Literature Reviews
Practice, Attitudes and Beliefs of Palliative Care Physicians Regarding Use of Methadone and Other Long-Acting Opioids in Children With Advanced Cancer
Madden K, Park M, Liu D, et al. Journal of Palliative Medicine 2018;21(10):1408-13
Children with advanced cancer, 20% of the pediatric palliative care population, often experience pain. This study aims to examine the practices, attitudes and beliefs of palliative care physicians prescribing long-acting opioids to children with advanced cancer.
Methods
A web-based survey (demographics, practice setting, opioid dosing, monitoring for adverse effects, and long-acting opioids) was e-mailed to members of the AAP Section of Hospice and Palliative Medicine (SOHPM) and to physicians identifying themselves as providing palliative care to children in postings on an SOHPM maintained independent LISTSERV. The survey closed after three reminders, 12 weeks after the initial email.
Results
The survey response rate was 62% (337 emails, 188 eligible, 116 responders). The majority was female (71%), <50 years of age (67%), board certified in pediatrics (91%) and pediatric hematology-oncology (56%), as well as grandfathered in HPM (64%) after 6-15 years (53%) of practice in HPM. Most (84%) of them prescribed opioids for children with advanced cancer and chronic pain. Provider comfort was highest with morphine as a long-acting opioid and significantly less with other ones. Morphine was seen as being most effective. Pediatric fellowship-trained HPM providers were less comfortable overall than non-fellowship trained ones. Cost was not an issue for morphine or methadone. Most prescribers (62%) did not obtain baseline ECG before initiation of methadone. Perceived family resistance was highest for fentanyl and methadone even though practitioners assessed these two opioids as being tolerated best.
Conclusion
The majority of palliative care physicians taking care of children feel comfortable prescribing long-acting opioids, though the degree varies between opioids. To increase comfort levels with opioid management pediatric HSP fellows may need to spend some time on adult HSP services where cancer and opioid management are more common. This study is limited by its survey structure and restriction to AAP members.
