Study determines that Pain Buddy app may aid in reduction of pain severity

A child, resting in bed, fires up her 7-inch tablet and opens an app.

She selects from a variety of cartoon avatars — such as a panda or penguin — and backgrounds that include a colorful ocean floor with fish and other sea creatures.

Game on.

But this isn’t a typical game. It’s a kid-friendly tool that allows the child, who is being treated for cancer, to report the severity and type of pain she’s experiencing from her home — information her doctor can access in real time.

Playing their way to pain reduction

The app, named Pain Buddy, may aid in the reduction of pain severity in children during cancer treatment, according to results of a pilot study recently published in the online journal Pediatric Blood & Cancer.

The study found that Pain Buddy may be especially beneficial in helping children who have high levels of pain.

Pain Buddy app
Pain Buddy app

Pain Buddy is the brainchild of Michelle A. Fortier, a CHOC Children’s pediatric psychologist who is also a faculty member of the UC Irvine Sue & Bill Gross School of Nursing.

Fortier, who specializes in pain management in children, was principal investigator of the recently published pilot study. that was based on clinical studies of CHOC patients monitored by pediatric oncologist Dr. Lilibeth Torno and pediatric oncology nurse practitioner Christine Yun.

“Pain management is an important part of cancer survivorship, and I think Pain Buddy’s potential for use is very broad,” Dr. Torno says.

Most of the 48 children participating in the eight-week study had been diagnosed with leukemia. All were between the ages of 8 and 18. Results of this particular study come amid ongoing studies on the Pain Buddy app at other sites., Results of the comprehensive research effort, which will track 206 children, are expected in three years, Fortier says.

Pain Buddy app
The Pain Buddy app allows users to identify their pain through various games, like sorting balls into baskets.

The gap in children’s pain management

Pain Buddy, Fortier explained, was developed a few years ago to address a gap in pain management of kids at home compared to kids in the hospital, where it’s easier for doctors and nurses to stay on top of patients’ needs. The 48 children who participated in the pilot study spent a lot of time at home.

Tapping the expertise of professional app developers and researchers at UCI in the California Institute for Telecommunication and Information Technology (Calit2), Fortier and several other colleagues came up with a way for children to rate their pain as they were feeling it from home.

“Most kids experience pretty moderate to severe pain throughout their cancer treatment, and this pain just wasn’t sufficiently being addressed when the patients were at home,” Fortier says. “And when we think about pain assessment, we’re really terrible retrospective reporters of our pain experience.”

But with Pain Buddy, users can say how much they’re hurting, and where, as it’s happening.

“Pain can come from the cancer itself, such as a solid tumor, and it can come from treatment procedures,” Fortier says. “For example, lots of skin-breaking procedures occur during cancer treatment. And treatments like chemotherapy can cause nerve pain, inflammation of the gastrointestinal tract and mouth sores.”

Pain Buddy app
The Pain Buddy app allows users to describe their pain with word bubbles, and can alert the care team.

In addition to completing a pain and symptom diary twice daily, the app automatically alerted the participants’ medical teams about such symptoms as nausea, itching, sadness and redness.

With a touch of a finger, the patients could select word bubbles to indicate descriptions — such as bad, annoying, or and terrible — to describe their pain.

Clinicians, in turn, could promptly address any symptoms that warranted intervention.

Learning skills to cope with pain

A key component of the Pain Buddy app, which for now only has been used by the pilot study participants, is the incorporation of coping skills shown to be effective in the management of pain, such as deep breathing, progressive muscle relaxation and guided imagery.

During these skills training exercises, patients could accumulate coins and, visiting a virtual store, customize their personal avatar and buy additional background themes.

Pain Buddy app
The Pain Buddy app can help patients learn coping skills.

Pain Buddy represents an effective partnership between parents, young cancer patients and the health care institutions that treat them, Dr. Torno says.

“Our focus on cancer survivorship begins on the day of diagnosis,” Torno says.

CHOC’s After Cancer Treatment Survivorship (ACTS) program features a multidisciplinary team of clinical experts who monitor the late effects of cancer and develop a plan for long-term surveillance to ensure the best possible outcomes. Every child at CHOC who has gone through cancer therapy eventually lands in the ACTS program.

Fortier said the ultimate goal is to further refine Pain Buddy and license the app to hospitals for widespread use.

“The goal is to have every kid undergoing cancer treatment — from sarcoma patients to those with bone and other cancers — to have the ability to use Pain Buddy.”

CHOC recognized as one of nation’s best children’s hospitals

CHOC Children’s is one of only 50 pediatric facilities in the nation to earn recognition as a best children’s hospital by U.S. News & World Report. The following CHOC specialties are honored in the 2019-20 Best Children’s Hospitals rankings: diabetes/endocrinology, cancer, neonatology, neurology/neurosurgery, pulmonology and urology. Cancer ranked in the “top 20.”

“The national recognition for CHOC’s cancer program is well-deserved. There’s nowhere else I’d rather have gone through treatment than CHOC,” says 17-year-old Sydney Sigafus, CHOC patient and cancer survivor. “Everyone who works at CHOC cares about you as a person, not just a patient. I was included in every decision and conversation about my care.”

The Best Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or life-threatening diseases find the best medical care available. Only the nation’s top 50 pediatric facilities are distinguished in 10 pediatric specialties, based on survival rates, nurse staffing, procedure and patient volumes, reputation and additional outcomes data. The availability of clinical resources, infection rates and compliance with best practices are also factored into the rankings.

“We understand how scary it can be for parents whose children are dealing with life-threatening illnesses or injuries. That’s why we are committed to the highest standards of care, safety and service,” says Dr. James Cappon, CHOC’s chief quality officer. “While we are proud of our accolades, including being named a best children’s hospital, we remain focused on preserving the magic of childhood for all kids, whether they are seriously ill or healthy, or somewhere in between.”

More information about the Best Children’s Hospitals rankings can be found here.

CHOC AYA Oncology Team to Present at International Conference

A team of CHOC Children’s staff members will offer two poster presentations at an upcoming international meeting of health care professionals who work with adolescent and young adult (AYA) patients with cancer.

The team involved in CHOC’s AYA Treatment Program will provide insight at the second annual Global Adolescent and Young Adult Cancer Congress into two topics: building the ideal AYA program and implementing an AYA retreat and education curriculum.

Designing, implementing a program

The first poster presentation, “Building the Ideal Adolescent and Young Adult (AYA) Program Model to Empower AYA Cancer Patients to Succeed, Lead and Thrive,” is authored by Sharon Bergeron, RN, BSN, CPON; Kara Noskoff, BS, CCLS; and Nadia Torres-Eaton, PsyD.

The presentation details CHOC’s efforts to establish a community where AYA patients with cancer can find support and assistance in developing leadership, life and survivorship skills. The program is designed to meet the psychosocial needs of a unique patient population.

Among other features, the program includes monthly empowerment activities, an inpatient fitness program and a leadership team. As a result, CHOC found a decrease in social isolation commonly reported by these patients, as well as a confidence boost and increased passion to embrace their experiences and advocate for their peers.

Investing in emerging AYA leaders

Also authored by Bergeron, Noskoff and Dr. Torres-Eaton, as well as Matthew Cawthon, RN, BSN; Danielle Mucker, RN, BSN; Karlie Allen, MS, CCLS; and Eric Mammen, MT-BC, the second poster presentation is “Implementing an Adolescent and Young Adult Mentor Retreat and Education Curriculum: Wise Investment for Emerging AYA Patient Leaders.”

Building upon efforts described in the first poster, the second presentation will detail how the AYA program cultivated emerging leaders among the patient participants by designing and implementing a weekend mentor retreat. During the event, participants learned mentorship skills, as well as specific knowledge about AYA cancer diseases.

As feedback, retreat attendees said the event was empowering and provided them with the essential knowledge to grow as leaders. They also noted increased confidence in meeting new patients with differing experiences and diagnoses.

Themed “Working Together-Achieving More,” the Global Adolescent and Young Adult Cancer Congress will be held Dec. 5 through 7 in Atlanta.

Learn more about CHOC Children’s AYA Treatment Program.

Dr. Jamie Frediani joins Hyundai Cancer Institute at CHOC Children’s

A pediatric hematologist/oncologist Dr. Jamie Frediani has joined the growing team of innovative specialists at the Hyundai Cancer Institute at CHOC Children’s.  Dr. Frediani looks forward to advancing CHOC’s leukemia and lymphoma programs, as well as the adolescent and young adult cancer program.

“The Hyundai Cancer Institute is experiencing an exciting time of immense growth, including creating new ways of delivering exceptional patient care, developing new treatments, expanding patient outreach and education, and enriching existing treatment teams,” says Dr. Frediani. “I am thrilled to be a part of this growth, and honored to join such a supportive team of experts.”

Pediatric hematologist/oncologist Dr. Jamie Frediani has joined the growing team of innovative specialists at the Hyundai Cancer Institute at CHOC Children’s.

After graduating with high honors from University of California, Davis with a bachelor’s degree in microbiology, Dr. Frediani completed medical school at University of Texas Southwestern Medical Center.  Her residency and fellowship training were done at Cincinnati Children’s Hospital and Children’s Hospital Los Angeles (CHLA), respectively.  Throughout her education and training, she assumed numerous leadership roles.  Most recently, she was chief fellow in the department of hematology/oncology at CHLA.  Aside from focusing on delivering excellent, family-centered care, Dr. Frediani would like to enhance the educational curriculum for medical students, residents and fellows, focusing on interactive and case-based learning experiences.

Dr. Frediani’s previous research includes examining the impact of the timing of central line placement in children with acute lymphoblastic leukemia on infection and thrombosis rates; studying perioperative complications in patients with high-risk vascular malformations who underwent surgical or interventional radiology procedures around the site of their lesions; investigating the incidence and clinical course of varicella and herpes zoster in children with acute lymphoblastic leukemia in the pre and post-vaccination era; and studying the outcome of empiric treatment with cefepime versus ceftazidime in pediatric oncology patients with febrile neutropenia.  The latter two studies were conducted in partnership with clinicians at St. Jude Children’s Research Hospital. Her fellowship research in the laboratory of Dr. Muller Fabbri focused on exosomal communication between endothelial cells and cancer cells, leading to miRNA-mediated increased migration of the cancer cells. In addition to numerous abstracts, Dr. Frediani has published in Molecular Cancer, Archives of disease in childhood and Pediatric blood and cancer.

When not caring for patients, she enjoys trips to Disneyland, hiking, and reading, particularly science fiction/fantasy novels. She loves to travel, exploring the world and other cultures.

Two Oncologists with Special Interest in Immunotherapy Join Hyundai Cancer Institute at CHOC Children’s

The Hyundai Cancer Institute at CHOC Children’s has added two oncologists, Dr. Josephine HaDuong and Dr. Ashley Plant, to its team of nationally recognized specialists. Both physicians were fellowship trained at two of the country’s top cancer programs, and share research interest in immunotherapy and targeted therapies.

Dr. Josephine HaDuong and Dr. Ashley Plant

Dr. Josephine HaDuong

Board-certified in pediatric hematology and oncology, Dr. HaDuong was drawn to the Cancer Institute for what she refers to as its gold standard of care. “The Hyundai Cancer Institute is a growing center that strives to be among the best. The team provides patients access to cutting-edge clinical trials that may lead to breakthroughs in pediatric cancer,” says Dr. HaDuong.

A published author and principal investigator in a number of studies, Dr. HaDuong’s major research activities include exploring developmental therapeutics in solid tumors using immunomodulatory and targeted agents, as well as functional imaging in bone and soft tissue sarcomas using magnetic resonance spectroscopy. Her research is driven, in large part, by her clinical interest in caring for patients with solid tumors.

Following medical school at the University of Pittsburgh, where she earned a full tuition merit scholarship, Dr. HaDuong completed her residency and pediatric hematology/oncology fellowship training at Children’s Hospital Los Angeles.  She was honored with the Fellow of the Year, Excellence in Teaching Award.

Dr. HaDuong is a member of numerous professional associations, including American Society of Clinical Oncology, American Society of Pediatric Hematology and Oncology, and North American Consortium for Histiocytosis. In addition to English, she speaks Spanish and Vietnamese.

Raised in Orange County, Dr. HaDuong is thrilled to be back in her hometown. “I have always wanted to return home to serve the children and families in Orange County. I look forward to being a part of an incredible team who works relentlessly to end cancer,” explains Dr. HaDuong.

Dr. Ashley Plant

Committed to growing CHOC’s neuro-oncology treatment program, Dr. Plant is eager to bring new and exciting therapies to patients with brain tumors. “I look forward to collaborating with academia and industry to bring early clinical trials to CHOC, especially in the area of immunotherapy. I am also excited to partner with my new colleagues to advance the work the Cancer Institute has been doing to reduce the long-term toxicities of cancer therapy,” says Dr. Plant.

A published author, Dr. Plant’s research interests include early phase clinical trial design for pediatric brain tumors. Her most recent project is a phase 1 clinical trial for a neo-antigen heat shock protein vaccine for diffuse intrinsic pontine glioma, a fatal brain tumor. She hopes to enroll patients in this trial within the next year. She considers herself fortunate to have worked under world-renowned immuno-oncologists Dr. Glenn Dranoff and Dr. Jerome Ritz at Dana Farber Cancer Institute in Boston. There, she won the Young Investigator Award for a project evaluating clonality of T cell receptors in pediatric gliomas.

Following medical school at Stanford University, Dr. Plant finished her residency at University of California, Los Angeles. Her fellowship training in pediatric hematology/oncology was completed at Boston Children’s Hospital. She received additional training in clinical trials and public health at Harvard Chan School of Public Health.

“I was attracted to CHOC because the hospital prioritizes excellent clinical care of patients above all else,” says Dr. Plant. “The hospital’s commitment to patient-and-family-centered care is something I wholeheartedly support. Cancer affects everyone in the family – physically, emotionally, psychologically and sometimes even financially. If we fail to address these issues, we are not completely caring for our patients and their families.”