Pharmacological management of cancer pain in children

Mercadante, Sebastiano; Giarratano, A

doi:10.1016/j.critrevonc.2014.01.005

Cited by 24 publications

(19 citation statements)

References 17 publications

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“…Furthermore, most state and federal clinical practice guidelines related to opioid prescribing exclude cancer patients 21 . As a result, many children and adults with cancer and sickle cell disease receive inadequate management of their pain 17,22–24 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

MacDonell-Yilmaz

Murillo

Panicker

et al. 2020

Pediatric Blood & Cancer

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Background Deficits in knowledge and comfort related to pain management have been demonstrated in adult hematology/oncology fellows. No such evaluation has been undertaken in pediatric hematology/oncology (PHO) trainees. Procedure An IRB‐approved survey was administered to PHO fellows throughout the United States (US) to assess comfort with opioid dosing, attitudes related to the use of opioids, and knowledge of basic concepts including weight‐based dosing, incomplete cross‐tolerance, and management of side effects. Results Email addresses were obtained for 132 fellows from 37 programs. Seventy‐eight (59%) fellows participated. No significant difference was demonstrated between training level and comfort with dosing opioids in an opioid‐naive patient, though a smaller proportion of first‐year fellows (65%) reported comfort compared to more senior fellows (85.2% of second‐year fellows, 80.6% of third‐ and fourth‐year fellows). First‐year fellows correctly answered a mean of 5.05 ± 0.43 out of 10 objective knowledge questions; second‐year fellows answered 5.74 ± 0.35 correctly, and third‐ and fourth‐year fellows 5.58 ± 0.30. The majority of respondents chose an appropriate dose of intravenous morphine based on weight (92%), and identified a low‐dose naloxone drip as an appropriate intervention for opioid‐induced pruritis (91%). However, the remainder of the questions had a correct response rate of 15‐68%. Conclusion This study characterizes PHO fellows’ knowledge and comfort with prescribing opioids. Despite high levels of reported comfort, PHO fellows in all levels of training demonstrated knowledge gaps. PHO fellows may benefit from further education in pain management.

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Section: Introductionmentioning

confidence: 99%

Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

MacDonell-Yilmaz

Murillo

Panicker

et al. 2020

Pediatric Blood & Cancer

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“…Young people with cancer experience multiple symptoms which negatively affect their quality of life [ 2 ]. Children with cancer often report pain (up to 89% of patients in an advanced stage of the disease) and over 70% of them sometimes report severe pain [ 3 , 4 ]. Even though pain relief is one of the main concerns of physicians [ 5 ] and the inter-patient variability in response to opioids is well known [ 6 ], pain relief is still often misdiagnosed or treated inappropriately.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the risk factors for clinical response to opioids for all-age patients with cancer-related pain and presentation of the paediatric STOP pain study

et al. 2018

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BackgroundInter-patient variability in response to opioids is well known but a comprehensive definition of its pathophysiological mechanism is still lacking and, more importantly, no studies have focused on children. The STOP Pain project aimed to evaluate the risk factors that contribute to clinical response and adverse drug reactions to opioids by means of a systematic review and a clinical investigation on paediatric oncological patients.MethodsWe conducted a systematic literature search in EMBASE and PubMed up to the 24th of November 2016 following Cochrane Handbook and PRISMA guidelines. Two independent reviewers screened titles and abstracts along with full-text papers; disagreements were resolved by discussion with two other independent reviewers. We used a data extraction form to provide details of the included studies, and conducted quality assessment using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.ResultsYoung age, lung or gastrointestinal cancer, neuropathic or breakthrough pain and anxiety or sleep disturbance were associated to a worse response to opioid analgesia. No clear association was identified in literature regarding gender, ethnicity, weight, presence of metastases, biochemical or hematological factors. Studies in children were lacking. Between June 2011 and April 2014, the Italian STOP Pain project enrolled 87 paediatric cancer patients under treatment with opioids (morphine, codeine, oxycodone, fentanyl and tramadol).ConclusionsFuture studies on cancer pain should be designed with consideration for the highlighted factors to enhance our understanding of opioid non-response and safety. Studies in children are mandatory.Trial registrationCRD42017057740.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4478-3) contains supplementary material, which is available to authorized users.

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“…The paucity of approved analgesics with pediatric labeling reflects both challenges in trial design and the lack of data to guide critical aspects of the drug development effort. Although clinical trials in children generally focus on the same drug indications as for adults, for many conditions (e.g., breakthrough cancer pain, osteoarthritis, or diabetic neuropathy), parallel pediatric indications are significantly different or absent [45]. Similarly, many chronic pain conditions in adults reflect physiological anatomical changes associated with aging and are not found in the pediatric population (e.g., degenerative arthritis is rare in 5-year-olds) [87].…”

Section: Introductionmentioning

confidence: 99%

Clinical trial designs and models for analgesic medications for acute pain in neonates, infants, toddlers, children, and adolescents: ACTTION recommendations

Walco

Kopecky

Weisman

et al. 2017

Pain

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Clinical trials to test the safety and efficacy of analgesics across all pediatric age cohorts are needed to avoid inappropriate extrapolation of adult data to children. However, the selection of acute pain models and trial design attributes to maximize assay sensitivity, by pediatric age cohort, remains problematic. Acute pain models used for drug treatment trials in adults are not directly applicable to the pediatric age cohorts-neonates, infants, toddlers, children, and adolescents. Developmental maturation of metabolic enzymes in infants and children must be taken into consideration when designing trials to test analgesic treatments for acute pain. Assessment tools based on the levels of cognitive maturation and behavioral repertoire must be selected as outcome measures. Models and designs of clinical trials of analgesic medications used in the treatment of acute pain in neonates, infants, toddlers, children, and adolescents were reviewed and discussed at an Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) Pediatric Pain Research Consortium consensus meeting. Based on extensive reviews and continuing discussions, the authors recommend a number of acute pain clinical trial models and design attributes that have the potential to improve the study of analgesic medications in pediatric populations. Recommendations are also provided regarding additional research needed to support the use of other acute pain models across pediatric age cohorts.

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Pharmacological management of cancer pain in children

Cited by 24 publications

References 17 publications

Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows

A systematic review of the risk factors for clinical response to opioids for all-age patients with cancer-related pain and presentation of the paediatric STOP pain study

Clinical trial designs and models for analgesic medications for acute pain in neonates, infants, toddlers, children, and adolescents: ACTTION recommendations

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