Multi-Center Evaluation of Opioid Administration or Prescription in Pediatric Oncology Patients Using the OMOP CDM

Opioid use in pediatric oncology is poorly characterized. The primary objective was to describe opioid administration or prescription patterns in pediatric oncology patients.

In this multi-center retrospective study conducted across three sites, we included patients aged 0-19 years with a malignant neoplastic disease who received their first chemotherapy between January 2019 and March 2024. Data were extracted from each site's Observational Medical Outcomes Partnership Common Data Model. We described patient characteristics based on: (1) first opioid administration or prescription, overall and for each specific opioid; and (2) all opioid administrations or prescriptions, overall and for each specific opioid. We also evaluated variability in opioid and naloxone use.

Of 2903 pediatric patients with cancer, 2707 (93.2%) were administered or prescribed at least one opioid. Among these patients, fentanyl was the most common (92.4%), followed by morphine (68.7%), hydromorphone (55.3%), and oxycodone (38.6%). Across centers, the proportion of patients receiving fentanyl ranged from 90.9% to 94.9%, morphine from 34.0% to 89.2%, oxycodone from 0.9% to 76.1%, and naloxone from 2.4% to 29.5%. Overall, 10.9% were administered or prescribed naloxone, but among 169 methadone patients, 43.5% were administered or prescribed it. Of the 153,849 total opioid administrations or prescriptions, 22.4% occurred more than 12 months after initiating chemotherapy.

Among pediatric patients with cancer who receive chemotherapy, 93.2% were administered or prescribed at least one opioid; fentanyl was the most common. There was heterogeneity in opioid choice and naloxone use across sites. These findings lay preliminary groundwork for understanding opioid use patterns and identifying potential areas for practice improvement in pediatric oncology.