Every year in Canada 1,400 children are diagnosed with cancer and must not only battle the disease itself, but also the pain associated with cancer and its treatment. Pain is a common and distressing symptom that affects a patient’s quality of life. To effectively manage pain, doctors and nurses rely on the patients to communicate how they are feeling. One way to do this is to have them fill out a detailed paper-based pain diary every day. The challenge is that after chemotherapy and radiation treatment, the last thing on these kids’ minds is completing a pain dairy.
While there are many hurdles in pain treatment, inadequate assessment and a patient’s reluctance to report pain are huge barriers. Researchers at The Hospital for Sick Children (SickKids) are always looking for new ways to improve pain management for cancer patients, and with the help of Cundari, a leading Toronto-based marketing communications agency; a pain diary app called “Pain Squad” was developed.
Pain Squad is an iPhone app that helps kids and teens with cancer track how intense their pain is, how long it lasts, where it hurts as well as what helps to treat it. They are also able to record how pain impacts their mood and daily activities, such as doing schoolwork, sleeping and interacting with others. Adolescents with cancer were involved in the development of the app, providing feedback on content and user-friendliness.
“We made it easier for kids and teens to track their pain symptoms by using technology that they’re familiar with. Keeping an iPhone pain diary is not only less work, but fun, too,” says Dr. Jennifer Stinson, Scientist and Nurse Practitioner in the Chronic Pain Program at SickKids. “Pain Squad is unique because while it helps patients keep track of their own symptoms, it also contributes to research by collecting data on cancer pain. Having solid information on the prevalence and severity of pain and the effectiveness of treatment will allow us to better manage pain and ultimately help improve the quality of life for our patients.”
Cundari created the Pain Squad theme to keep kids engaged and motivated to complete their pain surveys twice a day. Cundari sought the help of celebrities from two prime-time Canadian law enforcement shows, Rookie Blue and Flashpoint. Playing their crime fighting characters, the actors performed in encouraging video clips that are unlocked as the kids win promotions to higher ranks. Patient-users join the Pain Squad as “rookies” and progress through different levels. By completing more surveys they are promoted to higher ranks, such as Sergeant and Captain.
The iPhone’s user-friendly touch screen made the diary entry fun and easy. “Filling out a paper pain journal was like homework,” says Sam and Gloria Santarelli, parents of SickKids patient and study participant Olivia Santarelli, 11. “The Pain Squad app is interactive and the more Olivia used it, the more rewards she got. It only takes a few minutes to complete but it gave Olivia a better understanding of and more control over her pain.”
With a simple flick of the finger, they could identify exactly where and how much it hurt, as well as which medications were working best. Completing the diary is not a time-consuming endeavor either; a survey of questions can be completed in less than five minutes.
“Over the past three years we’ve gone to great lengths to reinvent Cundari as not just a creative ad agency, but as a technologically creative agency. This application was a unique opportunity to showcase this,” says Wayne Gomes, Chief Technology Officer (CTO) at Cundari. “Our creative staff worked closely with our newly formed mobile software group to deliver an impressive end result.” He continues, “It just so happened that the project itself was also rewarding, professionally as Cundari’s CTO, and personally as a parent.”
Pain Squad has just finished the third phase of testing to assess whether it’s easy for patients to use and understand. The app will soon be tested in three other Canadian paediatric oncology centres. The ultimate goal, explains Dr. Jennifer Stinson, lead researcher of the project, is to make the Pain Squad App available to all Canadian adolescents with cancer with the hope that improved pain monitoring will result in better pain management and improve the quality of life for these youths with cancer.