Melina Heinemann1,2,3,4, Christiane Hoffmann5,6, Jendrik Hardes6,7,4, Wiebke Guder6,7,4, Arne Streitbürger6,7,4, Miriam Götte2,8,4, Theresa Luisa Welz8,4, Heribert Jürgens2,4, Andreas Ranft2,8,4, Volker Vieth9,10, Matthias Weckesser3,4, Michael Schäfers3,4, Lars Stegger3,4, Uta Dirksen2,8,4,11. 1. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany. 3. Department of Nuclear Medicine, University Hospital Münster, Münster, Germany. 4. West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany. 5. Orthopaedic Hospital Volmarstein, Wetter, Germany. 6. Department of Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany. 7. Department of Oncologic Musculoskeletal Surgery, University Hospital Essen, Essen, Germany. 8. Paediatrics III, University Hospital Essen, Essen, Germany. 9. Department of Radiology, University Hospital Münster, Münster, Germany. 10. Department of Clinical Radiology, Klinikum Ibbenbüren, Ibbenburen, Germany. 11. DKTK, German Cancer Research Centre, Essen, Germany.
Abstract
BACKGROUND: While the prognosis of patients with Ewing sarcoma (EwS) is improving, little is known about the frequency of pain and its risk factors in survivors of EwS. This study aims to analyse the prevalence and risk factors of pain and its predictive value for recurrence. PATIENTS AND METHODS: In patients with remission after treatment of EwS, frequency and characteristics of pain within the first 5 years of follow up were assessed retrospectively. RESULTS: Of 80 patients, 37 (46%) presented with at least one episode of pain. Chronic pain (>3 months) was observed in 10 patients (13%). Experience of at least one episode of pain was associated with prior combined local treatment (surgery and radiation compared to surgery alone; odds ratio [OR] 5.83, 95% confidence interval [CI] 1.43-34.9, P = .007). A total of 59 episodes of pain were observed, including 47 acute and 12 chronic episodes. Lower limb pain accounted for 46% (27/59) of all episodes of pain, and was associated with primary tumour of the pelvis or lower extremity (OR 4.29, 95% CI 1.18-18.21, P = .025), which represented 64% (51/80) of all EwS. The positive predictive value of pain for recurrence was only 12%. CONCLUSION: Pain is a common problem in survivors of EwS, which mostly affects the lower extremity, and should be regularly assessed. Interventions to reduce pain may be particularly important in patients with combined local treatment with surgery and radiation, who seem to be at considerably increased risk for pain. Patients presenting with pain should be examined for recurrence.
BACKGROUND: While the prognosis of patients with Ewing sarcoma (EwS) is improving, little is known about the frequency of pain and its risk factors in survivors of EwS. This study aims to analyse the prevalence and risk factors of pain and its predictive value for recurrence. PATIENTS AND METHODS: In patients with remission after treatment of EwS, frequency and characteristics of pain within the first 5 years of follow up were assessed retrospectively. RESULTS: Of 80 patients, 37 (46%) presented with at least one episode of pain. Chronic pain (>3 months) was observed in 10 patients (13%). Experience of at least one episode of pain was associated with prior combined local treatment (surgery and radiation compared to surgery alone; odds ratio [OR] 5.83, 95% confidence interval [CI] 1.43-34.9, P = .007). A total of 59 episodes of pain were observed, including 47 acute and 12 chronic episodes. Lower limb pain accounted for 46% (27/59) of all episodes of pain, and was associated with primary tumour of the pelvis or lower extremity (OR 4.29, 95% CI 1.18-18.21, P = .025), which represented 64% (51/80) of all EwS. The positive predictive value of pain for recurrence was only 12%. CONCLUSION:Pain is a common problem in survivors of EwS, which mostly affects the lower extremity, and should be regularly assessed. Interventions to reduce pain may be particularly important in patients with combined local treatment with surgery and radiation, who seem to be at considerably increased risk for pain. Patients presenting with pain should be examined for recurrence.
Authors: Elizabeth Donovan; Sarah R Martin; Laura C Seidman; Lonnie K Zeltzer; Tara M Cousineau; Laura A Payne; Marla Knoll; Margorie Weiman; Noah C Federman Journal: J Adolesc Young Adult Oncol Date: 2021-04-12 Impact factor: 2.223