Tolerability and safety of strong opioid analgesics in children and adolescents with incurable oncological diseases

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Abstract

Relevance. One of the basic tasks of palliative medical care is to control pain in an incurable patient. To administer strong opioid analgesics as basic pain management in terminal patients, a treating physician must understand the risk of opioid-related adverse effects. According to the World Health Organization, the occurrence of the pain syndrome and importance of correct analgesic therapy in children and adolescents with incurable oncological diseases are underestimated.

Purpose. To improve the quality of palliative medical care provided to children and adolescents with incurable oncological diseases.

Materials and methods. A retrospective and prospective study was carried out. 400 patients with incurable oncological diseases aged 0 months to 20 years (median 9 years) were included into the study from June 2014 to December 2017, in particular, 235 boys and 165 girls (189 patients with extracranial solid tumors, 117 patients with CNS tumors and 94 patients with hemoblastoses). The study was approved by the Independent Ethics Committee and the Council of Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology (Protocol No. 5 dated May 21, 2013). Of 284 patients with the pain syndrome, 227 (80%) of children and adolescents aged 0–20 years (median 12 years) used strong opioid analgesics (morphine hydrochloride, morphine sulfate and transdermal therapeutic system with fentanyl) for pain relief. Their dosage was set in accordance with WHO 2012 recommendations related to the management of persisting pain syndrome in children. To estimate the severity of adverse events (AE) when strong opioids were used (nausea, vomiting, constipation, skin itching, urinary retention and respiratory failure), the CTCAE (Common Terminology Criteria for Adverse Events) displays Grades 1 through 5. Opioid-induced hyperalgesia and opioid-induced neurotoxicity were estimated by clinical signs (absence or presence of a symptom).

Results. Of 227 patients, 59 (26%) patients had AE associated with the administration of strong opioid analgesics: 11.5% of cases for constipation, 7.5% cases for nausea, 4% of cases for pruritus, 2.2% of cases for urinary retention, 0.44% of cases for opioid-induced hyperalgesia, 0.44% of cases for opioid-induced neurotoxicity. No respiratory failure was noted when strong opioid analgesics were used. In the majority of cases (95%), the registered AE were mild and required no termination of therapy with opioid analgesics. Of 284 patients, 281 (98.9%) underwent analgesic therapy with complete pain management.

Conclusion. Strong opioid analgesics are safe and effective in children and adolescents with incurable oncological diseases.

About the authors

Alexey V. Pshonkin

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology

Author for correspondence.
Email: alexey.pshonkin@fccho-moscow.ru

Pediatric oncologist, hematologist, head of short-term treatment department

Samora Machel st., 1, GSP-7, Moscow, Russia, 117997; phone: +7(495) 287–65–70

Russian Federation

Iruna V. Serkova

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology

Email: fake@neicon.ru

Pediatric oncologist short-term treatment department

Samora Machel st., 1, GSP-7, Moscow, Russia, 117997; phone: +7(495) 287–65–70

Russian Federation

Nikolay V. Zhukov

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology; Pirogov Russian National Research Medical University

Email: info@fnkc.ru

Dr. Sci.(Med.), Professor, Head of Multidisciplinary Oncology Department National Scientific-Practical Center of Pediatric Hematology, Oncology and Immunology n. a. D. Rogachev

Samora Machel st., 1, GSP-7, Moscow, Russia, 117997; phone: +7(495) 287–65–70

Russian Federation

Vladislav V. Shukin

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology

Email: info@fnkc.ru

Cand. Sci.(Med.), head of the of anesthesiology and intensive care Department National Scientific-Practical Center of Pediatric Hematology, Oncology and Immunology n. a. D. Rogachev

Samora Machel st., 1, GSP-7, Moscow, Russia, 117997; phone: +7(495) 287–65–70

Russian Federation

Elena V. Polevichenko

Pirogov Russian National Research Medical University

Email: ims@rsmu.ru

Dr. Sci.(Med.), Professor of the Pirogov Russian National Research Medical University (RNRMU); Ostrovityanov st., 1, Moscow, Russia, 117997, phone: +7(495)434–47–76. Chief Expert on Child Palliative Care of the Ministry of Health of Russian Federation. Executive committee member of Hospice Care Professionals Assotiation; Efremova st., 22, Moscow, Russia, 119048; phone: +7 (495) 545–58–95

Russian Federation

Elena A. Spiridonova

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology; A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Email: mail@msmsu.ru

Dr. Sci.(Med.), Professor of A. I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation; Delegatskaya st., 20, Moscow, Russia, 127473; phone: +7 (495) 631–25–44.

Chief executive secretary National Scientific-Practical Center of Pediatric Hematology, Oncology and Immunology n. a. D. Rogachev; Samora Machel st., 1, GSP-7, Moscow, Russia, 117997; phone: +7(495) 287–65–70

Russian Federation

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Copyright (c) 2019 Pshonkin A.V., Serkova I.V., Zhukov N.V., Shukin V.V., Polevichenko E.V., Spiridonova E.A.

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