Kevin Madden1, Sarah Mills1,2, Seyedeh Dibaj1,3, Janet L Williams1, Diane Liu1,3, Eduardo Bruera1. 1. 1 Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center , Houston, Texas. 2. 2 Department of Palliative Care, Dell Seton Medical Center, The University of Texas , Austin, Texas. 3. 3 Department of Biostatistics, University of Texas M.D. Anderson Cancer Center , Houston, Texas.
Abstract
BACKGROUND: Methadone is an attractive medication for treating children with advanced cancer with pain as it is the only long-acting opioid available as a liquid. However, it is not frequently used due to concerns about potential toxicities and side effects. OBJECTIVE: Evaluate the efficacy and safety of methadone as the first long-acting opioid in children with advanced cancer. DESIGN: Retrospective chart review of 52 consecutive patients referred to Pediatric Supportive Care for pain management started on methadone as their first long-acting opioid. Data collected at baseline, follow-up visits #1 (F1) and #2 (F2) included child and parent-reported outcomes for various physical and psychological symptoms, opioid side effects and other clinical data. Symptoms were rated on a 0 (not at all) to 4 (a lot) scale. RESULTS: Pain (mean ± standard deviation [SD]) scored by the child was 3.6 (±0.6)/4 at baseline and 1.8 (±1.1)/4 at F1 (p < 0.0001). Compared to baseline, pain scored by the child at F2 was 1.2 (±1.3)/4 (p < 0.0001). Pain scored by the parent was 3.5 (±0.7)/4 at baseline and 1.4 (±1.3)/4 at F1 (p < 0.0001). Compared to baseline, pain scored by the parent at F2 was 1.0 (±1.2)/4 (p < 0.0001). Thirty-three (70%) patients at F1 and 23 (79%) patients at F2 did not need a change in dose of methadone. No cardiac arrhythmias or opioid neurotoxicity was observed. CONCLUSIONS: Initiation of methadone was effective and safe as the first long-acting opioid in children with pain.
BACKGROUND:Methadone is an attractive medication for treating children with advanced cancer with pain as it is the only long-acting opioid available as a liquid. However, it is not frequently used due to concerns about potential toxicities and side effects. OBJECTIVE: Evaluate the efficacy and safety of methadone as the first long-acting opioid in children with advanced cancer. DESIGN: Retrospective chart review of 52 consecutive patients referred to Pediatric Supportive Care for pain management started on methadone as their first long-acting opioid. Data collected at baseline, follow-up visits #1 (F1) and #2 (F2) included child and parent-reported outcomes for various physical and psychological symptoms, opioid side effects and other clinical data. Symptoms were rated on a 0 (not at all) to 4 (a lot) scale. RESULTS:Pain (mean ± standard deviation [SD]) scored by the child was 3.6 (±0.6)/4 at baseline and 1.8 (±1.1)/4 at F1 (p < 0.0001). Compared to baseline, pain scored by the child at F2 was 1.2 (±1.3)/4 (p < 0.0001). Pain scored by the parent was 3.5 (±0.7)/4 at baseline and 1.4 (±1.3)/4 at F1 (p < 0.0001). Compared to baseline, pain scored by the parent at F2 was 1.0 (±1.2)/4 (p < 0.0001). Thirty-three (70%) patients at F1 and 23 (79%) patients at F2 did not need a change in dose of methadone. No cardiac arrhythmias or opioid neurotoxicity was observed. CONCLUSIONS: Initiation of methadone was effective and safe as the first long-acting opioid in children with pain.
Authors: Gayatri Palat; Charlotte Algotsson; Spandana Rayala; Vikranth Haridass; Jayalatha Nethagani; Vineela Rapelli; Maria Gebre Medhin; Eva Brun; Mikael Segerlantz Journal: Indian J Palliat Care Date: 2021-02-17
Authors: Veerle Piette; Kim Beernaert; Joachim Cohen; Nele S Pauwels; Anne-Lore Scherrens; Jutte van der Werff Ten Bosch; Luc Deliens Journal: Pediatr Res Date: 2020-07-09 Impact factor: 3.756