Background & Aims

Children with cancer frequently report pain across the disease trajectory starting from diagnosis and sometimes persisting into survivorship [1-3]. Additionally, many children with cancer experience changes in body composition during the cancer continuum [4,5]. Associations between pain and body composition have been found in adult cancer populations [6,7], yet have not been investigated in children with cancer. Therefore, the aim of this study is to gain insight into the (differences in) associations between pain and body composition in children with cancer compared to healthy controls.

Methods

This was a cross-sectional case-control study. Participants were 60 children (8-18 years old), including 30 children diagnosed with cancer and 30 healthy age- and sex-matched peers. We assessed children’s pain experiences in the past 2 weeks, chronic pain status, pressure pain thresholds (PPTs) at the dominant musculus tibialis anterior (MTA) and trapezius pars descendens (MTD), and anthropometric characteristics (i.e., waist circumference (WC), body fat %, fat mass, fat free mass, muscle mass, body water %, and Body Mass Index (BMI)). Statistical analyses were performed in SPSS to identify between-group differences in terms of pain and anthropometric characteristics, as well as group differences in the associations between those outcome measures.

Results

Study results showed that significantly more children with cancer had chronic pain compared to healthy peers. Further, children with cancer showed significantly lower PPTs at the MTA and total body water %, and higher WC and fat % compared to their healthy peers. Both children with cancer and healthy controls with a higher muscle mass reported higher pain intensity, and children with cancer with a higher fat free mass also reported higher pain intensity. Healthy controls with higher WC reported more pain locations. In children with cancer, higher muscle mass and fat free mass were associated with higher PPTs at the MTA; and higher WC, fat free mass, and muscle mass were associated with higher PPTs at the MTD. Healthy controls showed smaller associations between pain in the last 2 weeks (yes/no) and WC, fat free mass, and muscle mass; and larger associations between the number of pain locations and WC, and between PPTs at the MTA and WC, fat free mass, muscle mass, and BMI.

Conclusions

Although a more comprehensive pain testing protocol in future studies might provide a more complete insight in pain processing alterations in children with cancer, this study demonstrates that somatosensory abnormalities as well as changes in body composition are prevalent in children with cancer during treatment. Additionally, this study provides first proof for a differential relationship between pain and body composition in children with cancer compared to healthy controls.

References

[1] Lu Q, Krull KR, Leisenring W, Owen JE, Kawashima T, Tsao JCI, et al. Pain in long-term adult survivors of childhood cancers and their siblings: a report from the Childhood Cancer Survivor Study. Pain. 2011;152(11):2616-2624.
[2] Van Cleve L, Bossert E, Beecroft P, Adlard K, Alvarez O, Savedra MC. The pain experience of children with leukemia during the first year after diagnosis. Nurs Res. 2004;53(1):1-10.
[3] Tutelman PR, Chambers CT, Stinson JN, Parker JA, Fernandez CV, Witteman HO, et al. Pain in Children With Cancer: Prevalence, Characteristics, and Parent Management. Clin J Pain. 2018;34(3):198-206.
[4] Yang HR, Choi HS. A prospective study on changes in body composition and fat percentage during the first year of cancer treatment in children. Nutrition Research and Practice. 2019;13(3):214-221.
[5] Chow EJ, Pihoker C, Hunt K, Wilkinson K, Friedman DL. Obesity and hypertension among children after treatment for acute lymphoblastic leukemia. Cancer. 2007;110(10):2313-20.
[6] Leysen L, Beckwée D, Nijs J, Pas R, Bilterys T, Vermeir S, et al. Risk factors of pain in breast cancer survivors: a systematic review and meta-analysis. Support Care Cancer. 2017;25(12):3607-3643.
[7] Balderas-Peña LM, González-Barba F, Martínez-Herrera BE, Palomares-Chacón UR, Durán-Anguiano O, Salazar-Páramo M, et al. Body Composition and Biochemical Parameters of Nutritional Status: Correlation with Health-Related Quality of Life in Patients with Colorectal Cancer. Nutrients. 2020;12(7)

Presenting Author

Emma Rheel

Poster Authors

Emma Rheel

MSc

Vrije Universiteit Brussel

Lead Author

Sophie Pleysier

Pain in Motion research group (PAIN), Vrije Universiteit Brussel

Lead Author

Anneleen Malfliet

Pain in Motion research group (PAIN), Vrije Universiteit Brussel

Lead Author

Tine Vervoort

Ghent University

Lead Author

Kelly Ickmans

PT

Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care