Pain Management in Children With Cancer Using World Health Organization Guidelines at a Tertiary Cancer Center in Rural India

Abstract

Management of cancer pain among children is a difficult process due to the way they perceive pain, their dependence on parents, complexity of assessment, and limited availability of safe analgesics. Pain among children with cancer is still a less explored problem in India. This descriptive study was carried out in a tertiary cancer center to explore the characteristics of pain and its management among the children with cancer. We analyzed children diagnosed with hematologic malignancies, aged 4–18 years, admitted between January 2013 and December 2017. This retrospective cohort study involved the review of patient records available at the medical records department. During the study period, there were 290 admission episodes, of which 93 (32.1%) episodes were associated with pain. Of these 93 episodes, 14 (15%) were primarily for pain management. Step I analgesic was utilized in the majority (83%) of the admission episodes involving younger age group (4–9 years) children, whereas for the older age group (10–18 years) Step 2 analgesic (tramadol) was utilized in 29 (58%) episodes, and this was found to be statistically significant (P < .001). Only in 9 (9.7%) episodes Step 3 analgesic was utilized. A significant proportion of children with hematologic malignancies had pain episodes, and these episodes in older age group children were managed with weak opioids.

Keywords:

• Cancer pain
• children
• pain assessment
• WHO pain guidelines

Acknowledgments

The authors thank the staff of Malabar Cancer Center (MCC) for their assistance in data collection. The authors also thank the patients registered in MCC whose undisclosed data helped to carry out this research. This study is under the umbrella of the World Health Organization (WHO-TDR) SORT-IT (Structured Operational Research and Training IniTiative) program for capacity building in low- and middle-income countries. The authors thank Dr. Satheesan B, Director, Malabar Cancer Center, for guiding the research work. The authors acknowledge Dr. Sairu Philip for her inputs while writing the manuscript.

Availability of data and materials

The data are available and can be shared on request to the corresponding author.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

This research paper is an outcome of Structured Operational Research and Training IniTiative (SORT-IT)—Oncology program funded by the Academy for Public Health, Kozhikode, Kerala, India. This research was supported through an Operational Research Course that was jointly developed and run by the Academy for Public Health, Kozhikode, Kerala, India, and Malabar Cancer Center (MCC), Thalassery, Kerala, India, with the support of The Center for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), France.