title: Opioid use in palliative care of children and young people with cancer.
abstract: OBJECTIVE
  Identify opioids prescribed, preferred routes, and doses among children with incurable cancer.
  
  
  METHODS
  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.
authors.affiliation: Queen's Medical Centre, University Hospital, Nottingham, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Hewitt
authors.forename: Ann
authors.initials: A
authors.lastname: Goldman
authors.forename: Gary S
authors.initials: GS
authors.lastname: Collins
authors.forename: Margaret
authors.initials: M
authors.lastname: Childs
authors.forename: Richard
authors.initials: R
authors.lastname: Hain
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D003932:Heroin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D012107:Research Design; D011795:Surveys and Questionnaires; D013810:Therapeutic Equivalency; D006113:United Kingdom
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin; D009020:Morphine; D005283:Fentanyl