Improving the lives of children and young people – during and after cancer treatment

Most cancer pain research to date has focused on adult patients, but we now know that children experience and process pain differently. There is a pressing need to find out more about why and how children and adolescents experience cancer pain; whether it is pain associated with the cancer itself, pain related to treatments such as chemotherapy, palliative care pain, or ongoing pain in adult survivors.

Following on from our previous investments in this area, we are proud to be supporting this new work thanks to our donors, and the fundraising efforts of staff at Advent International (a global private equity firm).

Staff from Advent International are supporting the work of Dr Sandrine Géranton, Dr Alexander Davies, and Professor Suellen Walker.

Understanding ‘perceived injustice’ in children, young people and parents

Dr Emma Fisher from the University of Bath wants to better understand how cancer-related pain can impact young patients’ mental and physical wellbeing, as well as that of their parents.

Her team will focus on ‘perceived injustice’ – thoughts of loss, blame, a sense of unfairness and irreparability that is related to pain. While some studies in the field have explored this for adults with cancer, little is known for young patients.

Dr Fisher believes that perceived injustice could play a key role in helping young people adjust to their cancer and manage their pain. Her research will examine the relationships between perceived injustice and the experience of cancer-related pain, mental health, parenting behaviour and physical functioning in young patients.

Supporting the management of cancer-related pain

While pain can be a huge part of the journey for young people with cancer, there is limited data available to help us understand their pain and set appropriate guidelines for managing it.

For children, pain can result from several factors, including the routine physical interventions of cancer management and treatments themselves. Stress is also known to enhance pain, where repeated hospital visits can certainly contribute to the overall distress and pain experienced by children and young people.

In collaboration with paediatric pain specialists, paediatric oncologists and medical physicists, Dr Sandrine Géranton and her team at the University College London are working to strengthen our understanding of pain in children with cancer.

The team are looking at two key approaches; investigating the impact of treatment and stress on young cancer survivors by engaging directly with their families, and studying laboratory mice to investigate the impact of cancer management alone on pain.

Investigating how to reduce the pain of neuroblastoma treatment, while still targeting the cancer

Neuroblastoma is the most common cancer in children under five years old. An antibody therapy – called ‘anti-GD2’ – has brought hope to those with the highest risk cases, helping children to survive longer.

However, this form of treatment can be extremely painful for children, as the target of the antibody, GD2, is located on nerves throughout the body.

As well as this, the immune system’s natural response could also contribute to the nerve-related pain experienced by a patient during this type of therapy.

Dr Alexander Davies from the University of Oxford is investigating the immune profiles of neuroblastoma patients undergoing this therapy, alongside colleagues Dr Simon Rinaldi, Prof Juliet Gray and Prof Stephen Beers. Their work will uncover the extent to which the immune system is responsible for these nerve pain side effects.

This knowledge will equip Dr Davies’ team to re-design a neuroblastoma immunotherapy that will reduce the body’s immune mechanisms that cause pain, while still effectively targeting cancer. Through this work, Dr Davies hopes to ensure a better quality of life for cancer survivors that is free from nerve damage and pain.

How chemotherapy damages the immune system: The cause of pain in adult survivors of childhood cancer

Dr Richard Hulse and his team at Nottingham Trent University are working to uncover the pathways through which chemotherapy, a cancer treatment used to kill cancer cells, causes patients to experience pain.

Several adults who have been treated for childhood cancer report ongoing pain after chemotherapy. Dr Hulse has found that exposure to chemotherapy in early life can damage nerve cells in the body that detect pain, called ‘nociceptors’, altering how pain is perceived as a patient grows into adulthood.

Dr Hulse’s team are working to understand how platinum-based chemotherapy damages these nerve cells. In normal cases, the body’s natural immune system would help to preserve the mitochondria (the energy-producing powerhouse) of nociceptor cells – however, chemotherapy stops this from happening.

Through multiple experiments, the team aim to explore how the nociceptor and immune system interact. Their work could uncover more about the role played by the immune system in preserving mitochondria function in pain-detecting nerve cells, potentially helping to identify new treatments for chemotherapy-induced pain.

Identifying the type and impact of chronic pain following childhood cancer treatment

Chronic pain is reported by up to 44% of childhood cancer survivors. Many children and young people who have been treated for blood cancer, such as leukaemia or lymphoma, also report experiencing chronic pain long after treatment.

At Great Ormond Street Hospital, children and young people regularly attend follow-up appointments at the Haematology/Oncology Late Effect Clinic after they have undergone treatment for blood cancers.

Professor Suellen Walker and a specialist team from University College London are inviting these patients to participate in a study, where they will distribute questionnaires and carry out specialised tests to assess the type and severity of pain. The team will also look at the impact of this pain on physical activity, sleep, fatigue, emotions, and ability to think clearly and quickly.

Made up of specialists and experts in the field, the team aim to identify measures that will highlight chronic pain-related difficulties at earlier stages in a patient’s journey. Professor Walker’s work will help to bring about earlier interventions, improving the journey of young patients dealing with cancer pain.