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

Research output: Contribution to journalArticlepeer-review

4 Citations (SciVal)


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 languageEnglish
Pages (from-to)1679-1689
Issue number10
Publication statusPublished - 2021
Externally publishedYes

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


  • childhood cancer
  • neurocognition
  • pain
  • physical function
  • quality of life
  • survivorship


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