Palliative Analgesia in Patients With Childhood Cancer: A Retrospective Cohort Study

Although modern medicine provides multimodal approaches to treating pain, pain remains undertreated in 30% of pediatric palliative patients.

In this single center retrospective cohort study, our aim was to ascertain how pediatric palliative phase pain was managed at a tertiary university hospital during the years 2013-2022. The medical records of patients with childhood cancer were reviewed for palliative diagnosis, demographics, duration of palliative period, pain medication or other treatment modality, effects and adverse effects, pain assessment, and death location.

We identified 35 patients aged 1 to 19 years (median 9.0 years), of which 24 were female. Twenty-three patients had the ICD10 diagnosis for palliative care in their diagnoses. The palliative phase lasted from 1 to 491 days and took place at home in 15 cases. Fifteen patients had tumors of the central nervous system. Other diagnoses included sarcoma, neuroblastoma, acute lymphoblastic leukemia, and hepatocellular cancer. All patients were given acetaminophen and opioids. Non-steroidal anti-inflammatory drugs were given to 24 patients, anticonvulsants to 14, tricyclic antidepressants to 9, corticosteroids to 21, interventional pain procedures to 3, radiation therapy for analgesia to 10, and 5 patients underwent a procedure to alleviate pain and discomfort. Thirty-one patients used patient-controlled analgesia.

Patient data concerning analgesics' effects and adverse effects were heterogeneous. We followed the WHO analgesic ladder during palliative care. Use of opioids was beneficial; the outcome for other classes of drugs was uncertain based on our limited data.