, it can precipitate a cascade of adverse consequences.
Notably, undertreated pain may sensitize the nervous system, leading to increased pain sensitivity over time. Moreover, it can exacerbate emotional distress, instigating heightened levels of anxiety and psychological morbidity among pediatric cancer patients. These repercussions underscore the critical importance of proactive and comprehensive pain management strategies within the home environment. Moreover, parental emotional distress can negatively impact a child’s ability to cope with cancer treatment. Despite effective pain treatments being available, pain management at home remains suboptimal, indicating a need for interventions.
The researchers developed a pain monitoring app aimed at improving pain management and ultimately reducing clinically significant pain in children with cancer at home. The app provides families with educational information regarding pain management and offers real-time healthcare professional feedback following clinically significant pain scores. A previous study demonstrated the feasibility of the app. Smartphone apps have been developed and trialed for other conditions as well.
In this randomized controlled trial (RCT), the researchers compared an intervention group (using the pain monitoring app for home settings) to a control group (receiving usual care) to assess whether the app’s use yielded a lower prevalence of clinically significant pain in children with cancer at home (aim 1). Additionally, they compared pain severity, duration, interference, pain management strategies, and parental emotional well-being between the two groups (aim 2). Finally, the researchers evaluated the app’s use, acceptability, and relevance among children and parents in the intervention group (aim 3).
Overview
The study aimed to address pain management for children with cancer at home by introducing a pain monitoring app. This app provided educational resources and real-time feedback from healthcare professionals specifically tailored to clinically significant pain levels (rated as greater than 4 on the numeric rating scale [NRS]-11). The goal was to utilize this technology to alleviate pain experienced by pediatric cancer patients in a home setting.
Study Methods
In this monocenter, non-blinded randomized controlled trial conducted in the Netherlands, children aged 0–18 years undergoing cancer treatment were eligible for enrollment. To be included, participants had to be at least three months post-diagnosis with a minimum of two months of treatment remaining. The children were randomly assigned to one of two parallel groups: the intervention group, which utilized the pain monitoring app, or the control group, which received usual care.
The primary objective of the study (aim 1) was to evaluate whether the use of the pain monitoring app resulted in a reduction of clinically significant pain in pediatric cancer patients. Clinically significant pain was defined as a score above a certain threshold on a numeric rating scale. Additionally, the researchers aimed to investigate the impact of the app on various secondary outcomes related to pain management.
Secondary objectives (aim 2) included assessing the effect of the app on pain severity, duration, and interference with daily activities, as well as exploring any changes in pain management strategies employed by participants. Furthermore, the study aimed to examine the potential influence of the app on parental emotional well-being, recognizing the critical role caregivers play in supporting pediatric cancer patients.
Lastly, the researchers sought to evaluate the app’s usability, acceptability, and relevance to families (aim 3). This involved gathering feedback from both children and parents in the intervention group to assess their experiences with the app, including its interface, educational resources, and the utility of real-time feedback from healthcare professionals.
Overall, this trial aimed to comprehensively evaluate the effectiveness and feasibility of integrating a pain monitoring app into the care regimen of children undergoing cancer treatment, with a focus on improving pain management outcomes and enhancing the overall well-being of both patients and their families.
Results
The study included a total of 184 children, with 94 randomized to use the pain monitoring app and 90 to receive care as usual. However, there were some dropouts during the study, with 15 in the app group and 11 in the usual care group.
Among the participants who used the app (mean age: 7.5 [5.1] years, 48% girls, 63% hemato-oncology diagnosis) and those who received usual care (mean age: 7.5 [5.4] years, 52% girls, 65% hemato-oncology diagnosis), the app group reported significantly less clinically significant pain compared to the usual care group. Specifically, the odds ratio (OR) for experiencing clinically significant pain was 0.38 with a 95% confidence interval (CI) ranging from 0.198 to 0.734, indicating a notable reduction in the likelihood of experiencing significant pain among app users.
Final Thoughts
The study’s findings revealed a significant reduction in clinically significant pain among pediatric cancer patients who used the pain monitoring app at home compared to those receiving usual care. This outcome underscores the potential efficacy of the app as a valuable tool in managing pain in this vulnerable population within their home environments. However, while the observed effects are promising, further research is needed to elucidate the precise mechanisms through which the app operates to achieve these outcomes.
Regarding pain duration, interference, and pain management strategies, there were no notable variances detected between the groups. Notably, despite the intervention group experiencing significantly fewer instances of clinically significant pain compared to the control group, there was no discernible contrast in the utilization of pain management strategies between the two cohorts
It’s important to note that in the study, fewer children didn’t use pain relief methods even when experiencing significant pain, compared to a study conducted in 2017. Back then, 33% of children in a similar situation didn’t utilize any pain relief methods, whereas in the current study, only 7.8% in the intervention group and 12.4% in the control group abstained from using any. This improvement in pain management may be attributed to the centralization of care for children with cancer at the Princess Máxima Center since 2017, which potentially enhanced communication regarding appropriate pain treatment options.
Another factor could be the methodology used to inquire about pain treatments. In the previous study, families were simply asked about the treatments or medications they used for pain. However, in the current study, families were presented with choices between pain-relieving medications and other methods. It is possible that in the previous study, families only reported on the use of pain-relieving medications, which may explain the lower reported use of interventions.
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