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

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.