Pain and functional outcomes in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort study

Ingrid Tonning Olsson; Nicole M. Alberts; Chenghong Li; Matthew J. Ehrhardt; Daniel A. Mulrooney; Wei Liu; Alberto S. Pappo; Michael W. Bishop; Doralina L. Anghelescu; Deokumar Srivastava; Leslie L. Robison; Melissa M. Hudson; Kirsten K. Ness; Kevin R. Krull; Tara M. Brinkman

doi:10.1002/cncr.33303

Pain and functional outcomes in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort study

Ingrid Tonning Olsson, Nicole M. Alberts, Chenghong Li, Matthew J. Ehrhardt, Daniel A. Mulrooney, Wei Liu, Alberto S. Pappo, Michael W. Bishop, Doralina L. Anghelescu, Deokumar Srivastava, Leslie L. Robison, Melissa M. Hudson, Kirsten K. Ness, Kevin R. Krull, Tara M. Brinkman

St Jude Children´s Research Hospital, Memphis

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Although survivors of childhood cancer are at risk of chronic pain, the impact of pain on daily functioning is not well understood. Methods: 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. Results: 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]). Conclusions: 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.

Original language	English
Pages (from-to)	1679-1689
Journal	Cancer
Volume	127
Issue number	10
DOIs	https://doi.org/10.1002/cncr.33303
Publication status	Published - 2021
Externally published	Yes

Bibliographical note

Funding Information:
Alberto S. Pappo has received personal fees from Bayer, Loxo, Boehringer Ingelheim, Debiopharm, and UpToDate for work performed outside of the current study. Kirsten K. Ness has received grants from the National Institutes of Health for work performed as part of the current study. Kevin R. Krull has received grants from the National Cancer Institute for work performed as part of the current study. The other authors made no disclosures.

Funding Information:
Supported by the National Cancer Institute (CA195547; Melissa M. Hudson and Leslie L. Robison, Principal Investigators). Support to St. Jude Children's Research Hospital also was provided by the Cancer Center Support (CORE) grant (CA21765; C. Roberts, Principal Investigator) and the American Lebanese Syrian Associated Charities (ALSAC).

Publisher Copyright:
© 2020 American Cancer Society

Subject classification (UKÄ)

Cancer and Oncology

Free keywords

childhood cancer
neurocognition
pain
physical function
quality of life
survivorship

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/cncr.33303Licence: Unspecified

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Tonning Olsson, I., Alberts, N. M., Li, C., Ehrhardt, M. J., Mulrooney, D. A., Liu, W., Pappo, A. S., Bishop, M. W., Anghelescu, D. L., Srivastava, D., Robison, L. L., Hudson, M. M., Ness, K. K., Krull, K. R., & Brinkman, T. M. (2021). Pain and functional outcomes in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort study. Cancer, 127(10), 1679-1689. https://doi.org/10.1002/cncr.33303

@article{17b6dceff3774b53839e292f509ea7f4,

title = "Pain and functional outcomes in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort study",

abstract = "Background: Although survivors of childhood cancer are at risk of chronic pain, the impact of pain on daily functioning is not well understood. Methods: 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. Results: 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]). Conclusions: 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.",

keywords = "childhood cancer, neurocognition, pain, physical function, quality of life, survivorship",

author = "{Tonning Olsson}, Ingrid and Alberts, {Nicole M.} and Chenghong Li and Ehrhardt, {Matthew J.} and Mulrooney, {Daniel A.} and Wei Liu and Pappo, {Alberto S.} and Bishop, {Michael W.} and Anghelescu, {Doralina L.} and Deokumar Srivastava and Robison, {Leslie L.} and Hudson, {Melissa M.} and Ness, {Kirsten K.} and Krull, {Kevin R.} and Brinkman, {Tara M.}",

note = "Funding Information: Alberto S. Pappo has received personal fees from Bayer, Loxo, Boehringer Ingelheim, Debiopharm, and UpToDate for work performed outside of the current study. Kirsten K. Ness has received grants from the National Institutes of Health for work performed as part of the current study. Kevin R. Krull has received grants from the National Cancer Institute for work performed as part of the current study. The other authors made no disclosures. Funding Information: Supported by the National Cancer Institute (CA195547; Melissa M. Hudson and Leslie L. Robison, Principal Investigators). Support to St. Jude Children's Research Hospital also was provided by the Cancer Center Support (CORE) grant (CA21765; C. Roberts, Principal Investigator) and the American Lebanese Syrian Associated Charities (ALSAC). Publisher Copyright: {\textcopyright} 2020 American Cancer Society ",

year = "2021",

doi = "10.1002/cncr.33303",

language = "English",

volume = "127",

pages = "1679--1689",

journal = "Cancer",

issn = "0008-543X",

publisher = "John Wiley & Sons Inc.",

number = "10",

}

Tonning Olsson, I, Alberts, NM, Li, C, Ehrhardt, MJ, Mulrooney, DA, Liu, W, Pappo, AS, Bishop, MW, Anghelescu, DL, Srivastava, D, Robison, LL, Hudson, MM, Ness, KK, Krull, KR & Brinkman, TM 2021, 'Pain and functional outcomes in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort study', Cancer, vol. 127, no. 10, pp. 1679-1689. https://doi.org/10.1002/cncr.33303

TY - JOUR

T1 - Pain and functional outcomes in adult survivors of childhood cancer

T2 - A report from the St. Jude Lifetime Cohort study

AU - Tonning Olsson, Ingrid

AU - Alberts, Nicole M.

AU - Li, Chenghong

AU - Ehrhardt, Matthew J.

AU - Mulrooney, Daniel A.

AU - Liu, Wei

AU - Pappo, Alberto S.

AU - Bishop, Michael W.

AU - Anghelescu, Doralina L.

AU - Srivastava, Deokumar

AU - Robison, Leslie L.

AU - Hudson, Melissa M.

AU - Ness, Kirsten K.

AU - Krull, Kevin R.

AU - Brinkman, Tara M.

N1 - Funding Information: Alberto S. Pappo has received personal fees from Bayer, Loxo, Boehringer Ingelheim, Debiopharm, and UpToDate for work performed outside of the current study. Kirsten K. Ness has received grants from the National Institutes of Health for work performed as part of the current study. Kevin R. Krull has received grants from the National Cancer Institute for work performed as part of the current study. The other authors made no disclosures. Funding Information: Supported by the National Cancer Institute (CA195547; Melissa M. Hudson and Leslie L. Robison, Principal Investigators). Support to St. Jude Children's Research Hospital also was provided by the Cancer Center Support (CORE) grant (CA21765; C. Roberts, Principal Investigator) and the American Lebanese Syrian Associated Charities (ALSAC). Publisher Copyright: © 2020 American Cancer Society

PY - 2021

Y1 - 2021

N2 - Background: Although survivors of childhood cancer are at risk of chronic pain, the impact of pain on daily functioning is not well understood. Methods: 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. Results: 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]). Conclusions: 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.

AB - Background: Although survivors of childhood cancer are at risk of chronic pain, the impact of pain on daily functioning is not well understood. Methods: 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. Results: 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]). Conclusions: 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.

KW - childhood cancer

KW - neurocognition

KW - pain

KW - physical function

KW - quality of life

KW - survivorship

UR - http://www.scopus.com/inward/record.url?scp=85098212622&partnerID=8YFLogxK

U2 - 10.1002/cncr.33303

DO - 10.1002/cncr.33303

M3 - Article

C2 - 33369896

AN - SCOPUS:85098212622

SN - 0008-543X

VL - 127

SP - 1679

EP - 1689

JO - Cancer

JF - Cancer

IS - 10

ER -

Pain and functional outcomes in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort study

Abstract

Bibliographical note

Subject classification (UKÄ)

Free keywords

UN SDGs

Access to Document

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