Opioid use in palliative care of children and young people with cancer

Hewitt, Martin, Goldman, Ann, Collins, Gary S., Childs, Margaret and Hain, Richard D. W. 2008. Opioid use in palliative care of children and young people with cancer. The Journal of Pediatrics 152 (1) , pp. 39-44. 10.1016/j.jpeds.2007.07.005

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Abstract

Objective Identify opioids prescribed, preferred routes, and doses among children with incurable cancer. Study design Prospective survey with monthly questionnaires regarding patients 0 to 19 years old from oncology centers. Data were collected by professionals on each patient for 6 months or until death, and analyzed from patients who died. Impact of tumor was analyzed with Kruskal-Wallis and Mann-Whitney tests. Major opioid dosages are expressed as oral morphine equivalents. Results Of 185 children recruited, 164 (88 boys, 76 girls) died. Mean palliative care duration was 67 days. One hundred forty-seven (89.6%) received major opioids. Morphine, diamorphine, and fentanyl were prescribed in 75%, 57.9%, and 11.6%, respectively. Seventy-three (44.5%) received >1 major opioid. Median monthly maximum doses prescribed rose from 2.1 mg/kg/24 h (study entry) to 4.4 mg/kg/24 h (death) (P < .001); overall variable (0.09-1500 mg/kg/24 h, median 3.7 mg/kg/24 h). Opioids were given by the oral (117/164, 71.3%), intravenous (68/164, 41.5%), subcutaneous (40, 28%), rectal (20, 12.2%), and transdermal (18, 11%) routes. There was a shift to intravenous use as death approached. Numbers within each tumor group were too small to show significance. Children with solid tumors outside the central nervous system were likely to receive more opioids, be given multiple different opioids, and receive opioids in the last month. Conclusions The study shows the United Kingdom practice of opioid use and provides comparator data for practice in children’s palliative medicine.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) R Medicine > RJ Pediatrics
Publisher:	Elsevier
ISSN:	0022-3476
Last Modified:	19 Mar 2016 22:45
URI:	https://orca.cardiff.ac.uk/id/eprint/26030

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