Pain in pediatric oncology : Explorative and interventional studies focusing on oral mucositis

Sammanfattning: The aim of this thesis was to examine the prevalence of pain in children treated for cancer with a special focus oral mucositis. In addition, we wanted to examine if oral cryotherapy (OC) could reduce the incidence of severe oral mucositis in children undergoing hematopoietic stem cell transplantation (HSCT), and explore new methods to implement OC. In Study I, a retrospective questionnaire study including 71 parents and 38 children that had undergone HSCT in Sweden in the past three years, we found that 47% of the parents and 42 % of the children reported that the child experienced oral pain during the treatment. According to the parents, 52% of the children had needed medication for oral pain. Study II was a randomized clinical trial including 49 children randomized OC or standard oral care during HSCT. The prevalence of severe oral mucositis was 52% in the whole group with no differences between the two groups. However, compliance to OC was low, especially in younger children. In Study III a new intra oral cooling device (IOCD) was tested in 12 healthy adults. The temperature reduction in the oral cavity, after 60 minutes of OC with the IOCD, was similar to the temperature reduction seen after OC with ice, with few side effects reported. In Study IV, a questionnaire study including 120 nurses and 65 physicians, 57% of the healthcare professionals reported pain to be present often/very often in the children they treated for cancer. Treatment-related pain was perceived to be the most troublesome type of pain. In conclusion, this thesis demonstrates that pain is present in many children treated for cancer and that more than half of the children undergoing HSCT develop sever oral mucositis. Oral cryotherapy did not reduce the incidence of OM in children undergoing HSCT but compliance to the intervention was low. An IOCD has the potential benefit of less discomfort, improving compliance, but needs to be evaluated in children.