Background: Pain is one of the most common and distressing symptoms reported by adolescents with cancer (AWC). Despite advancements in pain assessment and management research, pain due to cancer and/or its treatment continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the AWC group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration and location and the impact pain has on an adolescent’s life (i.e., relationships, schoolwork, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 25 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a web interface. Each diary entry represents a pain case filed by an AWC and a reward system (i.e., moving up through the police team ranks, built-in videotaped acknowledgements from other ‘officers’) encourages consistent use of the diary.
Objective: To evaluate the usability and content validity of the multidimensional Pain Squad app in AWC.
Methods: Study Phases 1 and 2 involved qualitative usability testing with iterative cycles of semi-structured interviews. In Phase 1, 15 adolescents (9-18 years) participated in 3 iterative cycles of low-fidelity usability testing (i.e. likeability of prototype screenshots). In Phase 2, 18 adolescents (9-18 years) participated in 2 iterative cycles of high-fidelity usability testing (i.e. understandability and satisfaction with the app prototype). Usability themes were analyzed using the constant comparative method for both phases. Phase 2 participants also completed content validity testing (Phase 3) by rating the importance of each app question on a scale from ‘not at all important’ to ‘very important’. 
Results: Data from iterative cycles 1 and 2 of Phase 1 revealed that body maps, visual analogue scales and the app theme required modification. Cycle 1 of Phase 2, revealed that question wording, placement of selectable buttons and the body map (i.e. inability to select certain body parts) required modification. No new issues arose in cycle 2. Phase 3 revealed that for 87.5% of questions, most participants (> 50%) rated the question as ‘important’ or ‘very important’. Questions that did not achieve this rating related to how much pain interfered with: (1) things participants did, (2) participants’ relationships, and (3) participants’ schoolwork. However for these questions, less than 22.3% of participants rated the question as ‘not at all important’.
Conclusions: Next steps involve feasibility, reliability, validity and responsiveness testing of the app. An acceptable, feasible, reliable and valid electronic cancer pain app is expected to help adolescents and clinicians better understand and manage cancer pain. []

Development and Testing of a Multidimensional IPhone Pain Assessment Application for Adolescents with Cancer

The Society for Integrative Oncology (SIO) Online Task Force was created in response to the challenges facing continuity of integrative oncology care resulting from the COVID-19 pandemic. The Task Force set out to guide integrative oncology practitioners in providing effective and safe online consultations and treatments for quality-of-life-concerns and symptom management. Online treatments include manual, acupuncture, movement, mind-body, herbal, and expressive art therapies. The SIO Online Practice Recommendations employed a four-phase consensus process: (1) literature review and discussion among an international panel of SIO members, identifying key elements essential in an integrative oncology visit; (2) development, testing, and refinement of a questionnaire defining challenges and strategies; (3) refinement input from integrative oncology experts from 19 countries; and (4) SIO Executive Committee review identifying the most high-priority challenges and strategies. The SIO Online Practice Recommendations address ten challenges, providing practical suggestions for online treatment/consultation. These include overcoming unfamiliarity, addressing resistance among patients and healthcare practitioners to online consultation/treatment, exploring ethical and medical-legal aspects, solving technological issues, preparing the online treatment setting, starting the online treatment session, maintaining effective communication, promoting specific treatment effects, involving the caregiver, concluding the session, and ensuring continuity of care. The SIO Online Practice Recommendations are relevant for ensuring continuity of care beyond the present pandemic. They can be implemented for patients with limited accessibility to integrative oncology treatments due to geographic constraints, financial difficulties, physical disability, or an unsupportive caregiver. These recommendations require further study in practice settings.

/pdf/the-society-for-integrative-oncology-practice-4pzdoz2c6d.pdf

The Society for Integrative Oncology Practice Recommendations for online consultation and treatment during the COVID-19 pandemic.

Even with optimized medical management, pain remains an inevitable part of pediatric cancer care. The most effective interventions for nonpharmacologic pain management within pediatric psychology include parent skills training. This review specifically explored the role of parents in cancer-related pain management with the goal of defining a set of evidence-based skills that could translate to improved pediatric cancer pain management. Pain is now widely understood to be both a sensory and emotional experience. As a result, within pediatric non-cancer pain management there is increasing application of the biopsychosocial model for pain management, inclusive of evidence-based psychological intervention. This review, specifically focusing on the role of parent training in cancer-related pain management, finds few interventions that systematically included parents. There is a need for continued evidence-based innovation and knowledge dissemination in this area of care. This paper highlights a critical gap in translational science within pediatric cancer pain management, namely, that parents who have a child with cancer are not reliably gaining access to well-established, evidence-based psychological skills training that can help to mitigate pain and pain-related stress. Based on the literature, the authors provide recommendations for generating adaptable, evidence-informed interventions that support and empower parents to help their child with pain management through all phases of cancer treatment.

The Critical Role of Parents in Pediatric Cancer-Related Pain Management: a Review and Call to Action

Background Education plays an important role in cancer symptom management for patients and their families. With the advancement of information and communication technology, there may be additional evidence for the use of mobile apps to support patient and family education. Purpose The purpose of this review was to explore and synthesize scientific literature about cancer symptom management mobile apps that can be used by patients and their families. Methods This review adopted a scoping review study framework, using electronic databases including EBSCO, PubMed, ProQuest, Science Direct, and Google Scholar using search keywords: 'caregiver family', 'mobile application', 'symptom management' and 'palliative care'. Of a total of 2633 papers found, 11 papers were selected. Findings Assessment tools are a major component of mobile apps in reporting and assessing symptoms to provide appropriate education. The information in mobile apps is delivered through various mediums that include modules, videos, avatars and cultural integration features. Conclusion Mobile apps can improve provision of palliative care in several ways, most importantly by increasing the knowledge of the patient's family to manage cancer symptoms. Nurses are expected to play an active role in finding and utilizing appropriate mobile apps to assist families in managing a patient's symptoms at home.

Mobile applications for managing symptoms of patients with cancer at home: A scoping review.

Background Appropriately selected complementary therapies, such as virtual reality (VR) and active video games (AVG), provide support to young patients during the process of cancer treatment. Therefore, this systematic review with meta-analysis aimed to analyze the effects of VR and AVG on fear, physical functions, and quality of life. Methods A systematic search was performed independently in Scopus, PubMed, Embase, Web of Science and Cochrane Library electronic databases for relevant randomized controlled and crossover studies. From a total of 5,963 records, 11 met the inclusion criteria. After full-text screening two publications were excluded, yet six studies were included in the quantitative analysis because three studies had a large discrepancy in their measured outcomes. For methodological quality assessments, the RoB2 software program was used, while RevMan 5.4.1 was used for statistical analysis and meta-analysis. Standard Mean Difference (SMD) outcome measures were used for the analysis. Statistical heterogeneity was assessed using the I2 statistic with a cut-off value of 50% considering intervention and outcome measures. Results Our systematic review includes six randomized controlled studies and three randomized crossover studies. The participants represented both sexes and were children and adolescents (<18 years old) with a diagnosis of cancer. The analysis of the results allows for a careful conclusion that VR has the potential to become an accessory tool in rehabilitation and oncologic treatment. All of the included studies noted a significant advantage of this intervention. Conclusion VR has the potential to be an effective and important tool in the oncologic treatment of children. VR immerses the patient, and as a result, produces a distraction that effectively reduces pain associated with standard oncologic care procedures in children. However, this systematic review and meta-analysis highlights the need for more research into the use of VR as support for pediatric oncologic care. Systematic review registration PROSPERO database (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319000), CRD42022319000.

Virtual reality in chemotherapy support for the treatment of physical functions, fear, and quality of life in pediatric cancer patients: A systematic review and meta-analysis

Improving Children's cancer pain management in the home setting: Development and formative evaluation of a web-based program for parents.

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Improving Children's cancer pain management in the home setting: Development and formative evaluation of a web-based program for parents.