Reducing pain and distress related to needle procedures in children with cancer: A clinical practice guideline

E.A.H. Loeffen*, R.L. Mulder, A. Font-Gonzalez, P.L.J.M. Leroy, B.D. Dick, A. Taddio, G. Ljungman, L.A. Jibb, P.R. Tutelman, C. Liossi, A. Twycross, K. Positano, R.R. Knops, M. Wijnen, M.D. van de Wetering, L.C.M. Kremer, L.L. Dupuis, F. Campbell, W.J.E. Tissing

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


Background: Children with cancer often undergo long treatment trajectories involving repeated needle procedures that potentially cause pain and distress. As part of a comprehensive effort to develop clinical practice guidelines (CPGs) to address pain prevention and management in children with cancer, we aimed to provide recommendations on the pharmacological and psychological management of procedure-related pain and distress.Methods: Of the international inter-disciplinary CPG development panel (44 individuals), two working groups including 13 healthcare professionals focused on procedural pain and distress. Grading of Recommendations Assessment, Development and Evaluation methodology was used, including the use of systematic literature reviews to inform recommendations and the use of evidence to decision frameworks. At an in-person meeting in February 2018, the guideline panel discussed these frameworks and formulated recommendations which were then discussed with a patient-parent panel consisting of 4 survivors and 5 parents.Results: The systematic reviews led to the inclusion of 48 randomised controlled trials (total number of participants = 2271). Quality of evidence supporting the recommendations ranged from very low to moderate. Strong recommendations were made for the use of topical anesthetics in all needle procedures, for offering deep sedation (DS)/general anesthesia (GA) to all children undergoing lumbar puncture, for the use of DS/GA in major procedures in children of all ages, for the use of hypnosis in all needle procedures and for the use of active distraction in all needle procedures.Conclusion: In this CPG, an evidence-based approach to manage procedure-related pain and distress in children with cancer is presented. As children with cancer often undergo repeated needle procedures during treatment, prevention and alleviation of procedure-related pain and distress is of the utmost importance to increase quality of life in these children and their families. (C) 2020 The Authors. Published by Elsevier Ltd.
Original languageEnglish
Pages (from-to)53-67
Number of pages15
JournalEuropean Journal of Cancer
Publication statusPublished - 1 May 2020


  • cognitive-behavior therapy
  • distraction
  • efficacy
  • general-anesthesia
  • guideline
  • hypnosis
  • lumbar puncture
  • management
  • pediatric oncology
  • procedural pain
  • sedation
  • supportive care
  • Pediatric oncology
  • Guideline
  • Procedural pain
  • Supportive care


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