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Published on: February 11, 2017
Procedural distress in children with cancer: self-report, behavioral observations, and physiological parameters
Gary A Walco1, Paola M Conte, Larissa E Labay
1Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ 07601, USA. gwalco@humed.com
Insights
Pain and distress in children with cancer are measured differently across self-report, behavior, and physiology. While interventions reduced subjective distress, physiological responses like cortisol remained high, indicating distinct measurement modalities.
Area of Science:
- Pediatric Oncology
- Pain Management
- Psychoneuroimmunology
Background:
- Assessing pain and distress in pediatric cancer patients during invasive procedures is complex.
- Multiple indicators including self-report, behavioral observation, and physiological measures are used.
- Understanding the relationships between these indicators is crucial for effective pain management.
Purpose of the Study:
- To investigate the correlations between self-report, behavioral, and physiological indicators of pain and distress in pediatric cancer patients.
- To evaluate the impact of different interventions (sedation, cognitive-behavioral strategies) on these indicators during lumbar punctures.
Main Methods:
- Evaluated 48 children (3.1-17.7 years) undergoing lumbar punctures.
- Assessed self-report (anxiety, pain, self-efficacy), parent-reported anxiety, physician stress, behavioral observations, and physiological parameters (heart rate, cardiac vagal tone, salivary cortisol).
- Interventions included deep sedation, light sedation, or cognitive-behavioral strategies with topical anesthetic.
Main Results:
- High consistency was observed within self-report, behavioral, and physiological measures separately.
- Correlations between different modalities were low, with floor effects noted in distress measures.
- Salivary cortisol levels increased significantly post-procedure, indicating physiological stress despite perceived comfort; heart rate was lower with cognitive-behavioral strategies.
Conclusions:
- Self-report, behavioral, and physiological measures are not interchangeable indicators of distress.
- Interventions effectively reduced subjective and behavioral distress but not necessarily physiological responses.
- Future research should explore individual response differences and clarify intervention goals in distress reduction studies.
Objectives:
To examine the relationship among different indicators of pain and distress, including self-report, behavioral observations, and physiological parameters, in children with cancer undergoing invasive procedures.
Methods:
Forty-eight children between the ages of 3.1 and 17.7 years were evaluated while undergoing lumbar punctures. Self-report measures assessed anxiety, pain, self-efficacy, expectations of coping strategies, and coping self-efficacy. Parents reported on their own and their child's levels of anxiety, and physicians estimated their own level of stress and technical difficulty in completing the procedure. Behavioral observations were made prior to, during, and after the procedure. Physiological parameters included heart rate, cardiac vagal tone, and salivary cortisol. At the discretion of attending physicians, 32 children received deep sedation, 9 received light sedation, and 7 received cognitive-behavioral strategies with topical anesthetic as interventions to manage procedural distress.
Results:
There was a high degree of consistency within self-report, behavioral, and physiological parameters, but correlations between measures in different modalities were low. There were floor effects for most behavioral and self-report measures of distress. Cortisol showed marked changes preprocedure to postprocedure, demonstrating high levels of physiological response despite lack of apparent or perceived discomfort. Heart rate was significantly lower in the group using cognitive-behavioral techniques, especially at the point of needle insertion.
Discussion:
Self-report measures, behavioral indicators, and physiological changes are not interchangeable outcomes. Treatment strategies were effective for minimizing subjective and behavioral distress, but not necessarily for physiological reactions. Future research should focus on individual differences in these responses, and treatment outcome studies aimed at reducing distress must be clear about the specific goals of intervention.
