WebMAP for Childhood Cancer Survivors

Daily surveys, administered through REDCap, will be used to assess daily presence of pain and pain intensity for 7 days at each assessment period. Pain intensity will be assessed with an item asking about the magnitude of pain experienced answered on an 11-point numerical rating scale (0 = no pain, 10 = worst pain). This measure of pain intensity has demonstrated to be a reliable and valid measure of pain in many populations of children 8 years and older (Baeyer et al., 2009; Castarlenas, Jensen, Baeyer, \& Miro, 2017), but has not yet been validated in people with cancer.

The Child Activity Limitations Interview is a measure of children's perceived difficulty in completing typical daily activities because of pain. The CALI will be collected for 1 week at each of the study timepoints. Survivors will choose the top 8 activities from a list of 21 and will be asked each day whether the activity occurred and how difficult the activity was to perform because of their pain. Difficulty ratings are measures on a five-point scale (0 = no difficulty, 4 = extremely difficult), with a range of zero to 32. Higher scores indicate greater functional limitations. Average daily limitation scores across each assessment period will be computed.

The PROMIS Anxiety and Depression instruments (Cook, Reeve, Ader, \& Fries, 2010(31)) (8-item short form) will be administered via REDCap to screen for current symptoms of anxiety and depression. Survivors will complete the self-report instrument corresponding to their age (child: age 8-17; adult: age 18+). Items (e.g., "I felt worried") are rated on a five-point scale (1 = never, 5 = always). Higher scores signify greater severity of symptoms. Pain interference will be assessed using the four-item PROMIS interference scale for survivors 8-17 years of age, and the seven-item PROMIS interference scale for survivors over 18 years of age (Hinds et al., 2013). The PROMIS pediatric measures have been validated for use in pediatric oncology (Hinds et al., 2013).

The Adolescent Sleep Wake Scale (ASWS-S) (32, 33) is a measure of the subjective perception of sleep quality. The ASWS-S is a 10-item measure where items representing symptoms of sleep disturbance are scored on a 6-point Likert scale (1 = always, 6 = never), and will be administered online via REDCap. The measure produces a total sum score where higher scores represent more severe sleep disturbance. The ASWS has demonstrated acceptable reliability and validity among populations of youth with comorbid sleep and medical conditions (34) and among ethnically diverse youth (33).

The Pain Catastrophizing Scale - Parent Version (PCS-P) (37) is a 13-item measure used to assess parents' catastrophic thoughts and feelings about their child's pain and will be administered online via REDCap. Parents rate statements about their child's pain on a five-point Likert scale (i.e., "When my child has pain, I can't keep it out of my mind"). Items are summed to yield a total score and can also be summed to provide scores on three subscales: rumination, magnification, and helplessness. Lower scores indicate less catastrophizing. This scale has been found to have good reliability in parents with children who experience pain.

The Adult Responses to Children's Symptoms (ARCS) (38, 39) measures parental responses to their child's pain behaviors and will be administered online via REDCap. The current study will only utilize the Protect subscale, which assesses parents' responses that either positively or negatively reinforce pain complaints. Parents' responses are rated on a five-point scale (0 = never, 4 = always). Subscale scores represent an average of the items, with higher scores indicating more frequent use of that behavioral style. This scale has demonstrated reliability and validity for use with parents of children with chronic pain (38, 39).

The Kessler Psychological Distress Scale (40) is a 6-item measure used to assess non-specific psychological distress representing diagnoses of major depression and generalized anxiety disorder and also contains a positive affect domain. The measure has good precision in the 90-99th percentile range of the population, and has solid psychometric properties across major sociodemographic populations distribution in the United States of America and Canada (40). It also strongly discriminates between meeting and not meeting diagnostic thresholds for psychological disorders (40).