title: Attitudes and practices of pediatric oncologists regarding methadone use in the treatment of cancer-related pain: results of a North American Survey.
abstract: Methadone is effective in the treatment of cancer-related pain in adults. Pediatric oncologists may be reluctant to use methadone, given the paucity of existing research and a lack of familiarity with its use. This study's purpose was to assess pediatric oncologists' experience, comfort and practice of methadone prescription, and determine interest in and appropriate venues for education on methadone. A 22-item survey was sent by electronic mail to 1912 practicing pediatric oncologists. Six hundred thirty-one pediatric oncologists (33%) responded to the survey. Seventy-two percent of respondents reported they prescribe methadone to <10% of their patients receiving opioids. Physicians practicing ≥10 years (84% vs. 76%, P=0.01), at centers that see ≥100 new patients per year (86% vs. 76%, P=0.003), or who have received prior education on methadone (89% vs. 54%, P<0.001) were more likely to have prescribed methadone. The primary reasons respondents did not utilize methadone included a lack of knowledge of methadone's pharmacodynamics (39%), effectiveness (39%), and/or dosing equivalence (34%). Perceived competence with dose equivalence, belief that methadone is effective, and working in a division where >20 patients per year died were all independently associated with having prescribed methadone to >10% of patients on opioids. Eighty-five percent of respondents would like additional education on methadone. Many pediatric oncologists lack experience and education in the use of methadone. Formal education initiatives should be implemented to enhance pediatric oncologists' comfort and expertise in methadone use.
authors.affiliation: Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA. mroth@montefiore.org
authors.forename: Michael
authors.initials: M
authors.lastname: Roth
authors.forename: Dawn
authors.initials: D
authors.lastname: Davies
authors.forename: Sarah
authors.initials: S
authors.lastname: Friebert
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.forename: Mimi
authors.initials: M
authors.lastname: Kim
authors.forename: Shayna
authors.initials: S
authors.lastname: Zelcer
mesh_terms: D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced; D008297:Male; D008495:Medical Oncology / Q000193:education; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D010148:Intractable Pain / Q000188:drug therapy*; D010372:Pediatrics / Q000193:education
chemical_list: D008691:Methadone