Erik A H Loeffen1, Renée L Mulder2, Anna Font-Gonzalez2, Piet L J M Leroy3, Bruce D Dick4, Anna Taddio5, Gustaf Ljungman6, Lindsay A Jibb7, Perri R Tutelman8, Christina Liossi9, Alison Twycross10, Karyn Positano11, Rutger R Knops12, Marc Wijnen12, Marianne D van de Wetering12, Leontien C M Kremer2, L Lee Dupuis5, Fiona Campbell13, Wim J E Tissing14. 1. University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology/Hematology, Groningen, the Netherlands. Electronic address: eah.loeffen@umcg.nl. 2. Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands. 3. Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands. 4. Departments of Anesthesiology and Pain Medicine, Psychiatry &Pediatrics, University of Alberta, Edmonton, AB, Canada. 5. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Department of Pharmacy and Research Institute, The Hospital for Sick Children, Toronto, Canada. 6. Department of Women's and Children's Health, Pediatric Oncology, Uppsala University, Uppsala, Sweden. 7. School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada. 8. Centre for Pediatric Pain Research, IWK Health Centre Halifax, NS, Canada. 9. Pediatric Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. 10. School of Health and Social Care, London South Bank University, London, United Kingdom. 11. University of Toronto, Toronto, ON, Canada. 12. Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands. 13. Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 14. University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology/Hematology, Groningen, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Abstract
BACKGROUND: Children with cancer often undergo long treatment trajectories involving repeated needle procedures that potentially cause pain and distress. As part of a comprehensive effort to develop clinical practice guidelines (CPGs) to address pain prevention and management in children with cancer, we aimed to provide recommendations on the pharmacological and psychological management of procedure-related pain and distress. METHODS: Of the international inter-disciplinary CPG development panel (44 individuals), two working groups including 13 healthcare professionals focused on procedural pain and distress. Grading of Recommendations Assessment, Development and Evaluation methodology was used, including the use of systematic literature reviews to inform recommendations and the use of evidence to decision frameworks. At an in-person meeting in February 2018, the guideline panel discussed these frameworks and formulated recommendations which were then discussed with a patient-parent panel consisting of 4 survivors and 5 parents. RESULTS: The systematic reviews led to the inclusion of 48 randomised controlled trials (total number of participants = 2271). Quality of evidence supporting the recommendations ranged from very low to moderate. Strong recommendations were made for the use of topical anesthetics in all needle procedures, for offering deep sedation (DS)/general anesthesia (GA) to all children undergoing lumbar puncture, for the use of DS/ GA in major procedures in children of all ages, for the use of hypnosis in all needle procedures and for the use of active distraction in all needle procedures. CONCLUSION: In this CPG, an evidence-based approach to manage procedure-related pain and distress in children with cancer is presented. As children with cancer often undergo repeated needle procedures during treatment, prevention and alleviation of procedure-related pain and distress is of the utmost importance to increase quality of life in these children and their families.
BACKGROUND:Children with cancer often undergo long treatment trajectories involving repeated needle procedures that potentially cause pain and distress. As part of a comprehensive effort to develop clinical practice guidelines (CPGs) to address pain prevention and management in children with cancer, we aimed to provide recommendations on the pharmacological and psychological management of procedure-related pain and distress. METHODS: Of the international inter-disciplinary CPG development panel (44 individuals), two working groups including 13 healthcare professionals focused on procedural pain and distress. Grading of Recommendations Assessment, Development and Evaluation methodology was used, including the use of systematic literature reviews to inform recommendations and the use of evidence to decision frameworks. At an in-person meeting in February 2018, the guideline panel discussed these frameworks and formulated recommendations which were then discussed with a patient-parent panel consisting of 4 survivors and 5 parents. RESULTS: The systematic reviews led to the inclusion of 48 randomised controlled trials (total number of participants = 2271). Quality of evidence supporting the recommendations ranged from very low to moderate. Strong recommendations were made for the use of topical anesthetics in all needle procedures, for offering deep sedation (DS)/general anesthesia (GA) to all children undergoing lumbar puncture, for the use of DS/ GA in major procedures in children of all ages, for the use of hypnosis in all needle procedures and for the use of active distraction in all needle procedures. CONCLUSION: In this CPG, an evidence-based approach to manage procedure-related pain and distress in children with cancer is presented. As children with cancer often undergo repeated needle procedures during treatment, prevention and alleviation of procedure-related pain and distress is of the utmost importance to increase quality of life in these children and their families.
Authors: Nicole E MacKenzie; Christine T Chambers; Jennifer A Parker; Erin Aubrey; Isabel Jordan; Dawn P Richards; Justina Marianayagam; Samina Ali; Fiona Campbell; G Allen Finley; Emily Gruenwoldt; Bonnie Stevens; Jennifer Stinson; Kathryn A Birnie Journal: Can J Pain Date: 2022-05-17
Authors: Encarna Gómez-Gamboa; Olga Rodrigo-Pedrosa; Marta San-Millán; Maria Angeles Saz-Roy; Anna Negre-Loscertales; Montserrat Puig-Llobet Journal: Int J Environ Res Public Health Date: 2022-07-30 Impact factor: 4.614
Authors: Luisa Russo; Alberto Eugenio Tozzi; Angela Mastronuzzi; Ileana Croci; Francesco Gesualdo; Ilaria Campagna; Kiersten P Miller; Italo Ciaralli; Matteo Amicucci; Domitilla Elena Secco; Vito Andrea Dell'Anna; Adele Ripà; Elisa Piccinelli Journal: Int J Environ Res Public Health Date: 2022-09-21 Impact factor: 4.614
Authors: Julia D H P Simon; Sasja A Schepers; Martha A Grootenhuis; Maarten Mensink; Angelique D Huitema; Wim J E Tissing; Erna M C Michiels Journal: Support Care Cancer Date: 2021-06-16 Impact factor: 3.603