Internet-Delivered Cognitive Behavioral Treatment for Chronic Pain in Adolescent Survivors of Childhood Cancer: Protocol for a Single-group Feasibility Trial (Preprint)

BACKGROUND There are over 500,000 survivors of childhood cancer in North America alone. One in four survivors experiences chronic pain after treatment has completed. Youth with chronic pain report increased anxiety, depression, activity limitations, and sleep disturbances. An 8-week web-based cognitive-behavioral treatment for chronic pain (WebMAP) has demonstrated reduction in pain in youth but has not yet been explored in survivors. OBJECTIVE The objectives of the current study are to (1) test the feasibility and acceptability of WebMAP for a sample of surviors with chronic pain and their parents, (2) assess the acceptability of WebMAP using qualitative interviews, (3) assess WebMAP’s effect on activity limitations, pain intensity, depression and anxiety symptoms, and sleep disturbances, and (4) assess WebMAP’s effect on parent pain catastrophizing and parental response to their child’s pain. METHODS A single-arm mixed-methods pre-post intervention study design will be utilized. Participants will be 34 surviors and at least one of their parents/caregivers. Inclusion criteria are (1) cancer history (2) current age 10-17 years, (3) >2 years post-treatment or >5 years post-diagnosis, (4) pain present over prior 3 months impairing >1 area of daily life and occurring >1/month, (5) computer access with broadband internet. Survivors will complete a pre-treatment questionnaire, which will include: Child Activity Limitations Interview,the pain intensity Numerical Rating Scale, PROMIS –Pain Interference, Anxiety, Depression, Insomnia Severity Index, and Adolescent Sleep Wake Scale. Parents will complete the Pain Catastrophizing Scale – Parent Version and theAdult Responses to Child Symptoms. Upon completion of pre-treatment questionnaires (T0), survivors will begin WebMAP. After the 8 week intervention, survivors will complete the same measures (T1), and at 3 month follow-up (T2). Post-treatment interviews will be conducted to determine acceptability. Feasibility will be assessed via recruitment and retention rates. Treatment engagement will be measured by number of modules completed. Pre-post outcome data will be assessed using Linear Mixed Models. Qualitative data will be analyzed using thematic analysis. Patient partners will be involved in study design, recruitment, interpretation of results, and knowledge translation. RESULTS The current study has been funded in January 2022. Data collection started in June 2022 and is projected to end in August 2023. We have enrolled five participants as of December 2022. CONCLUSIONS Investigating whether WebMAP is useful to survivors will be an important step in improving pain management in this population. CLINICALTRIAL Trial registered at ClinicalTrials.gov: NCT05241717